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With Pfizer saying in January that it expects a big decline in revenue from its COVID-19 antiviral pill Paxlovid, sales could be hit down the road by an unlikely drug: metformin, the long-term drug for type 2 diabetes.
While drug combinations have long been used in clinical practice to produce better efficacy through synergistic results, metformin, one of the first drugs doctors turn to for diabetes, can be a pain in the neck. head. But it shouldn’t necessarily be.
This is because growing research indicates that Paxlovid and metformin could improve outcomes related to Long COVID, a chronic disease that could potentially affect millions of people who have contracted COVID.
Metformin could also stimulate the use of Paxlovid, especially if it is found to have synergistic effects, as many people are unwilling to take it due to reports of side effects and a COVID rebound effect, although it is unclear whether metformin mitigates The rebound.
Given its low price, especially compared to Paxlovid, metformin could eventually become a treatment for COVID, even without being taken with Paxlovid. Although the research on metformin for COVID looks promising, much more research on the diabetes drug is needed for this indication.
reuse drugs
If metformin does eventually find wide use as a COVID treatment, it wouldn’t be unusual. Many drugs, even after initial approval, are investigated for other purposes, often for conditions unrelated to the initial indication, in a process known as repurposing.
A good example is finasteride. While the drug was initially approved for overactive bladder under the name Proscar, it later gained approval in a different dosage as Propecia for hair loss.
Before the US FDA authorized Paxlovid, other antivirals, or monoclonal antibodies to treat COVID, scientists were working feverishly with a host of existing drugs to see if any might work against COVID. Among the most notable were the antiparasitic drug ivermectin and the antidepressant fluvoxamine. None have shown conclusive evidence of effectiveness against COVID.
Paxlovid is already under investigation in a federally funded treatment study for Long COVID.
The evidence for metformin
Although metformin was first discovered in 1922, it was not used as a medicine until 1957 in France. Its use in the US did not begin until 1995. The drug is the most widely used oral therapy for diabetes in the world and the third most prescribed drug in the US, as of 2020.
As for why metformin might be effective against COVID, Northwestern University researchers say the drug reduces high blood glucose levels, which are linked to worse COVID outcomes; the drug could also slow the viral cycle of COVID-19; and could make it harder for SARS-CoV-2, the virus that causes COVID, to enter cells.
the researchers also noted that metformin was used as a flu treatment in the 1940s and 1950s.
The evidence for metformin in COVID so far is promising, but by no means conclusive. A preprint study in the lancet published in early March led by researchers at the University of Minnesota found that those in the metformin group had a 42% relative decrease in the incidence of Long COVID compared to those in the control group. However, it is important to note that this study has not yet been peer reviewed.
The study, which enrolled just over 1,100 overweight or obese people, also examined the use of ivermectin and fluvoxamine to prevent prolonged COVID. She did not do it.
“Future research is needed to understand the optimal dosing regimens to prevent prolonged covid-19, whether extended-release is effective in people who have side effects from immediate-release metformin, and whether metformin could be used as a treatment for covid-19.” 19 prolonged,” the researchers wrote. “Future research could also test whether metformin is effective if started during an emergency department visit or hospitalization for COVID-19.”
The same Minnesota researchers previously looked at all three drugs in a similar demographic, even though these patients had early symptoms of COVID and were not hospitalized. Their study, published in the New England Journal of Medicine in August 2022, found that neither drug led to a decrease in emergency department visits, hospitalization, or death compared to a control group. However, those in the metformin group did show a possible reduction on a composite endpoint of emergency department visit, hospitalization, or death.
Another study that just came out in JAMA Internal Medicine examined nirmatrelvir, one of two antiviral drugs in Paxlovid (the other is ritonavir), to prevent long-term COVID symptoms. The researchers combed through US Veterans Administration healthcare databases to find those who tested positive for COVID and had at least one risk factor for progressing to severe illness.
Indicated Results that nirmatrelvir treatment reduced the risk of developing prolonged COVID symptoms, regardless of vaccination status or previous infection history, compared with the control group.
“When thinking about using Paxlovid or not, we need to think about the effectiveness in the acute phase, but also the effectiveness in reducing the long-term complications of COVID infection,” said co-author Ziyad Al-Aly, head of research and development of the VA St. Louis Health Care System, said CNN.
Despite the promise of Paxlovid and metformin in the treatment of Long COVID, there are still no results from studies of taking the two drugs together.
Pfizer concerns
In its fourth-quarter and full-year 2022 earnings report released in January, Pfizer (New York Stock Exchange: PFE) said that Paxlovid generated ~$19 billion in sales during the year. However, he warned that by 2023, that figure would drop 58% to $8 billion.
During his earnings call, CEO Albert Bourla admitted that the US government still has a backlog of Paxlovid inventory that will run out sometime in 2023. Also, Pfizer (PFE) is likely to increase the price from Paxlovid once the COVID public health emergency ends in May.
However, Bourla painted a more optimistic picture for Paxlovid after 2023. “We expect that in the years 2024 and beyond, courses sold and used will align closely each year.”
While the executive said he sees increased use of Paxlovid this year due to more infections, the company has not included any major new contracts outside of the US or outside of China in its Paxlovid sales projections.
