Reply to letter to the editor regarding “Use of DPP-4 inhibitors in patients with COVID-19”

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Reply to letter to the editor regarding “Use of DPP‑4 inhibitors in patients with COVID‑19” Sebastiano Bruno Solerte1,2 · Francesca D’Addio3 · Paolo Fiorina3,4,5  Received: 23 October 2020 / Accepted: 29 October 2020 © Springer-Verlag Italia S.r.l., part of Springer Nature 2020

Dear Editor-in-Chief, We have received and read with interest the letter from Dr. Kow and Dr. Hasan [1] on our article entitled “Dipeptidyl peptidase-4 (DPP4) inhibition in COVID-19” recently published on Acta Diabetologica [2]. We all appreciate the comments and the novel information provided that complement our manuscript. Two major points have been raised in the letter. The first one is related to the recent evidences which suggest that the development of COVID-19 is associated with episodes of thromboembolism and, in general, to a hypercoagulability state. The second one relies on the fact that the use of DPP-4 inhibitors may facilitate the establishment of a prothrombotic state in treated patients, and sitagliptin in particular has been associated with a higher probability of venous thromboembolism events. We have recently published with several international collaborators a retrospective analysis conducted on patients with type 2 diabetes and COVID-19, Managed By Massimo Porta. This reply refers to the article available at https​:// s0059​2-020-01629​-y. * Paolo Fiorina [email protected] 1

Department of Internal Medicine, Geriatric and Diabetology Unit, University of Pavia, Pavia, Italy


School of Geriatrics, University of Pavia ASP-Pavia, Pavia, Italy


International Center for T1D, Pediatric Clinical Research Center Romeo ed Enrica Invernizzi, DIBIC L. Sacco, Università di Milano, Milan, Italy


Division of Endocrinology, ASST Fatebenefratelli-Sacco, Milan, Italy


Nephrology Division, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave., Boston, MA 02115, USA

who, at the admission to hospital, were switched from their antidiabetic drugs to either insulin as standard-of-care treatment, or to insulin plus sitagliptin [3]. Data analyzed on 338 patients demonstrated that the addition of sitagliptin to the standard-of-care was associated with a reduced mortality and improvement of clinical outcomes. We did not observe any abnormality in prothrombotic markers; indeed, we observed a reduction in sitagliptin-treated patients of LDH, D-dimer and in general of pro-inflammatory markers, which are often associated with a hypercoagulability state. Nevertheless, we need to mention that the majority of patients with type 2 diabetes were on anticoagulant and antiplatelets medications, as a prothrombotic risk is part of diabetes as well, thus the balance between pro- and antithrombotic factors may be already altered. The letter points out also to the fact that the use of sitagliptin was associated with an increase in reporting venous thromboembolism events in diabetic patients and that this occurred in half of the patients in concomitance with an infecti