Exacerbation, hospitalization rates smaller with use vs. no use of metformin in COPD

Key takeaways:

• The rate of exacerbation was 46.8% in the group using metformin and 63% in the group not using metformin.
• The rate of FEV₁ percent decline was significantly improved in the group using metformin.

BOSTON — Among adults with COPD, the odds for exacerbations and hospitalizations were elevated in patients who did not use vs. did use the diabetes medication metformin, according to an abstract presented at the CHEST Annual Meeting.

“This study supports prior evidence that metformin can reduce rates [of] COPD exacerbation,” John Saylor, MD, post-graduate year five fellow at Marshall University’s Joan C. Edwards School of Medicine, and colleagues wrote in the abstract. “However, it also suggests that metformin may reduce the rate of FEV₁ decline in patients with COPD. This finding has not yet been reported in the literature.”

In this retrospective cohort study, Saylor and colleagues evaluated 536 adults with COPD and diabetes mellitus from a West Virginia hospital center via medical records from 2002 through 2022 to determine how use of metformin impacts respiratory outcomes, including exacerbation rate, hospitalization rate and FEV₁, when compared with no use of metformin.

In terms of exacerbations, the abstract reported a rate of 46.8% in the group of patients using metformin, and this was significantly smaller than the rate of 63% in the group of patients not using metformin (P = .001).

In line with the above finding, researchers observed significantly heightened odds for exacerbations with no use vs. use of metformin (adjusted OR = 1.659; 95% CI, 1.061-2.594) in a logistic regression analysis that accounted for age, gender, weight and smoking status.

The hospitalization rate followed a pattern similar to the exacerbation rate, with a smaller rate in the group using metformin compared with the group not using this medication (35.7% vs. 51%; P = .003).

Further, the adjusted likelihood for hospitalizations was significantly elevated among patients who did not use metformin vs. patients who did use metformin (aOR = 1.768; 95% CI, 1.129-2.768), according to the abstract.

Using data from two pulmonary function tests that occurred a minimum of 6 months apart, researchers additionally found that the rate of FEV₁ percent decline was significantly improved in the group using metformin when set against the group not using this medication (4.7 vs. 0.3; P = .028).

“This study may serve as a basis for future prospective trials and suggest that metformin may not only reduce COPD exacerbation, but also slow the progression of the disease process,” Saylor and colleagues wrote.