Targeting Accelerated Aging in COPD: The AMICO (A Trial of Metformin In COpd) Trial Design
21 affiliations
- 1Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain
- 2Pulmonary Department–Research Unit, Hospital Universitario Nuestra Señora de La Candelaria, CIBERES, ISCIII, Universidad de La Laguna, Tenerife, Spain
- 3Pulmonary Department, Hospital Universitario Miguel Servet, IIS Aragón & CIBERES, University of Zaragoza, Zaragoza, Spain
- 4Pulmonary Department, Hospital Universitario Doctor Negrín, CIBERES, ISCII, Las Palmas, Spain
- 5Pulmonary Department, Hospital San Pedro Alcántara, Cáceres, Spain
- 6Pulmonary Department, Hospital Universitario de Navarra, Pamplona, Spain
- 7Pulmonary Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
- 8Pulmonary Department, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Islas Baleares (IdISBa), Mallorca, Spain
- 9Pulmonary Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- 10Pulmonary Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- 11Group of Translational Research in Respiratory Medicine, IRB Lleida, Hospital Universitari Arnau de Vilanova i Santa Maria, CIBERES, ISCIII Lleida, Spain
- 12Pulmonary Department, Hospital Universitario San Pedro, Logroño, Spain
- 13Pulmonary Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
- 14Pulmonary Department, Hospital Universitario La Paz, Madrid, Spain
- 15Pulmonary Department, Pulmonary Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
- 16Pulmonary Department, Hospital Universitario Son Llatzer, Mallorca, Spain
- 17Pulmonary Department, Hospital Universitario de la Princesa, CIBERES, ISCIII, Madrid, Spain
- 18Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain
- 19Instituto de Investigación Sanitaria Galicia Sur, Vigo, Spain
- 20Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houton, Texas, USA
- 21Pulmonary Department, Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a disease of accelerated biological aging characterized by progressive lung function decline, emphysema progression and multiple age-related comorbidities. Current therapies improve symptoms and reduce exacerbations but have limited effects on disease progression. Metformin has demonstrated anti-aging properties through modulation of pathways involved in oxidative stress, inflammation, mitochondrial dysfunction and cellular senescence, making it a potential disease-modifying treatment in COPD.Methods AMICO (A Trial of Metformin In COPD) is an investigator-initiated, multicenter, randomized, double-blind, placebo-controlled phase III trial conducted in anonymous. A total of 212 patients with clinically stable COPD, centrilobular emphysema on computed tomography, post-bronchodilator FEV1 40%–70% predicted and accelerated FEV1 decline (>40 mL·year−1) will be randomized (1:1) to receive metformin (850 mg twice daily) or matching placebo for 36 months in addition to standard COPD treatment. Assessments include pulmonary function, chest computed tomography, exercise capacity, health status, muscle strength, body composition, age associated comorbidities development and aging-related biomarkers.The primary endpoint is the annual rate of FEV1 decline over 36 months. Secondary endpoints include emphysema progression, changes in diffusing capacity, COPD Assessment Test score, 6-minute walk distance, BODE index, handgrip strength, exacerbations, major cardiovascular events, cancer incidence and renal dysfunction.Conclusions AMICO is the first randomized trial specifically designed to evaluate metformin as a gerotherapeutic and disease-modifying intervention in COPD. The study may provide novel evidence supporting geroscience-based approaches to slow disease progression and improve long-term outcomes in patients with COPD.
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BibTeX
@article{detorres2026targeting,
title = {{Targeting Accelerated Aging in COPD: The AMICO (A Trial of Metformin In COpd) Trial Design}},
author = {Juan P. de-Torres and Ciro Casanova and José M. Marín and Marta Marín-Oto and Carlos Cabrera and Juan A. Riesco and Pablo Sanchez Salcedo and Carlos Amado and Nuria Toledo-Pons and Ingrid Solanes and Carolina Gotera and Jessica Gonzalez and Carlos Ruiz Martinez and Aurora Solier López and Francisco García Río and Cruz González and Antonia Fuster and Tamara Alonso and Ana Ezponda and Gorka Bastarrika and Verónica Hernández-Lopez and Francesca Polverino and Bartolome R. Celli},
journal = {COPD},
year = {2026},
month = oct,
doi = {10.1080/15412555.2026.2753977},
url = {https://doi.org/10.1080/15412555.2026.2753977},
note = {CC BY},
}
RIS
TY - JOUR
TI - Targeting Accelerated Aging in COPD: The AMICO (A Trial of Metformin In COpd) Trial Design
AU - Juan P. de-Torres
AU - Ciro Casanova
AU - José M. Marín
AU - Marta Marín-Oto
AU - Carlos Cabrera
AU - Juan A. Riesco
AU - Pablo Sanchez Salcedo
AU - Carlos Amado
AU - Nuria Toledo-Pons
AU - Ingrid Solanes
AU - Carolina Gotera
AU - Jessica Gonzalez
AU - Carlos Ruiz Martinez
AU - Aurora Solier López
AU - Francisco García Río
AU - Cruz González
AU - Antonia Fuster
AU - Tamara Alonso
AU - Ana Ezponda
AU - Gorka Bastarrika
AU - Verónica Hernández-Lopez
AU - Francesca Polverino
AU - Bartolome R. Celli
PY - 2026
DA - 2026/10/01
JO - COPD
DO - 10.1080/15412555.2026.2753977
UR - https://doi.org/10.1080/15412555.2026.2753977
AB - Introduction Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a disease of accelerated biological aging characterized by progressive lung function decline, emphysema progression and multiple age-related comorbidities. Current therapies improve symptoms and reduce exacerbations but have limited effects on disease progression. Metformin has demonstrated anti-aging properties through modulation of pathways involved in oxidative stress, inflammation, mitochondrial dysfunction and cellular senescence, making it a potential disease-modifying treatment in COPD.Methods AMICO (A Trial of Metformin In COPD) is an investigator-initiated, multicenter, randomized, double-blind, placebo-controlled phase III trial conducted in anonymous. A total of 212 patients with clinically stable COPD, centrilobular emphysema on computed tomography, post-bronchodilator FEV1 40%–70% predicted and accelerated FEV1 decline (>40 mL·year−1) will be randomized (1:1) to receive metformin (850 mg twice daily) or matching placebo for 36 months in addition to standard COPD treatment. Assessments include pulmonary function, chest computed tomography, exercise capacity, health status, muscle strength, body composition, age associated comorbidities development and aging-related biomarkers.The primary endpoint is the annual rate of FEV1 decline over 36 months. Secondary endpoints include emphysema progression, changes in diffusing capacity, COPD Assessment Test score, 6-minute walk distance, BODE index, handgrip strength, exacerbations, major cardiovascular events, cancer incidence and renal dysfunction.Conclusions AMICO is the first randomized trial specifically designed to evaluate metformin as a gerotherapeutic and disease-modifying intervention in COPD. The study may provide novel evidence supporting geroscience-based approaches to slow disease progression and improve long-term outcomes in patients with COPD.
SN - 1541-2563
SN - 1541-2555
ER -