*4.1.5 Dipeptidyl peptidase-4 inhibitors*

It has been proposed that SARS Cov-2 binds to Dipeptidyl peptidase-4 inhibitors (DPP4), but the clinical implications are not known. Dipeptidyl peptidase-4 inhibitors (DPP4i) are well tolerated in COVID-19 infection [15]. The majority of studies have shown either benefit with DPP4i in PWD and COVID-19, or no harm or benefit [20], Although DPP4 inhibitors appear to be safe in T2D and COVID-19 infection [4], in an observational study of 717 patients, in the diabetes sub-group, patients on DPP4I were at a higher risk of ICU admission [5]. As study that compared GLP-1 RA or DPP4i with SGLT2i did not note associated improved outcomes in patients with COVID-19 infection [28]. As DPP4 upregulation may be an indicator for severity of COVID-19 infection, there is interest regarding the use of DPP4i in COVID-19 infection and available information may form the path to discovering novel therapies [29]. RCTs involving Linagliptin versus placebo and Sitagliptin versus placebo have been registered [30, 31].
