Metformin in COVID-19: clinical trials are needed to prove its benefits
Abstract
The retrospective cohort study reported by Saygili and col-leagues [1] is the latest addition to the literature on the use of metformin in patients with coronavirus disease 2019 (COVID-19). The authors aimed to determine the effect of preadmission use of metformin on COVID-19-related mortality in 240 propensity score-matched patients hospitalized with COVID-19 [1]. The study reported reduced all-cause mortality (adjusted hazard ratio = 0.585; 95% confidence interval 0.371 to 0.920) with preadmission use of metformin relative to non-use of metformin [1]. In fact, the findings of the study were in agreement with the previously published systematic reviews and meta-analyses investigating the same topic. At least eight systematic reviews and meta-analyses [2–9] have been published (indexed in PubMed); the latest systematic review and meta-analysis [2], which included 19 observational studies, reported that the use of metformin is associated with significantly reduced COVID-19-related mortality (odds ratio = 0.66; 95% confidence interval 0.56 to 0.78). The beneficial clinical effects of metformin in patients with serious infection have been reported even before the beginning of the COVID-19 pandemic [10]; a meta-analysis [11] of five observational studies with 1282 patients demon-strated benefits with the use of metformin in patients with sepsis and concurrent diabetes in which there were significantly reduced odds of death (pooled OR = 0.59; 95%
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