Severe clinical outcomes of COVID-19 associated with proton pump inhibitors: a nationwide cohort study with propensity score matching, 2020, Lee et al

Andy

Andy

Retired committee member
Objective The 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.

Design Data 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).

Results In 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.

Conclusion Patients 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.
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Open access, https://gut.bmj.com/content/early/2020/07/30/gutjnl-2020-322248
 
I recall an early article about Chinese covid patients taking older H2 blockers for reducing stomach acid were experiencing better outcomes than other covid patients. Apparently these patients were mostly from poorer, more rural areas and thus couldn't afford more modern PPIs.

An alert doctor noticed this and was experimenting with H2 blockers as a covid treatment. There was even some panic-buying of brands like pepcid.

Unfortunately I can't locate the article and it seems that this potential treatment seems to have fallen by the wayside.
 
Sean said:
Relevant to me, as a long term user of PPIs. Yet another reason to avoid getting COVID-19 in the first place.
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Yes that is troubling to me too, thats a massive increase in risk. But i am not a scientist can someone, perhaps @Jonathan Edwards peruse the actual study to check if the conclusions are warranted from the actual data.

I reduced my dose of PPI recently because of the increased risk of osteoporosis with long term use. But i cant reduce any more i am now on the brink of 'manageable' gastric discomfort, ie it's present but doesnt keep me awake or trouble me significantly. Without them it's very painful 24/7. PPIs are a bit of a menace but also a miracle for acid reflux etc.

Do i understand this study to be saying that their use does not make one more susceptible to catching it, but is associated with worse outcomes once infected?

So does that mean that stopping/reducing them is a good idea as soon as symptoms are experienced in order to reduce risk. Their effects wear off very quickly for me - ie if i miss a dose by mistake i know about it with increased pain within 12-18hrs so their effects seem short lived? Although it says use in the previous 30 days associated with 90% increased risk, but current use only with 79% increased risk?? :confused: I'm very foggy can someone explain please
 
This really worries me as I’m due to go into hospital soon and I’m taking double dose PPIs (twice a day). I was thinking of reducing it to once a day anyway (I’m not actually monitored for these properly by any doctor, I was just told about 7 years ago that I can take them when I need them.. which is what I’ve done, on and off..and then a GP made them twice a day when gallbladder issues started.. so I can go back to my GP about it now) but not sure whether to come off them and switch to a H2 blocker like Famotidine or Ranitidine (if that’s available now or is it still banned)!

does anyone know if ranitidine is prescribed again now? In the U.K.?
 
lunarainbows said:
does anyone know if ranitidine is prescribed again now? In the U.K.?
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I don't know about ranitidine, but you can buy a limited supply of famotidine over the counter. It's one of those meds that's probably best prescribed by a doctor where possible, to make sure that you're being monitored properly, but I know from a friend with a history of gastric problems that you can buy it if necessary. I got her some from a local pharmacy last year when she was stuck at home with a broken ankle.
 
JemPD said:
I reduced my dose of PPI recently because of the increased risk of osteoporosis with long term use. But i cant reduce any more i am now on the brink of 'manageable' gastric discomfort, ie it's present but doesnt keep me awake or trouble me significantly. Without them it's very painful 24/7. PPIs are a bit of a menace but also a miracle for acid reflux etc.
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Same story here.

Only take enough to just control it (10mg Losec daily). Plus keep a bottle of Gaviscon handy for the occasional small top-up (maybe once every day or two).

Totally worth it. Persistent serious acid reflux is very not fun. :dead::dead::dead:
 
Just an update, Ranitidine is not currently available over the counter in the U.K., as far as I can see, and is still withdrawn.

I asked my GP to switch me over to Famotidine. They agreed and prescribed it however, none of the pharmacies or online pharmacies have it in stock. There’s a “supply problem”.. maybe lots of people buying it up.

From what I understand Cimetidine, also in the same family, carries a lot more side effects (according to some websites, but not others).

Nizatidine was also withdrawn along with Ranitidne I think.

so that just leaves..PPIs again!
 
This might explain why.. famotidine is being bought up by people as it is being looked at as a possible treatment for Covid! It looks like this was known about in April, and it’s August now; and there’s still a supply problem which I presume is most likely related to that.

https://www.bhf.org.uk/informations...-coronavirus-treatments-are-around-the-corner
Famotidine – used to treat heartburn and stomach ulcers
Famotidine is a heartburn medication which is available over the counter in many parts of the world. The first signs that it could help to treat coronavirus came from preliminary studies in China and a single hospital in New Yorksuggesting that people in hospital with Covid-19 were less likely to die if they took famotidine.

Famotidine helps to reduce stomach acid production by blocking histamine receptors in the stomach. Researchers believe it can also block an enzyme needed for the replication of Covid-19 coronavirus. (They did this by using computers to study the proteins that the genes in the Covid-19 produce, compared them with other types of coronaviruses, predicted their structures and then cross-reference these against “libraries” of existing drugs to see which ones are likely to work on the genes in the Covid-19 coronavirus.)
 
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