Effect of Acid Suppressants on the Risk of COVID-19: A Propensity Score-Matched Study Using UK Biobank

Fan et al., Gastroenterology, doi:10.1053/j.gastro.2020.09.028, Jan 2021
Mortality, all UGI -17% improvement lower risk ← → higher risk Mortality, positive UGI 4% Mortality, all 14% Mortality, all positive 20% Case, UGI -22% Case, all -8% Proton Pump Inhibitors  Fan et al.  PROPHYLAXIS Is prophylaxis with proton pump inhibitors beneficial for COVID-19? PSM retrospective study in the United Kingdom (Mar - Jun 2020) More cases with proton pump inhibitors (not stat. sig., p=0.15) c19early.org Fan et al., Gastroenterology, January 2021 0 0.5 1 1.5 2+ RR
PPIs for COVID-19
1st treatment shown to increase risk in September 2020, now with p = 0.000000048 from 40 studies.
6,200+ studies for 200+ treatments. c19early.org
Download Meta Analysis
PSM retrospective 9,469 UK Biobank participants tested for COVID-19, showing no significant association between proton pump inhibitor (PPI) or histamine-2 receptor antagonist (H2RA) use and risk of SARS-CoV-2 infection or COVID-19 mortality. Omeprazole was associated with higher risk of cases in patients with upper gastrointestinal diseases. The results for patients with upper gastrointestinal diseases should be more accurate due to reduced confounding and more accurate ascertainment of current use.
Standard of Care (SOC) for COVID-19 in the study country, the United Kingdom, is very poor with very low average efficacy for approved treatments1. The United Kingdom focused on expensive high-profit treatments, approving only one low-cost early treatment, which required a prescription and had limited adoption. The high-cost prescription treatment strategy reduces the probability of early treatment due to access and cost barriers, and eliminates complementary and synergistic benefits seen with many low-cost treatments.
Important missing comments or errors? Let us know.
risk of death, 17.1% higher, RR 1.17, p = 0.69, all upper gastrointestinal disease patients, propensity score matching.
risk of death, 4.0% lower, HR 0.96, p = 0.88, positive upper gastrointestinal disease patients only, propensity score matching.
risk of death, 13.6% lower, HR 0.86, p = 0.59, all patients, propensity score matching.
risk of death, 20.0% lower, HR 0.80, p = 0.18, all positive patients, propensity score matching.
risk of case, 22.0% higher, OR 1.22, p = 0.15, upper gastrointestinal disease patients, propensity score matching, RR approximated with OR.
risk of case, 8.0% higher, OR 1.08, p = 0.44, all patients, propensity score matching, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Fan et al., 31 Jan 2021, retrospective, United Kingdom, peer-reviewed, 8 authors, study period 16 March, 2020 - 29 June, 2020.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2025 United Kingdom Russia Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Zambia Fiji Bosnia-Herzegovina Ukraine Côte d'Ivoire Bulgaria Greece Slovakia Singapore Iceland New Zealand Czechia Mongolia Israel Trinidad and Tobago Hong Kong North Macedonia Belarus Qatar Panama Serbia CAR The United Kingdom favored high-profit treatments.The average efficacy of treatments was very low.High-cost protocols reduce early treatment, andforgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org November 2025 United Kingdom Russia Sudan Angola Colombia Kenya Mozambique Vietnam Peru Philippines Spain Brazil Italy France Japan Canada China Uzbekistan Nepal Ethiopia Iran Ghana Mexico South Korea Germany Bangladesh Saudi Arabia Algeria Morocco Yemen Poland India DR Congo Madagascar Thailand Uganda Venezuela Nigeria Egypt Bolivia Zambia Fiji Ukraine Côte d'Ivoire Eritrea Bulgaria Greece Slovakia Singapore New Zealand Malawi Czechia Mongolia Israel Trinidad and Tobago North Macedonia Belarus Qatar Panama Serbia Syria The UK favored high-profit treatments.The average efficacy was very low.High-cost protocols reduce early treatment,and forgo complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Effect of Acid Suppressants on the Risk of COVID-19: A Propensity Score-Matched Study Using UK Biobank
Xiude Fan, Zhengwen Liu, Tatsunori Miyata, Srinivasan Dasarathy, Daniel M Rotroff, Xiaoqin Wu, Kyle L Poulsen, PhD Laura E Nagy
Gastroenterology, doi:10.1053/j.gastro.2020.09.028
C oronavirus disease 2019 (COVID-19) is a highly contagious and life-threatening infection caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). 1 Identifying modifiable risk factors for COVID-19 would be of substantial public health benefit. To date, several studies exploring the association between use of acid suppressants and COVID-19 have produced conflicting results, 2-6 which makes it difficult to determine whether there is indeed an increased risk of SARS-CoV-2 infection and death for users of acid suppressants. Thus, we aimed to clarify the potential impact of acidsuppressant treatment on the risk of SARS-CoV-2 infection and death in patients with COVID-19.
