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No link between gastric acid-suppressing medications, pneumonia in NSAID users
Patients taking nonsteroidal anti-inflammatory drugs who also used proton pump inhibitors or histamine-2 receptor antagonists were no more likely to be hospitalized for community-acquired pneumonia than nonusers in a recent study.
Researchers performed retrospective cohort studies of eight cohorts of new nonsteroidal anti-inflammatory drug (NSAID) users aged 40 years or older, collected from eight databases throughout the US, UK and Canada (n=4,238,504) as part of the Canadian Network for Observational Drug Effect Studies (CNODES). All patients were prescribed oral NSAIDs between January 1997 and March 2010, with a duration of 28 days or longer. Incidence of hospitalization for community-acquired pneumonia (HCAP) was compared between users and nonusers of proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs).
PPIs were initiated in 2.3% of the entire cohort (n=96,870), while H2RA analysis included 47,344 exposed and 4,342,733 nonexposed participants. At 6 months of treatment the cumulative incidence of HCAP was 0.17% among PPI users and 0.12% among nonusers. No association was observed between HCAP and PPI use (adjusted OR=1.05; 95% CI, 0.89-1.25) or H2RA use (0.16% among users vs. 0.12% among nonusers; aOR=0.95; 95% CI, 0.75-1.21) after adjustment for confounders.
Site-specific ORs for HCAP and PPI us ranged from 0.93 to 1.21, with the exception of data from Nova Scotia (aOR=3.73; 95% CI, 1.12-12.4). Exclusion of the Nova Scotia data yielded similar results to pooled analysis (aOR=1.03; 95% CI, 0.87-1.22). Sensitivity analyses and random-effects meta-analyses also yielded similar results to the primary analyses.
“Proton pump inhibitors do not appear to increase the risk of HCAP,” researcher Kristian Filion, PhD, assistant professor of medicine in the clinical epidemiology division at Jewish General Hospital/McGill University in Montreal, told Healio.com. “Clinicians can now reassure their patients that use of PPIs will not increase their pneumonia risk. Patients may have worried about this potential side effect and decreased or stopped taking their PPIs because of these concerns. Our study provides evidence that this is not necessary.”
Disclosure: See the full study for a complete list of relevant financial disclosures.