November 17, 2020
Proton-Pump Inhibitors and COVID-19 Severity
Allan S. Brett, MD reviewing Li G-F et al. Gut 2020 Nov 10 Kow CS and Hasan SS. J Intern Med 2020 Oct 20
Observational studies suggest that PPI use might predispose patients to worse COVID-19 outcomes, but a causal relation has not been proven.
Observational studies have suggested associations between use of proton-pump inhibitors (PPIs) and COVID-19 (NEJM JW Gastroenterol Sep 2020 and Am J Gastroenterol 2020; 115:1707). In two meta-analyses, researchers now have addressed this issue, with the following findings:
- In one meta-analysis, “current or regular use” of PPIs was associated with nonsignificantly higher risk for becoming infected with SARS-CoV-2 (5 studies; odds ratio, 1.33) and with significantly higher risk for severe outcomes of COVID-19, including intensive care unit admission or death (9 studies; OR, 1.67).
- In another meta-analysis, PPI use was associated with significantly higher risk for severe outcomes of COVID-19 (3 studies; OR, 1.46) and for developing secondary infections (2 studies; OR, 2.91).
- Studies varied in methodology (cohort vs. case-control), country where study was performed, ways in which participants were identified, and extent of control for confounding variables.