Use of Dipeptidyl Peptidase-4 inhibitors and prognosis of COVID-19 in hospitalized patients with type 2 diabetes: a propensity score analysis from the CORONADO study
Dipeptidyl Peptidase-4 (DPP-4), the target of oral antidiabetic drugs DDP-4 inhibitors, has been suggested to be involved in the pathogenesis of coronavirus infections, including COVID-19. It is unclear whether the routine use of DPP-4 inhibitors increases the severity of COVID-19 in people with type 2 diabetes (T2D). The purpose of this work was to investigate the association between routine use of DPP-4 inhibitors and the severity of COVID-19 infection in a large multicentric study.
This study was a secondary analysis of the CORONADO study on 2,449 patients with T2D hospitalized for COVID-19 in 68 French centres. The composite primary endpoint combined tracheal intubation for mechanical ventilation and death within 7 days of admission. Stabilized weights were computed for patients based on propensity score (DPP-4 inhibitors users vs non-users) and were used into multivariable logistic regression models to estimate Average Treatment effect in the Treated as Inverse Probability of Treatment Weighting (IPTW).
596 participants were under DPP-4 inhibitors before admission to hospital (24.3%). The primary outcome occurred at similar rates in users and non-users of DPP-4 inhibitors (27.7% vs 28.6%, P=0.68). In propensity analysis, the IPTW-adjusted models showed no significant association between use of DPP-4 inhibitors and the primary outcome within day 7 or day 28. Similar neutral findings were found between use of DPP-4 inhibitors and the risk of tracheal intubation and death.
These data support the safety of DPP-4 inhibitors for diabetes management during the COVID-19 pandemic and they should not be discontinued.