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Sitagliptin confers survival benefit in COVID-19 patients with diabetes

Jairia Dela Cruz
29 Oct 2020

Initiating COVID-19 patients with type 2 diabetes (T2D) on sitagliptin at the time of hospitalization appears to reduce mortality and improve clinical outcomes as compared with administering standard-of-care treatment alone, a study has found.

“Dipeptidyl peptidase-4 (DPP-4) inhibitors may be beneficial for COVID-19 in multiple aspects,” as pointed out by a team of Italy-based researchers.

For the most part, the drugs may prevent SARS-CoV-2–related detrimental effects as the binding site for the virus' spike protein S1 exhibits structural homology to the DPP-4 sequence. This suggests that sitagliptin may reduce SARS-CoV-2 virulence and prevent the ensuing multiorgan failure and acute and chronic injury to the lungs, as well as impede the cytokine storm caused by pulmonary damage, they explained. [Science 2020;367:1444-1448; Emerg Microbes Infect 2020;9:601-604]

DPP-4 inhibitors may also reduce the excessive and prolonged cytokine responses observed in COVID-19 patients by modulating DPP-4 expression on immune cells, they added. “[Finally], sitagliptin may improve glycometabolic control, which would likely [antagonize] the clinical progression of COVID-19,” according to the researchers. [Emerg Microbes Infect 2020;9:601-604; Eur J Pharm Sci 2017;100:17-24; Cell Metab 2020;31:1068–1077.e3; Diabetes Care 2020;43:1399-1407]

In the present study, the researchers looked at 338 consecutive patients (mean age, 69 years; 70.4 percent male) with T2D and COVID-19 admitted in Northern Italy. Half of the population received standard of care alone, while the other half were given add-on sitagliptin.

Indeed, more patients died in the standard-of-care group (37 percent vs 18 percent). On multivariable Cox analysis, sitagliptin produced a 66-percent reduction in the risk of mortality (hazard ratio, 0.44, 95 percent confidence interval, 0.29–0.66; p=0.0001). [Diabetes Care 2020;10.2337/dc20-1521]

In parallel, significantly more patients who received the DPP-4 inhibitor exhibited improved clinical outcomes (60 percent vs 38 percent; p=0.0001) and were discharged from the hospital at day 30 (120 vs 89 patients; p=0.0008).

Preadmission therapy with metformin, insulin, or other glucose-lowering agents did not influence clinical outcomes.

Regardless of the presence of several limitations, the study indicates that T2D patients hospitalized for COVID-19 may fare well with the addition of sitagliptin to standard of care, according to the researchers.

The benefits of sitagliptin in diabetic patients with COVID-19 should be confirmed in a randomized, placebo-controlled trial with extended primary and secondary endpoints, including the measurement of DPP-4 level in biological samples collected at multiple time points, as well as tested in patients without diabetes, they added.

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Most Read Articles
Stephen Padilla, 09 Nov 2020
Tocilizumab (TCZ) therapy appears to be effective in patients at risk of cytokine release syndrome (CRS) from the novel coronavirus disease (COVID-19), suggests a study presented at ID Week 2020. Those receiving TCZ in a nonintensive care unit (non-ICU) setting show better response than ICU patients.
Stephen Padilla, 10 Nov 2020
Patients with chronic obstructive pulmonary disease (COPD) seem to benefit from using chlorhexidine oral rinses twice daily as shown by the reduction in oral and sputum microbiota alpha diversity and by clinically significant improvements in COPD symptoms, according to a study presented at ID Week 2020.
Rachel Soon, 28 Aug 2020
MOH Director-General Tan Sri Dato' Seri Dr Noor Hisham Abdullah speaks about NHMS 2019 and pharmacists' roles in combating NCDs among Malaysians.