Proton pump inhibitors fail to lower mortality, hospitalization in patients with IPF

Use of proton pump inhibitors in patients with idiopathic pulmonary fibrosis was not associated with lower mortality or hospitalization incidence, according to results of a large, real-world study.

“Because PPIs are the most commonly prescribed anti-acid treatment, the aim of this study was to assess the association between use of PPIs and all-cause mortality, respiratory-related mortality and respiratory-related hospitalizations in patients with IPF using a large population-based cohort design that avoided some of the methodological limitations in previous studies,” Tanja Tran, MSc, PhD candidate from the department of epidemiology, biostatistics and occupational health at McGill University and the Centre for Clinical Epidemiology in Montreal, and colleagues wrote in Chest.

The population-based cohort study included patients with IPF identified from the U.K. Clinical Practice Research Datalink from 2003 to December 2020. In total, 1,852 (mean age, 75.4 years; 62.1% men) patients who were using PPIs were matched with 1,852 (mean age, 75.6 years; 65.3% men) nonusers of PPIs. Patients were followed up until death or the end of the study.

The primary outcome was all-cause mortality. Secondary outcomes included respiratory-related mortality and respiratory-related hospitalizations.

Median survival was 2.8 years and the mortality rate was 26.7 per 100 per year. Seventy percent of patients died within 5 years of their IPF diagnosis.

History of PPI use before IPF diagnosis was reported in 62% of PPI users compared with 45% of matched nonusers.

Overall, there were 1,221 deaths (67% related to respiratory causes) among those using PPIs and 482 deaths (63% related to respiratory causes) among nonusers.

Compared with nonusers, the adjusted HR for all-cause mortality was 1.07 (95% CI, 0.94-1.22) among those using PPIs. The adjusted HRs for respiratory-related mortality and respiratory-related hospitalizations were 1.1 (95% CI, 0.94-1.28) and 1 (95% CI, 0.86-1.16), respectively, for those using PPIs compared with nonusers.

“Although a robust randomized controlled trial is still needed, this study suggests that PPIs may not be as beneficial in treating IPF as suggested by some studies and conditionally recommended in treatment guidelines,” the researchers wrote.