No need to discontinue DPP-4 inhibitors during hospitalization for COVID-19
medwireNews: Results from the CORONADO study indicate that use of dipeptidyl peptidase (DPP)-4 inhibitors does not affect outcomes for people with type 2 diabetes admitted to hospital with COVID-19.
“These data support safe use of this class of drugs for treating diabetes during the COVID-19 pandemic and they should not be discontinued,” write Ronan Roussel (Hôpital Bichat, Paris, France) and co-researchers in Diabetes, Obesity and Metabolism.
The study of 2449 patients showed no difference in the primary outcome of tracheal intubation for mechanical ventilation and death within 7 days of admission to one of 68 hospitals between those taking a DPP-4 inhibitor and those not.
The results contrast with those of a previous, smaller study looking only at patients taking or not taking sitagliptin, which found significantly better outcomes in those taking the DDP-4 inhibitor.
Nearly three-quarters of the 596 DPP-4 inhibitor users in the current analysis were using sitagliptin. The DPP-4 inhibitor users were a similar age to nonusers (average 70.3 vs 71.1 years), with a similar diabetes duration and glycated hemoglobin level. They were significantly less likely to be female (32.6 vs 37.1%), to have macrovascular complications (36.4 vs 41.1%), and to be taking insulin, but more likely to be taking metformin or a sulfonylurea.
The primary outcome occurred in 27.7% people taking a DPP-4 inhibitor versus 28.6% of those not taking one. There were also no significant differences at day 28, with corresponding rates of 18.1% versus 21.8%, or for the individual components of the primary outcome.
Adjusting for the propensity to be taking a DPP-4 inhibitor balanced the differences in baseline variables between the groups, but did not reveal any association between DPP-4 inhibitor use and risk for the primary outcome, even after allowing for kidney function, diabetes duration, and glycated hemoglobin level.
The researchers acknowledge the conflicting evidence from studies of DPP-4 inhibitors in COVID-19 patients to date, but stress that all these studies, including CORONADO, have many limitations, foremost of which is that they are observational and subject to confounding.
“Calls for randomized trials have been made, but they will take time to be delivered, and the community is in urgent need of more evidence meanwhile,” the team concludes.
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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