Current PPI use not a factor in COVID-19 outcomes

Proton pump inhibitors (PPIs) have been linked to higher risk of SARS-CoV-2 infection and hospital admission, but a recent study suggests that this is not the case. Specifically, the risk of hospital admission seen for current PPI users may be explained by residual confounding, and there is no association between PPI use and severity of COVID-19 among hospitalized patients.

In the present study, researchers conducted a nationwide observational study including all SARS-CoV-2 cases (n=83,224) in Denmark as of 1 December 2020. They evaluated the risk of severe outcomes, including mechanical ventilation, intensive care unit admission, or death among current PPI users (n=4,473) vs never users. To control for confounding, propensity score matching was applied.

Current PPI use conferred some risk of infection (adjusted odds ratio [OR], 1.08, 95 percent confidence interval [CI], 1.03–1.13). Among SARS-CoV-2 cases, PPI use was associated with a 13-percent higher risk of hospital admission (adjusted relative risk, 1.13, 1.03–1.24); there was no association found for other severe outcomes.

The researchers also performed an updated meta-analysis on the risks of SARS-CoV-2 infection and COVID-19 mortality attributable to PPI use. They pooled data from eight studies involving 730,941 individuals. The findings revealed no association between PPI use and risk of infection (OR, 1.00, 95 percent CI, 0.75–1.32) or mortality (relative risk, 1.33, 95 percent CI, 0.71–2.48).

The present data support that PPI use is generally safe in terms of risk of SARS-CoV-2 infection and severe COVID-19 outcomes, and the previous conflicting reports are more likely due to differences in study design and population.