Impact of metformin on the risk and treatment outcomes of tuberculosis in diabetics: a systematic review

Xinyu Yu, Ling Li, Liangtao Xia, Xin Feng, Fan Chen, Shiyi Cao, Xiang Wei, Xinyu Yu, Ling Li, Liangtao Xia, Xin Feng, Fan Chen, Shiyi Cao, Xiang Wei

Abstract

Background: Tuberculosis (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.

Methods: Databases 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.

Results: This 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.

Conclusions: According 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.

Keywords: Meta-analysis; Metformin; Tuberculosis.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study screening flowchart
Fig. 2
Fig. 2
Forest plot of the association between metformin and the risk of TB disease or LTBI. Abbreviations: TB, tuberculosis; LTBI, latent tuberculosis infection; n, number of cases; N, number of participants; CI, confidence interval; OR, odds ratio; SD, standard deviation
Fig. 3
Fig. 3
Forest plot of the association between metformin and treatment outcomes for TB disease. Abbreviations: TB, tuberculosis; N, number of participants; CI, confidence interval; OR, odds ratio; SD, standard deviation

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