Dipeptidyl peptidase 4 (DPP4) inhibitor and outcome from coronavirus disease 2019 (COVID-19) in diabetic patients: a systematic review, meta-analysis, and meta-regression

Background One of the drugs which is commonly used in diabetic patients is Dipeptidyl Peptidase-4 (DPP-4) inhibitor. Currently, the association between DPP-4 inhibitor and coronavirus disease 2019 (COVID-19) outcome is not yet established. This study aims to analyze the potential association between DPP-4 inhibitor and the composite poor outcome of COVID-19. Methods We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until November 29th, 2020. All articles published on COVID-19 and DPP-4 inhibitor were retrieved. Statistical analysis was done using Review Manager 5.4 and Comprehensive Meta-Analysis version 3 software. Results Our pooled analysis showed that DPP-4 inhibitor use was not associated with composite poor outcomes of COVID-19 [OR 1.09 (95% CI 0.93-1.28), p = 0.29, I-2 = 0%, random-effect modelling], and its subgroup which comprised of severe COVID-19 [OR 1.07 (95% CI 0.87-1.31), p = 0.54, I-2 = 0%, random-effect modelling], and mortality [OR 1.14 (95% CI 0.87-1.51), p = 0.35, I-2 = 8%, random-effect modelling]. Meta-regression showed that the association was not influenced by age (p = 0.663), hypertension (p = 0.454), and admission blood glucose (p = 0.310). Subgroup analysis showed that the association was weaker in East Asian populations (OR 1.02) compared to European populations (OR 1.11). Conclusion DPP-4 inhibitor in diabetic patients did not alter the outcomes from COVID-19. Our study suggest that the use of DPP-4 inhibitor in COVID-19 patients with diabetes may still be continued according to the patients' need.

Automated summary

The study found that the use of DPP-4 inhibitors in diabetic patients does not impact the outcomes of COVID-19, including severity and mortality. Factors such as age, hypertension, and admission blood glucose levels did not significantly influence the association. The association was weaker in East Asian populations compared to European populations.