Metformin effectively reduce viral load in COVID-19 patients, finds study

A recent study published in the Clinical Infectious Diseases journal uncovered the potential of metformin which is commonly used to treat type 2 diabetes to manage COVID-19. This research was conducted as part of the COVID-OUT trial and unveiled strong evidence of antiviral activity of metformin against the RNA viruses, including the SARS-CoV-2.

This comprehensive highlights that metformin exerts its antiviral effects by targeting the host mechanistic target of rapamycin pathway which in turn suppresses the protein translation that is crucial for viral replication. The implications of this mechanism extend beyond diabetes management which could offer a new avenue for tackling infectious diseases.

This rigorous randomized, placebo-controlled, double-blind COVID-OUT trial evaluated the efficacy of metformin along with other potential treatments for COVID-19, including fluvoxamine and ivermectin. The results were striking: metformin demonstrated remarkable effectiveness in reducing the odds of hospitalizations, deaths, and even the onset of long COVID.

The participants who received metformin underwent a sharp 58% reduction in the risk of hospitalizations or death within 28 days. Also, the medication decreased the likelihood of emergency department visits, hospitalizations or death by 42% within 14 days and reduced the incidence of long COVID by 42% over a span of 10 months.

The trial involved a total of 999 participants who self-collected anterior nasal swabs at specified intervals. The analysis of viral load using reverse-transcription quantitative polymerase chain reaction revealed a significant 3.6-fold reduction in SARS-CoV-2 viral load with metformin when compared to placebo. Also, metformin recipients were also less likely to express detectable viral loads on subsequent days that indicates sustained antiviral activity.

This study highlighted the consistency of metformin's effect across the various subgroups and its progressive improvement over time. Notably, neither ivermectin nor fluvoxamine demonstrated discernible benefits over placebo which points to the unique potency of metformin in the context of COVID-19 treatment. Overall, metformin offers clinical benefits and opens new avenues for exploring its pleiotropic actions against COVID-19 pathophysiology by significantly reducing the viral load. 

Reference:

Bramante, C. T., Beckman, K. B., Mehta, T., Karger, A. B., Odde, D. J., Tignanelli, C. J., Buse, J. B., Johnson, D. M., Watson, R. H. B., Daniel, J. J., Liebovitz, D. M., Nicklas, J. M., Cohen, K., Puskarich, M. A., Belani, H. K., Siegel, L. K., Klatt, N. R., Anderson, B., … Hartman, K. M. (2024). Favorable Antiviral Effect of Metformin on Severe Acute Respiratory Syndrome Coronavirus 2 Viral Load in a Randomized, Placebo-Controlled Clinical Trial of Coronavirus Disease 2019. In Clinical Infectious Diseases. Oxford University Press (OUP). https://doi.org/10.1093/cid/ciae159