Diabetes medication increases survival in patients with type 2 diabetes and COVID-19 pneumonia

COVID-19, Coronavirus

SARS-CoV-2 (shown here in electron microscopy image). Credit: National Institute of Allergy and Infectious Diseases, NIH

Sitagliptin, a blood sugar lowering drug in type 2 diabetes, also improves survival in patients with diabetes hospitalized with COVID-19, suggesting a multilevel observatory study in Italy. Patients given sitagliptin other than insulin had an 18 percent mortality rate compared to 37 percent in matched patients receiving insulin only. Led by PHO Fodina, PhD, MD, Boston Children’s Hospital, the study included seven Italian hospitals during the first surge of COVID cases last spring.

Although this study was retrospective and observational, the findings were published on September 29 Diabetes care-We performed a new randomized, placebo-controlled trial of sitagliptin. This study is now preparing to recruit patients in Europe.

“We think that if a patient is hospitalized with type 2 diabetes and COVID, it is appropriate to try sitagliptin,” says Fiorina, a diabetes researcher associated with the Boston Child Division of Nephrology and the University of Milan. “I am excited about my findings, as we still have very few therapeutic options for many diabetic patients affected by COVID.”

Based on the mechanism of action of ciatagliptin, Fiorina and colleagues believe that it may also work in nondiabetic patients with MOID. A randomized, controlled trial to test whether the idea is moving toward regulatory approval.

Why Sitagliptin?

Sitagliptin, an oral medication, is one of a class of drugs known as DPP-4 inhibitors, which is prescribed to an estimated 15 to 20 percent of patients with type 2 diabetes. It was approved by the FDA in 2006, and lowers blood sugar by blocking the receptor for the enzyme DPP-4 (also known as CD26), leading to increased insulin production.

But recent studies suggest that DPP-4 can also cause SARS-CoV-2-coronaviruses that cause COVID-19- found in respiratory cells. In addition to inhibiting DPP-4, cytagliptin has anti-inflammatory effects, reducing the production of cytokine IL-6, which is known to contribute to the “cytokine storm” that causes organ complications in COVID-19. Can be made.

Sitagliptin may also have a third benefit: keeping blood sugar low. Previous studies have shown that COVID-19 results in worse diabetes patients with glycemic control.

“We decided to try sitagliptin and collect data,” Fiorena says. “COVID-19 mortality in diabetes patients is high, and the drug is very safe, so we felt there was no reason not to use it.”

Study design and conclusions

The study enrolled 338 consecutive patients with type 2 diabetes and COVID-19 pneumonia, who were admitted to seven educational hospitals in northern Italy from 1 March until 30 March 2020. Of these, 169 were given only IV insulin for their type 2 diabetes (standard of control) and served as controls; Sitagliptin was found in 169 other than IV insulin. The two groups were matched for age and gender and their results were retrospectively analyzed.

The severity of the disease, other clinical features and use of other treatments of COVID-19 were similar in the two groups. Compared to controls, patients receiving sitagliptin had reduced mortality (18 percent vs. 37 percent) and were more likely to improve clinically.

In particular, patients treated with sitagliptin were:

  • Reduced need for mechanical ventilation (hazard ratio, 0.27 or 27 percent probability compared with controls)
  • Less need for intensive care (hazard ratio, 0.51)
  • More likely, at least a 2-point drop on a 7-point scale of disease severity (52 percent, vs. 34 percent control).
  • Clinical outcomes are less likely to deteriorate, as defined by any increase in clinical severity scores (26 percent vs. 46 percent).

“We should now confirm our findings in a placebo-controlled, prospective study,” says Fiorina. The new trial, recruiting patients in Italy and elsewhere in Europe, can be seen at ClinicalTrials.gov: Clintrials.gov/ct2/show/NCT04365517. The team is also seeking approval to test sitagliptin in COVID-19 patients without diabetes.

Sitagliptin is not associated with higher fracture risk in diabetes

Provided by Children’s Hospital Boston

Quotes: The diabetes drug increases survival in patients with type 2 diabetes and COVID-19 pneumonia (2020, September 29). Https://medicalxpress.com/news/2020-09-diabetes-drug-boosts-survival-patients retrieved from 30 September 2020. .html

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