Metformin as an adjunct in treatment of Pulmonary Tuberculosis in Non-Diabetic patients

<b>Background:</b> Development of novel Host Directed Therapies, aimed at optimizing the host’s response against the mycobacterium, in combination with existing antibiotics is the need of the hour. Pre-clinical evidence of recent in vitro study showed Metformin modulate immune function &amp; gene transcription involved innate response to Mycobacterium Tuberculosis in healthy subjects. <b>Aim:</b> To study the activity of metformin as adjunct in combination with standard anti-TB treatment (ATT) regimen, in terms of time to sputum conversion in newly diagnosed smear positive pulmonary TB. <b>Methods:</b> A randomised, open-labelled, controlled clinical trial was conducted. Study recruited 80 newly diagnosed non-diabetic pulmonary TB patients in control group (only ATT for whole duration) and metformin group (Metformin 500 mg with ATT for first 2 months and only ATT for the rest 4 months). All patients of both groups were followed up for sputum smear examination, fasting blood sugar &amp; GeneXpert&nbsp; for drug resistance pattern (at the end of 2 months) &amp; tolerability and adverse events. <b>Result:</b> The average time taken for sputum smear conversion was significantly lower in the Metformin group (3.59±1.74 weeks) in comparison with the control group (4.26±2.31 week), 2.67 % of Metformin group found Rifampicin resistance at the end of the intensive phase whereas 8 % in control group. There was no significant difference noted in the fortnightly FBS values between the two groups. No serious adverse reactions were encountered in either of the groups. <b>Conclusion:</b> Metformin added to anti-TB treatment inPulmonary TB significantly reduced the time for sputum smear concersion &amp; decrease refampicin resistance.