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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
ProphylaxisPSM retrospective · UK · Mar – Jun 2020
Proton Pump Inhibitors for COVID-19
Fan et al. Gastroenterology · January 2021
More cases with proton pump inhibitors
Not statistically significant · p = 0.15
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.
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OutcomeImprovementEffect · pTreatmentControl
risk of death 17.1% higher · RR 1.17 · p = 0.69 17.1% higherRR 1.17p = 0.69 , all upper gastrointestinal disease patientspropensity score matching
risk of death 4.0% lower · HR 0.96 · p = 0.88 4.0% lowerHR 0.96p = 0.88 , positive upper gastrointestinal disease patients onlypropensity score matching
risk of death 13.6% lower · HR 0.86 · p = 0.59 13.6% lowerHR 0.86p = 0.59 , all patientspropensity score matching
risk of death 20.0% lower · HR 0.80 · p = 0.18 20.0% lowerHR 0.80p = 0.18 , all positive patientspropensity score matching
risk of case 22.0% higher · OR 1.22 · p = 0.15 22.0% higherOR 1.22p = 0.15 , upper gastrointestinal disease patientsRR approximated with ORpropensity score matching
risk of case 8.0% higher · OR 1.08 · p = 0.44 8.0% higherOR 1.08p = 0.44 , all patientsRR approximated with ORpropensity score matching

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 2026 United Kingdom Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines USA Brazil France Italy Canada Pakistan Spain Vietnam Japan Nepal Iran Bangladesh Ethiopia Ghana Mexico South Korea Saudi Arabia Algeria Morocco Yemen Poland Uzbekistan India China Venezuela DR Congo Madagascar Thailand Uganda Egypt Nigeria Taiwan Fiji Zambia Bosnia-Herzegovina Dominican Republic Bolivia Côte d'Ivoire Eritrea Togo Iceland New Zealand Mongolia Czechia Belarus Israel Haiti North Macedonia Hong Kong Qatar Panama Serbia The United Kingdom favored high-profit treatments.The average efficacy of treatments was moderate.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 2026 United Kingdom Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines USA Brazil France Italy Canada Pakistan Spain Vietnam Japan Iran Bangladesh Ethiopia Ghana Mexico South Korea Saudi Arabia Algeria Morocco Yemen Poland Uzbekistan India China Venezuela DR Congo Madagascar Thailand Uganda Egypt Taiwan Fiji Zambia Dominican Rep. Bolivia Côte d'Ivoire Eritrea Mongolia Czechia Belarus Israel North Macedonia Hong Kong Qatar Panama Serbia The UK favored high-profit treatments.The average efficacy was moderate.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
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Lee, None, doi:10.1136/gutjnl-2020-322248
Luxenburger, None, J Intern Med, doi:10.1111/joim.13121
Sudlow, None, PLoS Med
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