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0 0.25 0.5 0.75 1 1.25 1.5 1.75 2+ Hospitalization 6% Improvement Relative Risk Hospitalization (b) 39% Extended ER observatio.. -14% primary Extended ER observatio.. (b) 12% ER visit 31% ER visit (b) 26% Virological cure 1% c19early.com/reis3.html Favors metformin Favors control
31 August 2021 - Early treatment study
Effect of early treatment with metformin on risk of emergency care and hospitalization among patients with COVID-19: The TOGETHER randomized platform clinical trial
Reis et al., The Lancet Regional Health - Americas, doi:10.1016/j.lana.2021.100142 (preprint 8/31/21) (Peer Reviewed)
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RCT with 215 patients treated with metformin and 203 controls, showing no significant difference with treatment.
The hospitalization risk for off-protocol patients was several times higher in both arms, resulting in Simpson's paradox when combining per-protocol and off-protocol patients [1].
risk of hospitalization, 5.6% lower, RR 0.94, p = 0.88, treatment 24 of 215 (11.2%), control 24 of 203 (11.8%), NNT 152, ITT.
risk of hospitalization, 39.1% lower, RR 0.61, p = 0.28, treatment 8 of 168 (4.8%), control 14 of 179 (7.8%), NNT 33, PP.
risk of extended ER observation or hospitalization, 14.0% higher, RR 1.14, p = 0.58, treatment 34 of 215 (15.8%), control 28 of 203 (13.8%), ITT.
risk of extended ER observation or hospitalization, 12.0% lower, RR 0.88, p = 0.72, treatment 14 of 168 (8.3%), control 17 of 179 (9.5%), NNT 86, PP.
risk of ER visit, 31.0% lower, RR 0.69, p = 0.48, treatment 8 of 216 (3.7%), control 11 of 205 (5.4%), NNT 60, ITT.
risk of ER visit, 25.9% lower, RR 0.74, p = 0.62, treatment 7 of 171 (4.1%), control 10 of 181 (5.5%), NNT 70, PP.
risk of no virological cure, 1.0% lower, RR 0.99, p = 0.85, treatment 215, control 203, adjusted per study.
Effect extraction follows pre-specified rules prioritizing more serious outcomes.
Reis et al., 8/31/2021, Double Blind Randomized Controlled Trial, Brazil, South America, peer-reviewed, 23 authors.
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