Sitagliptin Improves Survival In Diabetes Patients With COVI
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Sitagliptin, a drug to lower blood sugar in type 2 diabetes, also improves survival in diabetic patients hospitalized with COVID-19, suggests a multicenter observational study in Italy. Patients given sitagliptin in addition to insulin had a mortality rate of 18 percent as compared with 37 percent in matched patients receiving only insulin. The findings have been published in Diabetes Care.

Based on sitagliptin's mechanism of action, researchers believe it could also work in nondiabetic patients with COVID.

Why sitagliptin?

Sitagliptin, an oral drug, is one of a class of drugs known as DPP-4 inhibitors, prescribed to an estimated 15 to 20 percent of patients with type 2 diabetes. It was approved by the FDA in 2006, and lowers blood sugar by blocking the receptor for the enzyme DPP-4 (also known as CD26), causing an increase in insulin production.

But recent studies suggest that DPP-4 may also help SARS-CoV-2—the coronavirus that causes COVID-19—get into respiratory cells. In addition to blocking DPP-4, sitagliptin has anti-inflammatory effects, reducing production of the cytokine IL-6, which is known to contribute to the "cytokine storm" that can cause organ complications in COVID-19.

Sitagliptin may also have a third benefit: keeping blood sugar down. Previous studies have shown that diabetic patients with worse glycemic control have worse COVID-19 outcomes.

Study design and findings:

The study enrolled 338 consecutive patients with type 2 diabetes and COVID-19 pneumonia who were admitted to seven academic hospitals in northern Italy. Of these, 169 were given only IV insulin for their type 2 diabetes and served as controls; the other 169 received sitagliptin in addition to IV insulin. The two groups were matched for age and sex, and their outcomes were analyzed retrospectively.

Illness severity, other clinical characteristics, and use of other treatments for COVID-19 were similar in the two groups. Compared with the controls, patients receiving sitagliptin had reduced mortality (18 percent vs. 37 percent) and were more likely to improve clinically.

Specifically, patients treated with sitagliptin were:

-- Less likely to need mechanical ventilation (27 percent likelihood as compared with controls)
-- Less likely to need intensive care
-- More likely to have at least a 2-point drop on a 7-point scale of disease severity (52 percent, versus 34 percent of controls).
-- Less likely to have a worsening of clinical outcomes, as defined by any increase in the clinical severity score (26 percent vs. 46 percent).

"We must now confirm our findings in a placebo-controlled, prospective study," says researchers.

Source: https://clinicaltrials.gov/ct2/show/NCT04365517

https://care.diabetesjournals.org/content/diacare/early/2020/09/22/dc20-1521.full.pdf
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