PPI use associated with more severe illness from COVID-19

A Korean cohort study did not find any association between use of proton-pump inhibitors (PPIs) and risk of infection with SARS-CoV-2, but current use was associated with higher risk of a composite endpoint that included ICU admission, mechanical ventilation, or death from COVID-19.

Use of proton-pump inhibitors (PPIs) was associated with worse outcomes of COVID-19 but no difference in risk of infection with the novel coronavirus, a recent study found.

Researchers used a Korean nationwide study to analyze 132,316 adult patients who were tested for SARS-CoV-2 between Jan. 1 and May 15. The cohort included 111,911 patients who didn't use PPIs, 14,163 current PPI users, and 6,242 past PPI users. The primary outcome was SARS-CoV-2 positivity, and the secondary outcomes were composite measures of severe clinical outcomes of COVID-19. Results were published by Gut on July 30.

The overall positivity rate of SARS-CoV-2 in the cohort was 3.61%. Of the 4,785 patients who tested positive, 364 were current PPI users, 188 were past users, and the remaining 4,233 were nonusers. After propensity score matching, the study found no association between positivity for SARS-CoV-2 and current or past use of PPIs. However, current use of PPIs, particularly initiated within the previous 30 days, was associated with composite endpoints for severity of infection that included requirement of oxygen therapy, ICU admission, and invasive ventilation or death. Past use of PPIs was not associated with these outcomes.

The authors noted a number of limitations to the study, including the possibility of unmeasured confounders influencing the results, such as genetic polymorphisms, smoking, and body mass index. “Our findings provide an improved understanding of the relationship of COVID-19 and PPIs and suggest that clinicians should be aware of the increased risks of these agents in patients with COVID-19. Guidance on the usage of PPIs in COVID-19 is urgently required considering the wide use of these agents worldwide,” they concluded.

Several other recent studies addressed gastroenterological aspects of COVID-19, including two on patients who also have inflammatory bowel disease and two on the association between obesity and worse outcomes from the disease.