Metformin in severe exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial. Issue 7 (25th February 2016)

• Record Type: Journal Article
• Authors: Hitchings, Andrew W; Lai, Dilys; Jones, Paul W; Baker, Emma H
• Other Names: author non-byline.; Akunuri Srikanth author non-byline.; Tumilty Michael author non-byline.; Poloniecki Jan author non-byline.; Balasanthiran Anjali author non-byline.; Caneja Cielito author non-byline.; Norrie Kylie author non-byline.; Weldring Theresa author non-byline.; Carungcong Jaime author non-byline.; Harrison Richard author non-byline.; Bateman Nicola author non-byline.; Battram June author non-byline.; Kemp Sam author non-byline.; Whysall Karen author non-byline.; Wilkinson Mark author non-byline.; Craig Jayne author non-byline.; Tibke Clare author non-byline.; Jeffery Rebecca author non-byline.; Paracha Mohammed author non-byline.; Saba Tarek author non-byline.; Swarbrick Gemma author non-byline.; Saba Judith author non-byline.; Vyas Aashish author non-byline.; Mills Janet author non-byline.; Goddard Sarah author non-byline.; De Soyza Anthony author non-byline.; Small Therese author non-byline.; Dodds Ashley author non-byline.; Dashora Umesh author non-byline.; Golton Rachael author non-byline.
• Is Part Of: Thorax. Volume 71:Issue 7(2016)
• Page Start: 587
• Page End: 593
• Publication Date: 2016-02-25
• Subjects: COPD Exacerbations -- COPD Pharmacology; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2015-208035
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Severe exacerbations of COPD are commonly associated with hyperglycaemia, which predicts adverse outcomes. Metformin is a well-established anti-hyperglycaemic agent in diabetes mellitus, possibly augmented with anti-inflammatory effects, but its effects in COPD are unknown. We investigated accelerated metformin therapy in severe COPD exacerbations, primarily to confirm or refute an anti-hyperglycaemic effect, and secondarily to explore its effects on inflammation and clinical outcome. Methods: This was a multicentre, randomised, double-blind, placebo-controlled trial testing accelerated metformin therapy in non-diabetic patients, aged ≥35 years, hospitalised for COPD exacerbations. Participants were assigned in a 2:1 ratio to 1 month of metformin therapy, escalated rapidly to 2 g/day, or matched placebo. The primary end point was mean in-hospital blood glucose concentration. Secondary end points included the concentrations of fructosamine and C reactive protein (CRP), and scores on the COPD Assessment Test and Exacerbations of Chronic Pulmonary Disease Tool. Results: 52 participants (mean (±SD) age 67±9 years) were randomised (34 to metformin, 18 to placebo). All were included in the primary end point analysis. The mean blood glucose concentrations in the metformin and placebo groups were 7.1±0.9 and 8.0±3.3 mmol/L, respectively (difference −0.9 mmol/L, 95% CI −2.1 to +0.3; p=0.273). No significant between-group differences were observed on any of the secondary end points. Adverse reactions, particularly gastrointestinal effects, were more common in metformin-treated participants. Conclusion: Metformin did not ameliorate elevations in blood glucose concentration among non-diabetic patients admitted to hospital for COPD exacerbations, and had no detectable effect on CRP or clinical outcomes. Trial registration number: ISRCTN66148745 and NCT01247870 .