A meta-analysis on the preadmission use of DPP-4 inhibitors and risk of a fatal or severe course of illness in patients with COVID-19

Kow, Chia Siang; Hasan, Syed Shahzad

doi:10.1016/j.therap.2020.12.015

Cited by 11 publications

(7 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Because of the small number of patients, lack of randomization, and insufficient reporting of secondary outcomes in published studies [ 30 ], several authors have performed meta-analyses. One meta-analysis of six studies (heterogeneity [ I 2 ]: 54%) and another of seven studies ( I 2 : 55%) published in December 2020 and January 2021, respectively, revealed no significant difference in the risk for the development of a fatal or severe course of illness with the use of DPP-4is in patients with COVID-19 [ 31 , 32 ]. Two subsequent meta-analyses with very low heterogeneity, published in February 2021 and March 2021 and included nine and ten studies, respectively, came to similar conclusions [ 33 , 34 ], with the exception of some benefits of in-hospital use of DPP-4is.…”

Section: Discussionmentioning

confidence: 99%

Lower COVID-19 Mortality in Patients with Type 2 Diabetes Mellitus Taking Dipeptidyl Peptidase-4 Inhibitors: Results from a Turkish Nationwide Study

et al. 2021

View full text Add to dashboard Cite

Introduction To investigate the effect of preexisting treatment with dipeptidyl peptidase-4 inhibitors (DPP-4is) on COVID-19-related hospitalization and mortality in patients with type 2 diabetes mellitus (T2DM). Methods A multicenter, retrospective cohort study was conducted using patient data extracted from the Turkish National Electronic Database. All patients who tested positive for COVID-19 (PCR test) between 11 March through to 30 May 2020 were screened for eligibility ( n = 149,671). Following exclusion of patients based on pre-determined inclusion criteria, patients with T2DM using a DPP-4i or glucose-lowering medications other than a DPP-4i were compared for mortality and hospitalization. The propensity score method was used to match age, gender, micro- and macrovascular complications, and medications in the two groups. Independent associates of mortality were analyzed using multivariable analysis on the whole T2DM population. Results A total of 33,478 patients with T2DM who tested postive for COVID-19 who met the inclusion criteria were included in the analysis. Median (interquartile range) age was 54 (22) years and 42.4% were male. Of these, 9100 patients using DPP-4is ( n = 4550) or other glucose-lowering drugs ( n = 4550) were matched in two groups. After matching, analysis revealed a lower mortality in the DPP-4i group (9.5 vs. 11.8%; p < 0.001). In the multivariable model, the use of DPP-4is (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.35–0.91; p = 0.02) was associated with lower mortality in the whole sample, while age, male gender, computed tomography finding of COVID-19, obesity, low glomerular filtration rate, and an insulin-based regimen also predicted increased risk of death. There was no association between the preexisting treatment with DPP-4is and COVID-19-related hospitalization in the matched analysis or multivariate model. The rate of admission to the intensive care unit and/or mechanical ventilation favored the DPP-4i group (21.7 vs. 25.2%; p = 0.001), although this association became saturated in the multivariate analysis (OR 0.65, 95% CI 0.39–1.08; p = 0.099). Conclusions The results of this study demonstrate an association between DDP-4i use and reduced mortality in people with T2DM who tested PCR positive for COVID-19.

show abstract

Section: Discussionmentioning

confidence: 99%

Lower COVID-19 Mortality in Patients with Type 2 Diabetes Mellitus Taking Dipeptidyl Peptidase-4 Inhibitors: Results from a Turkish Nationwide Study

et al. 2021

View full text Add to dashboard Cite

show abstract

“…However, we had included only those studies that had reported COVID-19 clinical outcomes in terms of mortality for uniformity. Besides, unlike the hitherto published only meta-analysis reporting preadmission DPP4i use and risk of a fatal or severe course of illness in patients with COVID-19, 38 we have provided pooled analyses of both unadjusted and adjusted ORs, making the results more robust and reproducible.…”

Section: Discussionmentioning

confidence: 99%

Dipeptidyl peptidase-4 inhibitor use and mortality in COVID-19 patients with diabetes mellitus: an updated systematic review and meta-analysis

