Preventing Long COVID With Metformin
Abstract
(See the Major Article by Chaichana et al on pages e423–32.) Chaichana et al conducted a sequential trial emulation to assess whether starting metformin after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection prevented the development of post-coronavirus 19 (COVID 19) condition or long COVID [1]. Their work provides critical validation of previously published randomized clinical trial data and is consistent with emerging data. We review this body of literature and why metformin should now be offered to outpatient adults for treating acute SARS-CoV-2 infection to prevent long COVID [2]. Repurposing a chronic diabetes medication for acute viral infection may seem counterintuitive, so we will briefly review the rationale. Early papers on biguanides were for use against viruses and malaria [3–5]. In about 1940, biguanides fell out of favor because of lactic acidosis with phenformin and buformin [3]. Metformin was less potent for lowering glucose but had fewer safety concerns and was approved for treating type 2 diabetes [3]. This led to studies of metformin's anti-inflammatory actions and cohort studies in which there was no increased risk of lactic acidosis with metformin [6–9]. In the 2000's, metformin was studied in vitro against viruses because of its host-directed, immunometabolic actions [10]. In 2020, observational, in silico computer modeling and in vitro studies of SARS-CoV-2 added to the rationale for studying metformin as acute SARS-CoV-2…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 6 participants or records.
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