Metformin as a potential treatment for COVID-19

ABSTRACT

Introduction

Early treatment for SARS-CoV-2 infection is essential to limit the clinical progression of COVID-19. However, limited therapeutic options are available for standard-risk patients, including those under age 50 who have received the primary series of COVID-19 vaccination as well as a bivalent booster.

Areas covered

Metformin is a widely used, inexpensive antihyperglycemic for the treatment of diabetes mellitus type 2 as well as polycystic ovarian syndrome, with a well-described safety profile.

Expert opinion

Although the mechanism of action has not been fully elucidated, metformin is known to alter glucose metabolism and is under investigation as an antiviral agent, demonstrating in vitro and in vivo activity against SARS-CoV-2. Recent work suggests metformin may also serve as a therapeutic option for patients with COVID-19 as well as those with post-acute sequelae of SARS-CoV-2 infection, known more commonly as ‘long COVID-19.’ This manuscript examines what is known about metformin for the treatment of COVID-19 and explores how this drug may be used in the future to address the SARS-CoV-2 pandemic.

KEYWORDS:

• Metformin
• SARS-CoV-2
• antiviral
• COVID-19
• diabetes mellitus

Article highlights

• Metformin is a widely used, inexpensive medication used for the treatment of diabetes, mellitus type 2, and polycystic ovarian syndrome.

• Metformin exerts its effects in humans through a variety of mechanisms.

• Metformin inhibits the mTOR pathway via AMP-kinase signaling, through the activation of tumor suppressor gene p53, inhibition of hypoxia inducible factor (HIF)-1α, and reduction of reactive oxygen species.

• Metformin has antiviral and anti-inflammatory properties and may serve as a therapeutic option for outpatients infected with SARS-CoV-2

• Metformin may also serve as a therapeutic option for patients with post-acute sequelae of SARS-CoV-2 infection (PASC).

Declaration of interest

M W McCarthy has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.