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Sitagliptin treatment at the time of hospitalization was associated with reduced mortality in patients with Type 2 Diabetes and COVID-19: a multicenter case-control retrospective observational study

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posted on 25.09.2020 by Sebastiano Bruno Solerte, Francesca D’Addio, Roberto Trevisan, Elisabetta Lovati, Antonio Rossi, Ida Pastore, Marco Dell’Acqua, Elio Ippolito, Cristiana Scaranna, Rosalia Bellante, Silvia Galliani, Alessandro Roberto Dodesini, Giuseppe Lepore, Francesca Geni, Roberta Maria Fiorina, Emanuele Catena, Angelo Corsico, Riccardo Colombo, Marco Mirani, Carlo De Riva, Salvatore Endrio Oleandri, Reza Abdi, Joseph V. Bonventre, Stefano Rusconi, Franco Folli, Antonio Di Sabatino, Gianvincenzo Zuccotti, Massimo Galli, Paolo Fiorina
Background. Poor outcomes have been reported in patients with type 2 diabetes and coronavirus disease 2019 (COVID-19), thus it is mandatory to explore novel therapeutic approaches for this population.

Methods. In a multicenter case-control retrospective observational study, sitagliptin, an oral and highly selective DPP-4 inhibitor, was added to standard-of-care (e.g.; insulin administration) at the time of hospitalization in patients with type 2 diabetes who were hospitalized with COVID-19. Every center also recruited at 1:1 ratio untreated controls matched for age and gender. All patients had pneumonia and exhibited oxygen saturation lower than 95% when breathing ambient air, or were receiving oxygen support. The primary endpoints were discharge from the hospital/death and improvement of clinical outcomes, defined as an increase in at least two points on a seven-category modified ordinal scale. Data were collected retrospectively from patients receiving sitagliptin from March 1 through April 30, 2020.

Results. Of the 338 consecutive patients with type 2 diabetes and COVID-19 admitted in Northern Italy hospitals included in this study, 169 were on sitagliptin, while 169 were on standard-of-care. Treatment with sitagliptin at the time of hospitalization was associated with reduced mortality (18% vs. 37% of deceased patients; HR=0.44, 95% CI: 0.29-0.66, p=0.0001), with an improvement in clinical outcomes (60% vs. 38% of improved patients, p=0.0001) and with a greater number of hospital discharges (120 vs. 89 of discharged patients, p=0.0008), compared to patients receiving standard-of-care respectively.

Conclusions. In this multicenter case-control retrospective observational study of patients with type 2 diabetes admitted to the hospital for COVID-19, sitagliptin treatment at the time of hospitalization was associated with reduced mortality and improved clinical outcomes as compared to standard-of-care treatment. The effects of sitagliptin in patients with type 2 diabetes and COVID-19 should be confirmed in an ongoing randomized, placebo-controlled trial.

Funding

F.D. is supported by a SID Lombardia Grant and by the EFSD/JDRF/Lilly Programme on Type 1 Diabetes Research 2019. P.F. is supported by the Italian Ministry of Health grant RF-2016-02362512 and by the Linea-2 2019 funding from Università di Milano. R.A. is the recipient of the Stepping Strong Innovator Award 116260. We thank the “Fondazione Romeo e Enrica Invernizzi” for extraordinary support. We thank also Mediolanum-farma for providing sitagliptin and Dr. Giorgio Bedogni, statistician, for the support in the data analysis.

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