Metformin may reduce COVID-19 severity in prediabetes, PCOS

Among patients with prediabetes or polycystic ovary syndrome (PCOS), the use of metformin appears to be associated with lower incidence of severe COVID-19, according to a study.

The study used data from the electronic health record from 52 hospitals across the US. The prediabetes cohort included 3,136 patients treated with metformin vs levothyroxine and 8,015 patients treated with metformin vs ondansetron. The PCOS cohort included 282 patients treated with metformin vs levothyroxine and 501 patients treated with metformin vs ondansetron.

COVID-19 severity was grouped into five, according to the following categories: mild (outpatient, World Health Organization [WHO] severity 1–3), mild emergency department (ED; outpatient with ED visit, WHO severity 3), moderate (hospitalized without invasive ventilation, WHO severity 4–6), severe (hospitalized with invasive ventilation or extracorporeal membrane oxygenation [ECMO], WHO severity 7–9), and mortality/hospice (hospital mortality or discharge to hospice, WHO Severity 10).

In the prediabetes cohort, patients on metformin had a much lower incidence of mild ED or worse (odds ratio [OR, 0.636, 95 percent confidence interval [CI], 0.455–0.888) and moderate or worse severity (OR, 0.493, 95 percent CI, 0.339–0.718) COVID-19 outcome as compared with those on levothyroxine.

Likewise, patients on metformin vs ondansetron were less likely to have mild ED or worse (OR, 0.039, 95 percent CI, 0.026–0.057), moderate or worse (OR, 0.045, 95 percent CI, 0.03–0.069), severe or worse (OR, 0.183, 95 percent CI, 0.077–0.431), and mortality/hospice (OR, 0.223, 95 percent CI, 0.071–0.694) COVID-19 outcome.

In the PCOS cohort, there was no significant difference in disease severity between metformin and levothyroxine, but the former was associated with a significantly lower incidence of mild ED or worse (OR, 0.101, 95 percent CI, 0.061–0.166) and moderate or worse (OR, 0.094, 95 percent CI, 0.049–0.18) COVID-19 outcome compared with ondansetron.