Clin Transl Sci. 2020 Sep 21. doi: 10.1111/cts.12897. Online ahead of print.
The current outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has spread across the world. No specific antiviral agents have been adequately evidenced for the treatment of COVID-19. Although metformin has been recommended as a host-directed therapy for COVID-19, there are some opposite views. And the effect of metformin on the disease severity of COVID-19 patients with diabetes during hospitalization remains unclear. This study aimed to determine the effect of metformin on disease severity. We enrolled 110 hospitalized COVID-19 patients with diabetes under either metformin or non-metformin hypoglycemic treatment for a case-control study. The primary outcome was the occurrence of life-threatening complications. There were no differences between the two groups in age, gender, comorbidities, and clinical severity at admission. Blood glucose and lactate dehydrogenase (LDH) levels of the metformin group were higher than those of the non-metformin group at admission. Other laboratory parameters at admission and treatments after admission were not different between the two groups. Strikingly, the percentage of cases who experienced life-threatening complications was significantly higher in the metformin group (28.6% (16/56) versus 7.4% (4/54), P = 0.004). Antidiabetic therapy with metformin was associated with a higher risk of disease progression in COVID-19 patients with diabetes during hospitalization (adjusted odds ratio = 3.964, 95%CI 1.034-15.194, P = 0.045). This retrospective analysis suggested a potential safety signal for metformin, the use of which was associated with a higher risk of severe COVID-19. We propose that metformin withdrawal in COVID-19 patients be considered to prevent disease progression.