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#Diabetes and Endocrinology
Mounting evidence indicates the benefits of metformin in prevention and treatment of tuberculosis in comparison to non-users in diabetic patients.1 Metformin exerts its effects on the immune response and inflammation in various ways. Its protecting action on tuberculosis is mediated by increased host cell production of mitochondrial reactive oxygen species and increased acidification of mycobacterial phagosome. In addition, it could limit the intracellular growth of Mycobacterium tuberculosis through adenosine monophosphate-activated protein kinase (AMPK)-dependent pathway and reduce the inflammatory process through activation of this pathway.2
Experimental studies support the host-directed effect of metformin on tuberculosis. Metformin may shorten the standard course of anti-tuberculosis therapy and reduce the probability of drug resistance.2 A systematic review and meta-analysis showed that metformin therapy remarkably reduced active tuberculosis incidence and mortality among people with diabetes mellitus, and those with concomitant tuberculosis and diabetes.1 Another systematic review that analyzed the impact of metformin prescription on the risk of tuberculosis also revealed lower risk of tuberculosis in diabetic patients taking metformin. In addition, the findings showed lesser deaths related to tuberculosis, and a higher probability of sputum culture conversion at two months. Moreover, it was observed that treatment outcomes of tuberculosis could be improved by metformin usage among diabetics.2
The researchers thus highlight that use of metformin may help in preventing diabetes mellitus and tuberculosis simultaneously. This drug may magnify the effectiveness of antibiotics, shorten the duration of anti-tuberculosis regimen, and promote the development of immunological memory, thereby reducing the chances of relapse.2
- Zhang M, Jian-qing He. Impacts of metformin on tuberculosis incidence and clinical outcomes in patients with diabetes: a systematic review and meta-analysis. European Journal of Clinical Pharmacology. 2020;76:149–159.
- Yu X, Li L, Xia L, et al. Impact of metformin on the risk and treatment outcomes of tuberculosis in diabetics: a systematic review. BMC Infectious Diseases. 2019;19(1):859.