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Back to the Future: Repurposing Metformin, a Metabolically Active Drug, to Treat Mild-to-Moderate Ulcerative Colitis
Elisabetta Antonelli1, Alessandra Dell'Era2, Giovanni Maconi2
1Gastroenterology and Endoscopy Unit, Santa Maria della Misericordia Hospital, 06156 Perugia, Italy.
Metabolites
|April 27, 2026
Summary
Metformin shows promise as an affordable, repurposed drug for ulcerative colitis (UC) treatment. While some studies suggest benefits for mild-to-moderate UC, further research is needed to confirm its long-term effectiveness and mechanisms.
Area of Science:
- Gastroenterology and Hepatology
- Pharmacology and Pharmaceutical Sciences
- Inflammatory Bowel Disease Research
Background:
- Ulcerative colitis (UC) incidence is increasing globally, causing significant psychological distress and reduced quality of life.
- Current UC treatments have unpredictable efficacy, difficulty achieving long-term remission, and accessibility issues with newer drugs.
- The need for novel, accessible therapeutic options drives research into drug repurposing.
Purpose of the Study:
- To review the potential of metformin, an established oral antidiabetic agent, as a repurposed drug for ulcerative colitis.
- To evaluate the existing evidence for metformin's efficacy and safety in managing UC.
- To discuss the implications of metformin's low cost and wide availability for UC treatment strategies.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) investigating metformin as an adjunct therapy for UC.
- Analysis of population-based observational and genetic studies examining metformin's role in UC.
- Assessment of mechanistic studies and literature on drug repurposing.
Main Results:
- RCTs indicate metformin may improve clinical outcomes in mild-to-moderate UC when used alongside conventional therapies.
- Observational and genetic studies provide conflicting data regarding metformin's impact on long-term UC disease modification and primary prevention.
- Metformin's established safety profile, low cost, and widespread availability make it an attractive candidate for repurposing.
Conclusions:
- Metformin represents a potential repurposed therapeutic agent for ulcerative colitis, particularly for mild-to-moderate cases.
- Further human mechanistic studies are essential to validate its efficacy and understand its role in UC management.
- The repurposing of metformin for UC warrants continued investigation due to its accessibility and cost-effectiveness.
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