PPI use not linked to severe COVID-19 among US veterans
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Proton pump inhibitors are not correlated with severe COVID-19 among U.S. veterans, according to results published in Gut.
“There have been a few studies to date evaluating the association between PPIs and severe outcomes of COVID-19,” Shailja Shah, MD, MPH, from the department of gastroenterology at Veterans Affairs San Diego Healthcare System in La Jolla, California, told Healio Gastroenterology. “Apart from the robust propensity score weighted analysis that allowed preservation of the full sample size, unique strengths of this nationwide cohort study, which demonstrated a null association between PPI use and severe COVID-19 outcomes, include accounting for protopathic bias, meticulous exposure calculation, standardized outcome definitions, and comorbidity ascertainment. This study spanned over one year of the pandemic time frame, and we also accounted for variation in COVID-19 prevalence and geography.”
Shah and colleagues performed a retrospective cohort of 97,674 U.S. veterans, of whom 14,958 tested positive for SARS-CoV-2. Current outpatient PPI use up to and including the index date served as the primary exposure and was compared with nonuse. There were 6,262 PPI users and 8,696 nonusers. Mechanical ventilation use or death within 60 days served as the primary composite outcome. Other composite outcomes included hospital or ICU admission. Severe COVID-19 outcomes between current PPI uses compared with nonusers were assessed with weighted logistic regression models.
According to results from the unweighted cohort, current PPIs users compared with nonusers were older, more often current or former smokers and had more comorbidities. All covariates were balanced after weighting, Shah and colleagues wrote.
Higher odds of primary (9.3% vs. 7.5%; OR = 1.27; 95% CI, 1.13-1.43) and secondary (25.8% vs. 21.4%; OR = 1.27; 95% CI, 1.18-1.37) composite outcomes among PPI users compared with nonusers were noted in the unweighted cohort. Investigators noted PPI use compared with nonuse did not correlate with the primary (8.2% vs. 8%; OR = 1.03; 95% CI, 0.91-1.16) or secondary (23.4% vs. 22.9%; OR = 1.03; 95% CI, 0.95-1.12) composite outcomes after propensity score weighting. No significant interactions were observed between age and PPI use on the composite or individual outcomes.
“In the unweighted analysis, we were able to replicate the significant associations demonstrated in prior studies, suggesting that incomplete covariate adjustment might account for earlier reports that PPIs are associated with more severe COVID-19 outcomes,” Shah said. “These findings should provide reassurance to both patients and providers regarding the safety of PPIs with respect to COVID-19.”
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