Pal

Banerjee

Mukherjee

et al. 2021

Therapeutic Advances in Endocrinology

View full text Add to dashboard Cite

Background: Few observational studies have shown a beneficial effect of dipeptidyl peptidase-4 inhibitors (DPP4i) in patients with coronavirus disease 2019 (COVID-19), although results are not consistent. The present systematic review and meta-analysis was undertaken to provide a precise summary of the effect of DPP4i use (preadmission or in-hospital) and mortality in COVID-19 patients with diabetes mellitus (DM). Methods: PubMed and Google Scholar databases were systematically searched using appropriate keywords to 4 January 2021, to identify observational studies reporting mortality in COVID-19 patients with DM using DPP4i versus those not using DPP4i. Preadmission and in-hospital use of DPP4i were considered. Study quality was assessed using the Newcastle–Ottawa Scale. Unadjusted and adjusted pooled odds ratio (OR) with 95% confidence intervals (CIs) were calculated. Subgroup analysis was performed for studies reporting preadmission and in-hospital use of DPP4i. Results: We identified nine observational studies of high quality pooling data retrieved from 7008 COVID-19 patients with DM. The pooled analysis of unadjusted and adjusted data did not show any significant association between DPP4i use and mortality in COVID-19 patients with DM. However, on subgroup analysis, we found that in-hospital (and not preadmission) DPP4i use was associated with reduced mortality (unadjusted OR 0.37, 95% CI 0.23, 0.58, p < 0.0001, I2 = 0% and adjusted OR 0.27, 95% CI 0.13, 0.55, p = 0.0003, I2 = 12%). Conclusions: In-hospital use of DPP4i is associated with a significant reduction in COVID-19 mortality. Hence, it would be prudent to initiate or continue DPP4i in COVID-19 patients with DM if not contraindicated.

show abstract

“…However, it was found in an in-vitro setup that vildagliptin, sitagliptin, or saxagliptin were ineffective in blocking entry of coronavirus into host cells[ 15 ]. In a recently reported study of 1531 patients with COVID-19, it was observed that DPP4-inhibitors produced neither harmful nor beneficial effects and did not support the discontinuation of this class of drugs[ 68 ]. Thus, it is premature to predict the effect of DPP4-inhibitors in COVID-19 patients with DM as most of the published reports were carried out using a small set of patients showing only clinical outcomes; however, molecular aspects should also be verified.…”

Section: Antidiabetic Medication and Covid-19mentioning

confidence: 99%

Diabetes mellitus and COVID-19: Understanding the association in light of current evidence

Sen

Chakraborty

Kalita³

et al. 2021

WJCC

View full text Add to dashboard Cite

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections have posed a problematic healthcare situation worldwide since December 2019. Diabetes mellitus is associated with an increased risk and severity of coronavirus disease 2019 (COVID-19). While interacting with various other risk factors, high blood sugar was found to reduce immunity and increase the replication of SARS-CoV-2. Oxidative stress and the release of pro-inflammatory cytokines are greater in diabetic individuals than in healthy people, worsening the outcome of SARS-CoV-2 infection in diabetics. Increased expression of furin and angiotensin converting enzyme 2 (ACE-2) receptor in the hyperglycemic environment may promote the entry of SARS-CoV-2 in the host cell. COVID-19 infection primarily modulates immune and inflammatory responses, and may cause a cytokine storm, resulting in possible lethal outcomes in diabetics. An experimental report suggests that ACE expressed in the pancreas and the SARS-CoV-2 virus invariably destroy β-cells which contain ACE-2 receptors and results in acute diabetes. Moreover, COVID-19 also causes hyperglycemia in an individual with diabetes which may be related to insulin resistance and destruction of β-cells during SARS-CoV-2 infection. Early observations also suggest a correlation between oral hypoglycemic agents and the risk of COVID-19. This review focused on the possible cause and mechanism involved in SARS-CoV-2 infection in diabetics and the role of antidiabetic drugs in COVID-19.

show abstract

A meta-analysis on the preadmission use of DPP-4 inhibitors and risk of a fatal or severe course of illness in patients with COVID-19

Cited by 11 publications

References 10 publications

Lower COVID-19 Mortality in Patients with Type 2 Diabetes Mellitus Taking Dipeptidyl Peptidase-4 Inhibitors: Results from a Turkish Nationwide Study

Lower COVID-19 Mortality in Patients with Type 2 Diabetes Mellitus Taking Dipeptidyl Peptidase-4 Inhibitors: Results from a Turkish Nationwide Study

Dipeptidyl peptidase-4 inhibitor use and mortality in COVID-19 patients with diabetes mellitus: an updated systematic review and meta-analysis

Diabetes mellitus and COVID-19: Understanding the association in light of current evidence

Contact Info

Product

Resources

About