Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching

Abstract

ObjectiveThe adverse effects of proton pump inhibitors (PPIs) have been documented for pneumonia; however, there is no consensus regarding whether the use of PPIs might be harmful regarding the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this regard, we aimed to measure the potential associations of the current use of PPIs with the infection rates of COVID-19 among patients who underwent SARS-CoV-2 testing.DesignData were derived from a Korean nationwide cohort study with propensity score matching. We included 132 316 patients older than 18 years who tested for SARS-CoV-2 between 1 January and 15 May 2020. Endpoints were SARS-CoV-2 positivity (primary) and severe clinical outcomes of COVID-19 (secondary: admission to intensive care unit, administration of invasive ventilation or death).ResultsIn the entire cohort, there were 111 911 non-users, 14 163 current PPI users and 6242 past PPI users. After propensity score matching, the SARS-CoV-2 test positivity rate was not associated with the current or past use of PPIs. Among patients with confirmed COVID-19, the current use of PPIs conferred a 79% greater risk of severe clinical outcomes of COVID-19, while the relationship with the past use of PPIs remained insignificant. Current PPI use starting within the previous 30 days was associated with a 90% increased risk of severe clinical outcomes of COVID-19.ConclusionPatients taking PPIs are at increased risk for severe clinical outcomes of COVID-19 but not susceptible to SARS-CoV-2 infection. This suggests that physicians need to assess benefit–risk assessments in the management of acid-related diseases amid the COVID-19 pandemic.

Allergic disorders and susceptibility to and severity of COVID-19: A nationwide cohort study

“…During the COVID-19 pandemic, the Korean government provided mandatory and free health insurance for all Korean patients with COVID-19. 23,24 Therefore, the data set analyzed in this study includes the records of personal data, health care records of inpatients and outpatients from the past 3 years (including health care visits, prescriptions, diagnoses, and procedures), pharmaceutical visits, COVID-19-related outcomes, and death records. The study protocol was approved by the Institutional Review Board of Sejong University (SJU-HR-E-2020-003).…”

Do proton pump inhibitors influence SARS-CoV-2 related outcomes? A meta-analysis

“…The article by Lee et al 1 showed that the current use of proton pump inhibitors (PPIs) increased the risk of severe clinical outcomes of COVID-19 rather than the susceptibility to SARS-CoV-2 infection in a Korean nationwide cohort. Instead, a significant association between susceptibility to SARS-CoV-2 infection and current use of PPIs, either one time or two times a day, was found by another recent study 2 based on US nationwide data.…”

“…Six studies [1][2][3][4][5][6] including 318 261 participants reported data on PPI usage and the risk of SARS-CoV-2 infection. Among them, five studies had information of current PPI users compared with nonusers and four on past PPI users versus non-users.…”

Review article: Acid suppressant therapy and risk of COVID-19 infection - to use, to alter or not to use?

“…Recently published observational studies highlight the various impacts of the use of acid suppressant therapy in COVID-19 infection (11)(12)(13)(14). We review here the biological plausibility, the evidence and the recommendations that can be made for acid suppressant use in the present COVID-19 pandemic.…”