What EMERGE Revealed About Early Metformin Beyond Statistical Significance

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In EMERGE, the prespecified primary analysis found a risk difference of −6.9% (95% CI, −15.1% to 1.4%; P = .13) for metformin vs placebo.
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A secondary generalized pairwise comparison analysis reported a win ratio of 1.46 (P = .004), but the authors characterize such reanalysis findings as exploratory or suggestive.
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The primary analysis confidence interval was compatible with benefits ranging from substantial to minimal and indicated a low probability of harm on the composite outcome.
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With uninformative priors, Bayesian analysis estimated a 95% probability that metformin reduced the primary composite and a 70% probability of a reduction exceeding 5 percentage points.
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The authors state that EMERGE analyses favor metformin over harm, while the magnitude of benefit remains uncertain and requires further research.

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