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09-30-2020 | COVID-19 | News

Early findings suggest sitagliptin benefits for COVID-19 in diabetes

Eleanor McDermid

medwireNews: Findings from a retrospective case–control study suggest that the dipeptidyl peptidase (DPP)-4 inhibitor sitagliptin may improve outcomes in people with type 2 diabetes who are hospitalized with COVID-19.

The risks for mechanical ventilation, intensive care admission, and mortality were all reduced by half or more, show the results published in Diabetes Care.

The study was conducted in Italy, where standard practice for hospitalized patients with type 2 diabetes is to stop all medications and manage blood glucose with intravenous or subcutaneous insulin.

But in light of emerging evidence during the pandemic, some patients with diabetes hospitalized with COVID-19 were also given add-on sitagliptin. Paolo Fiorina (University of Milan, Italy) and co-researchers identified 169 such patients and matched them by age and sex to 169 given insulin only.

The two groups had similar baseline characteristics, with the only significant differences being use of beta blockers, at 33% versus 56% in the sitagliptin and standard care groups; respiratory rate, at an average of 23.7 versus 25.8 breaths/min; and C-reactive protein level, at 14 versus 19 mg/L.

By 30 days after hospital admission, 18% of patients given sitagliptin had died, compared with 37% of those given standard treatment, which on multivariable analysis equated to a significant 77% reduction in risk.

Likewise, six versus 17 patients required mechanical ventilation (73% risk reduction), and 15 versus 25 needed intensive care unit admission (49% risk reduction).

Average blood glucose was significantly lower in patients given sitagliptin versus standard care during hospitalization, in line with previous research linking hyperglycemia during hospitalization to poor COVID-19 outcomes.

And when evaluated at the 30-day follow-up, patients given sitagliptin also had significantly lower levels of inflammatory markers such as procalcitonin and C-reactive protein. The researchers note that “modulation of DPP-4 expression on immune cells by sitagliptin may induce broad anti-inflammatory and immunoregulatory effects.”

But they say a key rationale for using a DPP-4 inhibitor in COVID-19 patients is emerging evidence that “DPP-4 may facilitate SARS-CoV-2 entry into cells.”

“Thus, the use of DPP-4 inhibitors may reduce SARS-CoV-2 virulence, thereby preventing the ensuing multi-organ failure and acute and chronic injury to the lungs, as well as impeding the cytokine storm caused by pulmonary damage,” say Fiorina and team.

The researchers are now preparing to recruit patients to a randomized controlled trial (NCT04365517) to confirm the benefits of sitagliptin seen in this retrospective study, and they suggest it may also be worth testing the medication in COVID-19 patients without diabetes.

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group

30 September 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.

Diabetes Care 2020; doi:10.2337/dc20-1521

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