Evidence mapPaperPMID 34849651Full record

Trial reportClinical infectious diseases : an official publication of the Infectious Diseases Society of America2022

Randomized Trial of Metformin With Anti-Tuberculosis Drugs for Early Sputum Conversion in Adults With Pulmonary Tuberculosis.

Chandrasekaran Padmapriydarsini, Megha Mamulwar, Anant Mohan, Prema Shanmugam, N S Gomathy, Aarti Mane, Urvashi B Singh, Nathella Pavankumar, Abhijeet Kadam, Hemanth Kumar and 10 more

Registry-linked trialOpen access · bronzeAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07136987 (A Randomized Controlled Trial of 2 Disease-Modifying Drugs), which is not on this map. Cited by 42 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 1 pooled it
2.8field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07136987 phase3not yet recruitingnot on this mapstarted 2026, after this paper: background citation

A Randomized Controlled Trial of 2 Disease-Modifying Drugs (Metformin and N-acetylcysteine ) to Promote TB Lung Function Recovery (TB-MET-NAC)

TypeinterventionalSponsorOpen Source Pharma FoundationRan2026 to 2031Enrolled1,104ConditionsTuberculosisArmsMetformin, N-Acetylcysteine (NAC) Treatment, Standard TB treatment
3 · Its place in the literature

Who cites it

42 citing papers in PubMed, 1 synthesis or guideline pooled it, 72 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Review
  4. Review
  5. Article
  6. Review
  7. Article
  8. Recent advances in tuberculosis treatment: Towards shorter, safer, and more effective therapies.Journal of clinical tuberculosis and other mycobacterial diseases · 2026
    Review
  9. Article
  10. Molecular signaling in coinfection: howFrontiers in immunology · 2026
    Review
  11. Review
  12. Review
  13. Article
  14. Review
  15. Post-tuberculosis morbidities and their associated mortality: moving from challenges to solutions.European respiratory review : an official journal of the European Respiratory Society · 2025
    Review
  16. Anti-TB Drugs for Drug-Sensitive and Drug-ResistantCurrent issues in molecular biology · 2025
    Review
  17. Review
  18. Host-directed therapy for tuberculosis.European journal of medical research · 2025
    Review
  19. Inducible antibacterial responses in macrophages.Nature reviews. Immunology · 2025
    Review
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors at 5 institutions in 1 country.

Chandrasekaran PadmapriydarsiniDepartment of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India.
Megha MamulwarDivision of Data Management, Biostatistics and IT, Department of Clinical Research, Indian Council of Medical Research-National AIDS Research Institute, Pune, India.
Anant MohanDepartment of Pulmonary, Critical Care & Sleep Medicine, All India Institute for Medical Sciences, New Delhi, India.
Prema ShanmugamDepartment of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India.
N S GomathyDepartment of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India.
Aarti ManeDivision of Data Management, Biostatistics and IT, Department of Clinical Research, Indian Council of Medical Research-National AIDS Research Institute, Pune, India.
Urvashi B SinghDepartment of Pulmonary, Critical Care & Sleep Medicine, All India Institute for Medical Sciences, New Delhi, India.
Nathella PavankumarDepartment of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India.
Abhijeet KadamDivision of Data Management, Biostatistics and IT, Department of Clinical Research, Indian Council of Medical Research-National AIDS Research Institute, Pune, India.
Hemanth KumarDepartment of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India.
Chandra SureshDepartment of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India.
Devaraju ReddyDepartment of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India.
Poornaganga DeviDepartment of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India.
P M RameshDepartment of Thoracic Medicine, Government Ottery TB Hospital, Chennai, India.
Lakshmanan SekarDepartment of Clinical Research, Indian Council of Medical Research-National Institute for Research in Tuberculosis, Chennai, India.
Shaheed JawaharOpen Source Pharma Foundation, Bangalore, India.
R K ShandilOpen Source Pharma Foundation, Bangalore, India.
Manjula SinghEpidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India.
Jaykumar MenonOpen Source Pharma Foundation, Bangalore, India.
Randeep GuleriaDepartment of Pulmonary, Critical Care & Sleep Medicine, All India Institute for Medical Sciences, New Delhi, India.
Indian Council of Medical Research · INAll India Institute of Medical Sciences · INOpen Source Drug Discovery · INNational AIDS Research Institute · INGovernment Hospital of Thoracic Medicine · IN

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMetformin, by reducing intracellular Mycobacterium tuberculosis growth, can be considered an adjunctive therapy to anti-tuberculosis treatment (ATT). We determined whether metformin with standard ATT reduces time to sputum culture conversion and tissue inflammation in adults with pulmonary tuberculosis (PTB).

methodsIn a randomized, 8-week, clinical trial, newly diagnosed, culture-positive PTB patients were randomized to standard ATT (HREZ = control arm) or standard ATT plus daily 1000 mg metformin (MET-HREZ = Metformin with Rifampicin [METRIF] arm) for 8 weeks during 2018-2020 at 5 sites in India. The primary end point was time to sputum culture conversion by liquid culture during 8 weeks of ATT. Plasma inflammatory markers were estimated in a subset. A Cox proportional hazard model was used to estimate time and predictors of culture conversion.

resultsOf the 322 patients randomized, 239 (74%) were male, and 212 (66%) had bilateral disease on chest radiograph with 54 (18%) showing cavitation. The median time to sputum culture conversion by liquid culture was 42 days in the METRIF arm and 41 days in the control arm (hazard ratio, 0.8; 95% confidence interval [CI], .624-1.019). After 8 weeks of ATT, cavitary lesions on X-ray (7, 5.3% vs 18, 12.9%; relative risk, 0.42; 95% CI, .18-.96; P = .041) and inflammatory markers were significantly lower in the METRIF arm. Higher body mass index and lower sputum smear grading were associated with faster sputum culture conversion.

conclusionsThe addition of metformin to standard ATT did not hasten sputum culture conversion but diminished excess inflammation, thus reducing lung tissue damage as seen by faster clearance on X-ray and reduced inflammatory markers. CLINICAL TRIALS REGISTRATION: Clinical Trial Registry of India (CTRI/2018/01/011176).

Indexed as

MetforminMycobacterium tuberculosisTuberculosis, PulmonaryAdultAntitubercular AgentsFemaleHumansInflammationMaleSputumAntitubercular AgentsMetforminhost-directed therapyimmunomodulationmetforminpharmacokineticstuberculosis

Identifiers

PMID34849651
PMCPMC9427151
OpenAlexW3216014327

What Socratic holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.