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DPP-4 Inhibitor Found to Boost Survival in T2D Patients with COVID-19


According to a new study, adults with T2D who were hospitalized with COVID-19 in northern Italy had a lower mortality rate when treated with sitagliptin.

Adults with type 2 diabetes (T2D) who were hospitalized with coronavirus disease 2019 (COVID-19) in northern Italy had a lower mortality rate and better health outcomes when treated with the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin, suggests a new study published September 29, 2020, in Diabetes Care.

In a retrospective study of 338 adults with T2D and COVID-19 pneumonia who were admitted to 7 academic hospitals in northern Italy between March 1 through April 30, 2020, those given sitagliptin in addition to insulin (n=169) saw significantly lower odds of mortality vs those given insulin only (the standard of care; n=169) (odds ratio 0.37; 95% confidence interval 0.23-0.62; P=.0001).

This equated to an 18% mortality rate among adults on sitagliptin and insulin vs a 37% mortality rate among those receiving insulin only as standard of care, wrote authors led by Paolo Fiorina, MD, PhD, a diabetes researcher affiliated with Boston Children’s Hospital division of nephrology and the University of Milan.

"We think it’s reasonable to try sitagliptin if a patient is admitted to the hospital with type 2 diabetes and COVID-19."

Also, participants who received sitagliptin in addition to insulin demonstrated a greater likelihood to improve clinically, as defined by hospital discharge and/or a reduction of at least 2 points on a 7-point scale of disease severity at day 30 of follow-up. Overall, 52% of patients on sitagliptin saw this amount of clinical improvement vs 34% of those on standard of care.

In addition, compared to participants who received standard of care only, those treated with sitagliptin were less likely to need mechanical ventilation (hazard ratio [HR], 0.27) and intensive care (HR, 0.51).

“We think it’s reasonable to try sitagliptin if a patient is admitted to the hospital with type 2 diabetes and COVID-19,” said Fiorina in a Boston Children’s Hospital press release. “I’m excited about our findings, because we still have very few therapeutic options for the many diabetic patients affected by COVID-19.”

It is not fully understood what properties of the DPP-4 inhibitor may be responsible for its effect, but recent studies have suggested that the protein may help the SARS-CoV-2 virus enter respiratory cells, thus inhibition might help reduce the viral load in the lungs; sitagliptin also curbs inflammation, reducing production of the cytokine IL-6 that contributes to the “cytokine storm” causing organ complications in COVID-19.

It is worth noting that while the study was retrospective and observational, the results have sparked a new randomized, placebo-controlled trial of sitagliptin that is now preparing to enroll patients in Europe. The team is also seeking approval to test sitagliptin in COVID-19 patients without diabetes.

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