March 9, 2023: Metformin appears to play a role in preventing prolonged COVID when taken early in a COVID-19 infection, according to a new pre-printed study from The Lancet. The preprint has not yet been peer-reviewed or published in a journal. .
In particular, metformin resulted in a 42% reduction in long-term COVID in other people who had mild to moderate COVID-19 infection.
“Prolonged COVID affects millions of people, and saving you from prolonged COVID through a remedy like metformin can spare you significant disruptions in people’s lives,” says lead author Carolyn Bramante, MD, assistant professor of internal medicine and pediatrics at the University of Minnesota.
Between January 2021 and February 2022, Bramante and colleagues tested 3 oral medications — metformin (usually used to treat type 2 diabetes), ivermectin (an antiparasitic), and fluvoxamine (an antidepressant) — in a clinical trial in the United States called COVID-OUT The study people, researchers, health care providers, and others involved in the study were not informed about randomized treatments. The trial was decentralised, with no face-to-face contact with participants.
The researchers included patients older than 30 to 85 years who were obese, had evidence of COVID-19 infection, had less than 7 days of symptoms, had no known past infection, and joined the study within 3 days of testing positive. The study included monthly follow-up for 300 days, and participants reported whether they had received a prolonged COVID diagnosis from a doctor, which researchers showed in medical records after participants gave consent.
The medications were prepackaged in tablet dispensers for quick delivery to participants and to make sure they were taking the correct number of tablets. Packages were mailed the same day or shipped the next day.
Metformin doses were distributed over 1four days: with 500 milligrams on the first day, 500 milligrams twice over the next four days, then 500 milligrams in the morning, and 1000 milligrams in the evening for the remaining nine days.
Of the other 1323 people studied, 1125 agreed to long-term follow-up for long-term COVID, adding 564 in the metformin organization and 561 in the placebo-blind organization. The average age was forty-five years and 56% were women, of whom 7% were pregnant.
The median time from onset of symptoms to onset of the remedy was five days and 47% started taking the drug within four days or less. Approximately 55% had won the number one COVID-19 vaccination series, and 5. 1% had won an initial vaccine. booster, before enrolling in the study.
Overall, 8. 4% of participants reported that they had been diagnosed with prolonged COVID by a medical professional. Of those taking metformin, 6. 3% developed prolonged COVID, with 10. 6% among those taking the same placebo.
Threat relief for metformin was 42% compared to placebo, which was consistent across all subgroups, adding prestige to vaccination and other variants of COVID-19.
When metformin started less than four days after the onset of COVID-19 symptoms, the effect was potentially even greater, with 64% relief, compared with 36% relief in those who started taking metformin after four days or more after symptoms.
Neither ivermectin nor fluvoxamine have been shown in preventing long COVID.
At the same time, the study authors caution that more is needed.
“The COVID-OUT trial does not imply whether or not metformin would be effective in preventing prolonged COVID if started at the time of the emergency branch scale or COVID-19 hospitalization, or whether metformin would be effective as a remedy in others who already have prolonged COVID,” they wrote. “With the burden of prolonged COVID on society, confirmation in a trial addressing the limitations of our examination is urgently needed to translate those findings into practice and policy. “
Several points of threat to prolonged COVID emerged in the analysis. About 11. 1% of women had a long-term diagnosis of COVID, compared with 4. 9% of men. In addition, those who had won at least the number one vaccine series had a lower threat of prolonged COVID, at 6. 6%, compared to 10. 5% among the unvaccinated. Only one of the other 57 people who won a booster shot developed prolonged COVID.
In particular, pregnant and breastfeeding women were included in this study, which is vital given that pregnant women are at increased risk for poor COVID-19 outcomes and are excluded from most non-obstetric clinical trials, the study authors wrote. were randomised to obtain metformin or placebo, but not ivermectin or fluvoxamine due to limited studies on the protection of these medicines during pregnancy and lactation.
The effects are being reviewed recently in a review, but show consistent effects from other recent studies. Additionally, in August 2022, authors of COVID-OUT effects showed metformin resulted in 42% relief in hospital visits, emergency room visits, and severe deaths from COVID-19.
“Given the absence of side effects and the burden of a 2-week course, I think they now know the use of metformin,” says Eric Topol, MD, founder and director of the Scripps Research Translational Institute and editor-in-chief of Medscape, WebMD’s sister site for health professionals.
Topol, who was not involved in this study, has been a leading voice in studies of the COVID-19 pandemic. He noted the need for further studies, adding a factorial design trial to test metformin and Paxlovid, which showed promise in preventing long COVID. . Topol also wrote about preprints in Ground Truths, his online newsletter.
“As I have written in the past, I do not use the term ‘breakthrough’ lightly,” he wrote. “But to see such a pronounced advantage in the existing randomized trial of metformin, in the context in which it is so inexpensive, would give it a revolutionary categorization. “
Another way of putting it, Topol wrote, is that in this study, he himself would take metformin if he became inflamed with COVID-19.
Jeremy Faust, MD, an emergency physician at Brigham and Women’s Hospital in Boston, also wrote about the exam in his newsletter Inside Medicine. He noted that the 42% relief in prolonged COVID cases means that 23 COVID-19 patients want to be treated with metformin at a prolonged COVID diagnosis, which is a “significant relief. “
“Conclusion: If a user who meets the criteria for obesity or obese asks me if they take metformin (for 2 weeks) as soon as they learn they have COVID-19, I would say yes in many, if not most cases, based on this new data,” he wrote. “It’s starting to look like a genuine victory. “
SOURCES:
The Lancet (preprint): “Outpatient treatment of COVID-19 and 10-month COVID progression: a multicenter, quadruple-blind, parallel-group randomized Phase 3 trial. “
Carolyn Bramante, MD, Assistant Professor of Internal Medicine and Pediatrics, University of Minnesota.
Eric Topol, MD, founder and director of the Scripps Research Translational Institute; Editor-in-Chief, Medscape.
Truths on the ground: “A break in the waves of Covid and a breakthrough to save you Long Covid”.
Inside Medicine: “Metformin Proved Effective in Cutting Long Covid in a Clinical Trial. “
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