Proton Pump Inhibitors: Current Use and the Risk of Coronavirus Infectious Disease 2019 Development and its Related Mortality. Meta-analysis

Abstract

Background The ongoing Coronavirus Infectious Disease (COVID-19) pandemic is a global health crisis that has had a magnanimous worldwide impact on all aspects of people's lives. Several observational studies investigated the relationship between Proton Pump Inhibitors use and the risk of COVID-19 development and mortality. Aim of the Study The aim of this meta-analysis is to investigate the association between current PPIs use and the development of COVID-19 as well as its mortality. Methods Pubmed, Google Scholar, ScienceDirect and medRxiv were searched until November 21, 2020 using the following keywords: proton pump inhibitors and COVID-19 as well as their related MESH terms. The studies considered in the meta-analysis were either cohort or case-control in design and adjusted for confounding factors. The quality of the studies included in this meta-analysis were assessed using the Newcastle-Ottawa Scale. In addition, a random-effects model was used to calculate the pooled Odds Ratio (ORs) and the corresponding confidence interval (95% CI). Heterogeneity was evaluated using The Cochran's Q heterogeneity test and I 2 statistic. Results Six observational studies with 195,230 participants were included. In this meta-analysis, current use of PPIs increased risk of COVID-19 development (OR = 1.19; 95% CI: 0.62-2.28) and mortality (OR = 1.67; 95% CI: 1.41-1.97). Conclusions Our meta-analysis indicates that current PPIs use significantly increased the risk of COVID-19 mortality, but it did not reach a significant threshold in regards to the risk of COVID-19 development.

Acid suppressant use in association with incidence and severe outcomes of COVID-19: a systematic review and meta-analysis

“…Recently, four meta-analyses [ 31 – 34 ] were published regarding the association between the use of acid suppressants and COVID-19. Three meta-analyses [ 31 – 33 ] identified the relationship for PPIs and one by Kow et al [ 34 ] for famotidine.…”

“…Recently, four meta-analyses [ 31 – 34 ] were published regarding the association between the use of acid suppressants and COVID-19. Three meta-analyses [ 31 – 33 ] identified the relationship for PPIs and one by Kow et al [ 34 ] for famotidine. Supplemental Table 5 describes the differences in study characteristics and the main results among the past meta-analysis and the present study.…”

Adverse Effects Associated with Long-Term Use of Proton Pump Inhibitors

“…According to a meta-analysis of six observational studies, current PPI users have a significantly higher risk of developing COVID-19 as well as dying from it. 76 Similarly, in another meta-analysis, which included twelve observational retrospective cohort studies, the poor outcome in PPI-using patients was quantified. 77 Also, a meta-analysis of four case-control studies and 10 cohort studies found a significantly enhanced risk of severity and mortality of COVID-19 infection in current users of PPIs.…”

A Pharmacogenetics-Based Approach to Managing Gastroesophageal Reflux Disease: Current Perspectives and Future Steps

“…In addition, long term PPI-use has been reported to be associated with increased risk of dementia, gastroenteritis, 60 , 61 acute 62–65 and chronic 66–68 kidney disease, pneumonia (eg, highest risk at 1 month regardless of dose), 69 mortality, 70 and more recently, COVID-19-associated mortality. 71 …”