Abstract

BackgroundTuberculosis (TB) remains one of the infectious diseases with a leading cause of death among adults worldwide. Metformin, a first-line medication for the treatment of type 2 diabetes, may have potential for treating TB. The aims of the present systematic review were to evaluate the impact of metformin prescription on the risk of tuberculosis diseases, the risk of latent TB infection (LTBI) and treatment outcomes of tuberculosis among patients with diabetic mellitus.MethodsDatabases were searched through March 2019. Observational studies reporting the effect of metformin prescription on the risk and treatment outcomes of TB were included in the systematic review. We qualitatively analyzed results of included studies, and then pooled estimate effects with 95% confidence intervals (CIs) of different outcome using random-effect meta-analyses.ResultsThis systematic review included 6980 cases from 12 observational studies. The meta-analysis suggested that metformin prescription could decrease the risk of TB among diabetics (pooled odds ratio [OR], 0.38; 95%CI, 0.21 to 0.66). Metformin prescription was not related to a lower risk of LTBI (OR, 0.73; 95%CI, 0.30 to 1.79) in patients with diabetes. Metformin medication during the anti-tuberculosis treatment is significantly associated with a smaller TB mortality (OR, 0.47; 95%CI, 0.27 to 0.83), and a higher probability of sputum culture conversion at 2 months of TB disease (OR, 2.72; 95%CI, 1.11 to 6.69) among patients with diabetes. The relapse of TB was not statistically reduced by metformin prescription (OR, 0.55; 95%CI, 0.04 to 8.25) in diabetics.ConclusionsAccording to current observational evidence, metformin prescription significantly reduced the risk of TB in patients with diabetes mellitus. Treatment outcomes of TB disease could also be improved by the metformin medication among diabetics.

Highlights

  • Tuberculosis (TB) remains one of the infectious diseases with a leading cause of death among adults worldwide

  • To clarify the relationship between metformin and TB, we conducted this systematic review of observational studies (1) to summarize epidemiological evidence on the association between metformin and TB disease; (2) to figure out whether metformin prescription could reduce the risk of TB or latent TB infection (LTBI) among patients with diabetes mellitus (DM); and (3) to explore the effects of metformin prescription on the treatment outcomes of TB in diabetics

  • We conducted random-effects meta-analyses to combine the estimates from selected researches reported as hazard ratios (HRs), odds ratios (ORs) and relative risks (RRs)

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Summary

Methods

Definitions In this systematic review, latent TB infection (LTBI) represented an asymptomatic TB infection status which could be diagnosed by interferon gamma release assays. We identified observational studies reporting an effect of metformin prescription on the risk and treatment of TB disease. Study selection Cohort, case-control, or cross-sectional studies exploring the impact of metformin on the risk of TB and the anti-. On the basis of qualitative material, we tried to pool estimate effects in meta-analyses from two perspectives: one kind reported a risk of TB in patients with metformin usage versus no metformin usage, and the other analyzed effects of metformin on varied TB treatment outcomes, such as increased TB treatment success, lower TB mortality, and enhanced sputum culture conversion. We conducted random-effects meta-analyses to combine the estimates from selected researches reported as hazard ratios (HRs), odds ratios (ORs) and relative risks (RRs).

Results
Background
Study Design Participants
Participants without metformin treatment
Result
Study design
Discussion
Strengths and limitations
Conclusion
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