Metformin use is associated with reduced mortality rate from coronavirus disease 2019 (COVID-19) infection

Abstract

Background and aims The coronavirus disease 2019 (COVID-19) pandemic has caused a significant impact on all aspects of life. One of the comorbidities associated with severe outcome and mortality of COVID-19 is diabetes. Metformin is one of the drugs which is most commonly used for the treatment of diabetes patients. This study aims to analyze the potential benefit of metformin use in reducing the mortality rate from COVID-19 infection. Methods We systematically searched the Google Scholar database using specific keywords related to our aims until August 3rd, 2020. All articles published on COVID-19 and metformin were retrieved. Statistical analysis was done using Review Manager 5.4 software. Results A total of 5 studies with a total of 6937 patients were included in our analysis. Our meta-analysis showed that metformin use is associated with reduction in mortality rate from COVID-19 infections [RR 0.54 (95% CI 0.32–0.90), p = 0.02, I 2 = 54%, random-effect modelling]. Conclusion Metformin has shown benefits in reducing the mortality rate from COVID-19 infections. Patients with diabetes should be advised to continue taking metformin drugs despite COVID-19 infection status.

Predictors of adverse in-hospital outcome and recovery in patients with diabetes mellitus and COVID-19 pneumonia in Iraq

“…Some studies showed no definite association between metformin use and clinical outcomes, including survival, and raised concerns about the possible risk of lactic acidosis in cases of multiple organ failure [ [13] , [14] , [15] ], while others reported that metformin use was associated with a higher risk of disease progression in patients with COVID-19 with DM during hospitalization [ 16 ]. However, five studies with a total of 6937 patients showed that metformin use was associated with reduction in mortality rate from COVID-19 infection [ 17 ]. The potential beneficial effect of metformin noted in COVID-19 infection might be attributed to its inherent anti-inflammatory properties beyond its glucose-lowering action and independent of glucose control, which could positively influence the prognosis and disease course of patients with DM and COVID-19 [ 18 , 19 ].…”

Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis

“…This abrupt onset of disease progression has contributed to an increase in the mortality rate of the disease. Several comorbidities have also been demonstrated to be associated with the development of severe COVID-19, such as hypertension, diabetes mellitus, dyslipidemia, thyroid disease, cardiovascular disease, dementia, and pulmonary disease [ [6] , [7] , [8] , [9] ]. Therefore, prompt identification and containment, which are achievable through strict surveillance and early diagnosis, are very important.…”

The potential effects of clinical antidiabetic agents on SARS‐CoV‐2

“…Notably, although our results indicated that all these six antidiabetic drugs might not affect the expression of ACE2 and other two potential receptors, that is, L‐SIGN and DC‐SIGN, a recent study also found other influence factors of SARS‐CoV‐2 host entry, such as cellular serine protease TMPRSS2, 42 which required to be examined in future studies. Besides M pro , various factors have been found to affect the infection of SARS‐CoV‐2, and several drugs including metformin and sitagliptin that were assessed at lower docking scores in our study were reported to show positive outcomes in COVID‐19 patients 43,44 . Therefore, we cannot exclude the possibility that drugs that rank lower in our docking results of M pro may have a beneficial role in hindering the replication and infection of SARS‐CoV‐2 through other ways.…”