Results of a study published in Gut suggest that while patients who take proton pump inhibitors (PPIs) are at an increased risk for severe clinical outcomes of COVID-19, they are not more likely to be infected with the SARS-CoV-2 virus.
The researchers, led by Seung Won Lee, Department of Data Science, Sejong University College of Software Convergence, Seoul, Korea, investigated the potential associations between current use of PPIs and infection rates of COVID-19 among patients who underwent SARS-CoV-2 testing. They noted that the study was carried out as the adverse effects of PPIs have previously been documented in patients with pneumonia, in association with ventilator-associated adverse events, and sometimes mortality.
To investigate further, the scientists looked at data from a Korean nationwide cohort study that included 132,316 patients older than 18 years who were tested for SARS-CoV-2 between January 1 and May 15 this year, of whom 4,785 showed positive results for the novel coronavirus. The primary endpoint of the study was a positive laboratory test result for SARS-CoV-2, while secondary endpoints were severe clinical outcomes of COVID-19, which comprised admission to intensive care unit, administration of invasive ventilation or death.
In the entire cohort, there were 111,911 patients who had never used PPIs, 14,163 currently taking the medicines and 6,242 who had previously used PPIs. Individuals with current use of PPIs and those with history of past use of PPIs were matched individually to an equal number of non-PPI exposed patients in two propensity score-matched cohorts.
Results showed that after propensity score matching, the SARS-CoV-2 test positivity rate was not associated with current or past use of PPIs. Findings revealed that the SARS-CoV-2 test positivity rate in patients without history of PPI use was 3.1% compared with 2.6% in those with current use of the medicines. Meanwhile, the SARS-CoV-2 test positivity rate in another group of patients without history of PPI use was 3.3%, versus 3.1% for those with past use of the medicines.
Results also showed that among patients with confirmed SARS-CoV-2 infection, the current use of PPIs conferred a 79% greater risk of severe clinical outcomes of COVID-19, while the relationship with past use of the medicines remained insignificant. In addition, findings indicated that current PPI use starting within the previous 30 days was associated with a 90% increased risk of severe clinical outcomes of COVID-19.
The researchers concluded that given the results, clinicians should be aware of the increased risks of PPIs in patients with SARS-CoV-2 infection, while they also urgently called for guidance on use of the medicines during the COVID-19 pandemic considering how widely they are used.
Nonetheless, the researchers noted several limitations of the study, which include the possibility of additional unmeasured confounders influencing the results, such as genetic polymorphisms, smoking and body mass index and PPI use of over 3 years was not considered as COVID-19-related data in the cohort were short-term data. They further noted that “more longitudinal clinical studies are warranted to provide more information and to validate the association between PPIs and COVID-19.”