Use of dipeptidyl peptidase‐4 inhibitors and prognosis of COVID‐19 in hospitalized patients with type 2 diabetes: A propensity score analysis from the CORONADO study

Abstract

Aim To investigate the association between routine use of dipeptidyl peptidase‐4 (DPP‐4) inhibitors and the severity of coronavirus disease 2019 (COVID‐19) infection in patient with type 2 diabetes in a large multicentric study. Materials and Methods This study was a secondary analysis of the CORONADO study on 2449 patients with type 2 diabetes (T2D) hospitalized for COVID‐19 in 68 French centres. The composite primary endpoint combined tracheal intubation for mechanical ventilation and death within 7 days of admission. Stabilized weights were computed for patients based on propensity score (DPP‐4 inhibitors users vs. non‐users) and were used in multivariable logistic regression models to estimate the average treatment effect in the treated as inverse probability of treatment weighting (IPTW). Results Five hundred and ninety‐six participants were under DPP‐4 inhibitors before admission to hospital (24.3%). The primary outcome occurred at similar rates in users and non‐users of DPP‐4 inhibitors (27.7% vs. 28.6%; p = .68). In propensity analysis, the IPTW‐adjusted models showed no significant association between the use of DPP‐4 inhibitors and the primary outcome by Day 7 (OR [95% CI]: 0.95 [0.77–1.17]) or Day 28 (OR [95% CI]: 0.96 [0.78–1.17]). Similar neutral findings were found between use of DPP‐4 inhibitors and the risk of tracheal intubation and death. Conclusions These data support the safety of DPP‐4 inhibitors for diabetes management during the COVID‐19 pandemic and they should not be discontinued.

Association Between Anti-diabetic Agents and Clinical Outcomes of COVID-19 in Patients with Diabetes: A Systematic Review and Meta-Analysis

“…Among the 31 studies included, these, 23 studies related to metformin ( 11 , 12 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ), 13 studies related to DPP-4i ( 23 , 28 , 29 , 32 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ), 5 studies related to sulfonylurea or glinides ( 23 , 29 , 36 , 41 , 46 ), 5 studies related to SGLT-2i ( 23 , 29 , 36 , 41 , 42 ) and 4 study related to GLP-1RA ( 23 , 29 , 42 , 46 ). Some of these studies included multiple outcomes to different medications.…”

Sex disparities in COVID-19 outcomes of inpatients with diabetes: insights from the CORONADO study

“…There is thus a need for further studies to definitely characterize the sex-specific benefits of metformin in COVID-19 patients with T2D. While DPP4-inhibitors appeared to be neutral in both sexes, as reported in the whole population (41), insulin therapy was associated with higher COVID-19 mortality in women only. Apart from CORONADO, the association of previous insulin therapy with severe COVID-19 outcomes has already been reported in patients with T2D (42).…”

Use of Novel Antidiabetic Agents in Patients with Type 2 Diabetes and COVID-19: A Critical Review

“…Similarly, a study based on medical charts of patients with fatal COVID-19 from different Italian districts reported that geographical differences in DPP4i use did not correlate with DM prevalence among COVID-19 deaths [ 43 ]. Consistent with such findings, in the secondary analysis of the CORONADO study, 2449 patients with T2DM hospitalised for COVID-19 in 68 French centres were included [ 44 ]. The primary outcome (tracheal intubation for mechanical ventilation and death within 7 days of admission) occurred at similar rates in users vs. non-users of DPP4i [ 44 ].…”