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Metformin use is associated with a reduced risk of mortality in patients with diabetes hospitalised for COVID-19

Jean-Daniel Lalau 1, 2, 3 Abdallah Al-Salameh 1, 3 S. Hadjadj 4, 5 T. Goronflot 6 N. Wiernsperger 7 M. Pichelin 4, 5 I. Allix 8 C. Amadou 9 O. Bourron 10 T. Duriez 11 J. F. Gautier 12 A. Dutour 13 C. Gonfroy 14 D. Gouet 15 M. Joubert 16 I. Julier 17 E. Larger 18 L. Marchand 19 M. Marre 20 L. Meyer 21 F. Olivier 22 G. Prevost 23, 24 P. Quiniou 25 C. Raffaitin-Cardin 26 R. Roussel 10 P. J. Saulnier 27 D. Seret-Begue 28 C. Thivolet 29 C. Vatier 30 Rachel Desailloud 3, 2 M. Wargny 6 P. Gourdy 31 B. Cariou 5, 4 
Abstract : AIMS: Metformin exerts anti-inflammatory and immunosuppressive effects. We addressed the impact of prior metformin use on prognosis in patients with type 2 diabetes hospitalised for COVID-19. METHODS: CORONADO is a nationwide observational study that included patients with diabetes hospitalised for COVID-19 between March 10 and April 10, 2020 in 68 French centres. The primary outcome combined tracheal intubation and/or death within 7 days of admission. A Kaplan-Meier survival curve was reported for death up to day 28. The association between metformin use and outcomes was then estimated in a logistic regression analysis after applying a propensity score inverse probability of treatment weighting approach. RESULTS: Among the 2449 patients included, 1496 were metformin users and 953 were not. Compared with non-users, metformin users were younger with a lower prevalence of diabetic complications, but had more severe features of COVID-19 on admission. The primary endpoint occurred in 28.0% of metformin users (vs 29.0% in non-users, P =  0.6134) on day 7 and in 32.6% (vs 38.7%, P = 0.0023) on day 28. The mortality rate was lower in metformin users on day 7 (8.2 vs 16.1%, P \textless  0.0001) and on day 28 (16.0 vs 28.6%, P \textless 0.0001). After propensity score weighting was applied, the odds ratios for primary outcome and death (OR [95%CI], metformin users vs non-users) were 0.838 [0.649-1.082] and 0.688 [0.470-1.007] on day 7, then 0.783 [0.615-0.996] and 0.710 [0.537-0.938] on day 28, respectively. CONCLUSION: Metformin use appeared to be associated with a lower risk of death in patients with diabetes hospitalised for COVID-19.
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Submitted on : Wednesday, June 23, 2021 - 4:35:09 PM
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Jean-Daniel Lalau, Abdallah Al-Salameh, S. Hadjadj, T. Goronflot, N. Wiernsperger, et al.. Metformin use is associated with a reduced risk of mortality in patients with diabetes hospitalised for COVID-19. Diabetes & Metabolism, Elsevier Masson, In press, 47 (5), pp.101216. ⟨10.1016/j.diabet.2020.101216⟩. ⟨inserm-03269072⟩



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