Supplementary Material Note: To access the supplementary material accompanying this article, visit the online version of Gastroenterology at www.gastrojournal.org, and at https://doi.org/10. 1053
References
Almario, None, Am J Gastroenterol, doi:10.14309/ajg.0000000000000798
Benjamini, None, J R Stat Soc Series B Stat Methodol
Bergmann, None, Cleve Clin J Med
Blanc, None, doi:10.20944/preprints202005.0016.v1
Freedberg, None, Gastroenterology, doi:10.1053/j.gastro.2020.05.053
Lee, None, doi:10.1136/gutjnl-2020-322248
Luxenburger, None, J Intern Med, doi:10.1111/joim.13121
Sudlow, None, PLoS Med
DOI record: { "DOI": "10.1053/j.gastro.2020.09.028", "ISSN": [ "0016-5085" ], "URL": "http://dx.doi.org/10.1053/j.gastro.2020.09.028", "alternative-id": [ "S0016508520352094" ], "assertion": [ { "label": "This article is maintained by", "name": "publisher", "value": "Elsevier" }, { "label": "Article Title", "name": "articletitle", "value": "Effect of Acid Suppressants on the Risk of COVID-19: A Propensity Score-Matched Study Using UK Biobank" }, { "label": "Journal Title", "name": "journaltitle", "value": "Gastroenterology" }, { "label": "CrossRef DOI link to publisher maintained version", "name": "articlelink", "value": "https://doi.org/10.1053/j.gastro.2020.09.028" }, { "label": "Content Type", "name": "content_type", "value": "article" }, { "label": "Copyright", "name": "copyright", "value": "© 2021 by the AGA Institute" } ], "author": [ { "affiliation": [], "family": "Fan", "given": "Xiude", "sequence": "first" }, { "affiliation": [], "family": "Liu", "given": "Zhengwen", "sequence": "additional" }, { "affiliation": [], "family": "Miyata", "given": "Tatsunori", "sequence": "additional" }, { "affiliation": [], "family": "Dasarathy", "given": "Srinivasan", "sequence": "additional" }, { "affiliation": [], "family": "Rotroff", "given": "Daniel M.", "sequence": "additional" }, { "affiliation": [], "family": "Wu", "given": "Xiaoqin", "sequence": "additional" }, { "affiliation": [], "family": "Poulsen", "given": "Kyle L.", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-0580-2809", "affiliation": [], "authenticated-orcid": false, "family": "Nagy", "given": "Laura E.", "sequence": "additional" } ], "container-title": "Gastroenterology", "container-title-short": "Gastroenterology", "content-domain": { "crossmark-restriction": true, "domain": [ "clinicalkey.fr", "clinicalkey.jp", "gastrojournal.org", "clinicalkey.com.au", "clinicalkey.es", "clinicalkey.com", "elsevier.com", "sciencedirect.com" ] }, "created": { "date-parts": [ [ 2020, 9, 24 ] ], "date-time": "2020-09-24T16:27:25Z", "timestamp": 1600964845000 }, "deposited": { "date-parts": [ [ 2024, 3, 7 ] ], "date-time": "2024-03-07T03:43:52Z", "timestamp": 1709783032000 }, "funder": [ { "DOI": "10.13039/100000002", "doi-asserted-by": "publisher", "name": "National Institutes of Health" }, { "DOI": "10.13039/501100004543", "doi-asserted-by": "publisher", "name": "China Scholarship Council" }, { "DOI": "10.13039/501100001691", "doi-asserted-by": "publisher", "name": "Japan Society for the Promotion of Science" } ], "indexed": { "date-parts": [ [ 2024, 7, 18 ] ], "date-time": "2024-07-18T09:54:37Z", "timestamp": 1721296477624 }, "is-referenced-by-count": 35, "issue": "1", "issued": { "date-parts": [ [ 2021, 1 ] ] }, "journal-issue": { "issue": "1", "published-print": { "date-parts": [ [ 2021, 1 ] ] } }, "language": "en", "license": [ { "URL": "https://www.elsevier.com/tdm/userlicense/1.0/", "content-version": "tdm", "delay-in-days": 0, "start": { "date-parts": [ [ 2021, 1, 1 ] ], "date-time": "2021-01-01T00:00:00Z", "timestamp": 1609459200000 } } ], "link": [ { "URL": "https://api.elsevier.com/content/article/PII:S0016508520352094?httpAccept=text/xml", "content-type": "text/xml", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://api.elsevier.com/content/article/PII:S0016508520352094?httpAccept=text/plain", "content-type": "text/plain", "content-version": "vor", "intended-application": "text-mining" } ], "member": "78", "original-title": [], "page": "455-458.e5", "prefix": "10.1053", "published": { "date-parts": [ [ 2021, 1 ] ] }, "published-print": { "date-parts": [ [ 2021, 1 ] ] }, "publisher": "Elsevier BV", "reference": [ { "DOI": "10.3949/ccjm.87a.20047", "author": "Bergmann", "doi-asserted-by": "crossref", "first-page": "321", "journal-title": "Cleve Clin J Med", "key": "10.1053/j.gastro.2020.09.028_bib1", "volume": "87", "year": "2020" }, { "DOI": "10.14309/ajg.0000000000000798", "author": "Almario", "doi-asserted-by": "crossref", "first-page": "1707", "journal-title": "Am J Gastroenterol", "key": "10.1053/j.gastro.2020.09.028_bib2", "volume": "115", "year": "2020" }, { "author": "Lee", "journal-title": "Gut", "key": "10.1053/j.gastro.2020.09.028_bib3", "year": "2020" }, { "author": "Luxenburger", "journal-title": "J Intern Med", "key": "10.1053/j.gastro.2020.09.028_bib4", "year": "2020" }, { "DOI": "10.1053/j.gastro.2020.05.053", "author": "Freedberg", "doi-asserted-by": "crossref", "first-page": "1129", "journal-title": "Gastroenterology", "key": "10.1053/j.gastro.2020.09.028_bib5", "volume": "159", "year": "2020" }, { "author": "Blanc", "journal-title": "Preprint", "key": "10.1053/j.gastro.2020.09.028_bib6", "year": "2020" }, { "DOI": "10.1371/journal.pmed.1001779", "author": "Sudlow", "doi-asserted-by": "crossref", "journal-title": "PLoS Med", "key": "10.1053/j.gastro.2020.09.028_bib7", "volume": "12", "year": "2015" }, { "author": "Benjamini", "first-page": "289", "journal-title": "J R Stat Soc Series B Stat Methodol", "key": "10.1053/j.gastro.2020.09.028_bib8", "volume": "57", "year": "1995" } ], "reference-count": 8, "references-count": 8, "relation": {}, "resource": { "primary": { "URL": "https://linkinghub.elsevier.com/retrieve/pii/S0016508520352094" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [], "subtitle": [], "title": "Effect of Acid Suppressants on the Risk of COVID-19: A Propensity Score-Matched Study Using UK Biobank", "type": "journal-article", "update-policy": "http://dx.doi.org/10.1016/elsevier_cm_policy", "volume": "160" }
Please send us corrections, updates, or comments. c19early involves the extraction of 200,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.
  or use drag and drop   
Submit    
Post
Share
@CovidAnalysis
FAQ
Public domain CC0 1.0