All Studies Meta Analysis

Do proton pump inhibitors influence SARS-CoV-2 related outcomes? A meta-analysis

Li et al., Gut, doi:10.1136/gutjnl-2020-323366

Nov 2020

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PPIs for COVID-19

1st treatment shown to increase risk in September 2020, now with p = 0.00000012 from 39 studies.

5,100+ studies for 109 treatments. c19early.org

Meta analysis of 16 studies from 10 countries with a total of 318,261 participants, showing current proton pump inhibitor (PPI) use was associated with higher risk of severe COVID-19 outcomes, but not with increased susceptibility to SARS-CoV-2 infection.

8 meta analyses show significant harm with PPIs for mortality1-3, severity1,2,4-8, and cases2.

Currently there are 39 PPIs for COVID-19 studies, showing 40% higher mortality [17‑67%], 14% higher ventilation [-1‑32%], 15% higher ICU admission [1‑30%], 9% higher hospitalization [3‑16%], and 2% fewer cases [-6‑10%].

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risk of severe case, 67.0% higher, OR 1.67, p = 0.003, RR approximated with OR.

Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates

1. Hariyanto et al., Proton pump inhibitor use is associated with increased risk of severity and mortality from coronavirus disease 2019 (COVID-19) infection, Digestive and Liver Disease, doi:10.1016/j.dld.2020.10.001.sciencedirect.com, doi.org.

2. Fatima et al., The Use of Proton Pump Inhibitors and COVID-19: A Systematic Review and Meta-Analysis, Tropical Medicine and Infectious Disease, doi:10.3390/tropicalmed7030037.mdpi.com, doi.org.

3. Toubasi et al., Proton Pump Inhibitors: Current Use and the Risk of Coronavirus Infectious Disease 2019 Development and its Related Mortality. Meta-analysis, Archives of Medical Research, doi:10.1016/j.arcmed.2021.03.004.sciencedirect.com, doi.org.

4. Wardhana et al., Different Outcome in COVID-19 Patients with or without PPI Use: A Systematic Review and Meta-analysis, International Journal of Biomedical Science and Travel Medicine, doi:10.22225/ijbstm.1.1.2024.19-23.ac.id, doi.org.

5. Yan et al., Does Proton Pump Inhibitor Use Lead to a Higher Risk of Coronavirus Disease 2019 Infection and Progression to Severe Disease? a Meta-analysis, Japanese Journal of Infectious Diseases, doi:10.7883/yoken.JJID.2021.074.go.jp, doi.org.

6. Li et al., Do proton pump inhibitors influence SARS-CoV-2 related outcomes? A meta-analysis, Gut, doi:10.1136/gutjnl-2020-323366.bmj.com, doi.org.

7. Pranata et al., Proton pump inhibitor on susceptibility to COVID-19 and its severity: a systematic review and meta-analysis, Pharmacological Reports, doi:10.1007/s43440-021-00263-x.springer.com, doi.org.

8. Kow et al., Use of proton pump inhibitors and risk of adverse clinical outcomes from COVID‐19: a meta‐analysis, Journal of Internal Medicine, doi:10.1111/joim.13183.wiley.com, doi.org.

Li et al., 10 Nov 2020, India, peer-reviewed, 9 authors. Contact: ansaraya@yahoo.com.

This Paper PPIs All

Abstract: PostScript Soumya Jagannath,1 Ashish Agarwal,1 Deepak Gunjan ‍ ‍,1 Samir Mohindra,2 Vishal Sharma,3 Sudipta Dhar Chowdhury,4 Sanjeev Sachdeva,5 Vivek A Saraswat,6 Rakesh Kochhar,3 Anoop Saraya ‍ ‍,1 GAIN Group 1 Figure 1 Distribution of type of endoscopy procedures done in April–May 2020 and risk of infection to patients and healthcare workers. EGD, esophagoduodenoscopy; ERCP, endoscopic retrograde cholangiopancreatography; EUS,endoscopic ultrasound; HCW, healthcare worker. Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, Delhi, India 2 Gastroenterology, SGPGIMS, Lucknow, Uttar Pradesh, India 3 Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India 4 Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India 5 Govind Ballabh Pant Hospital, New Delhi, Delhi, India 6 Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India Correspondence to Professor Anoop Saraya, Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi 110029, India; ansaraya@yahoo.com Six (0.4%, 95% CI; 0.14%- 0.86% with continuity correction) patients turned out to be COVID-19 posi- Collaborators Members of GAIN Group (in tive within 48–72 hours of the endo- alphabetical order)- All India Institute of Medical scopic procedure. Of 74 HCWs, 3 (4%, Sciences, New Delhi, India: Ashish Agarwal, Samagra Agarwal, Vineet Ahuja, Abhinav Anand, Rajat Bansal, 95% CI; 0.8% -t 11.4% with conti- Vikas Banyal, Kaushik Chatterjee, Anugrah Dhooria, nuity correction) developed COVID-19 Anshuman Elhence, Pramod Garg, Srikanth Gopi, infection. The risk of a HCWs getting Deepak Gunjan, Yegurla Jatin, Vikas Jindal, Bhaskar COVID-19 positive after using adequate Kante, Kanav Kaushal, Saurabh Kedia, Soumya Jagannath Mahapatra, Govind Makharia, Srikant PPE was 0.26% per 100 endoscopies Mohta, Sandeep Kumar Mundhra, Piyush Pathak, (figure 1). None of the patients devel- Shubham Prasad, Mahendra Singh Rajput, Atul Rana, oped COVID-19 after 72 hours up to Anoop Saraya, Pabitra Sahu, Rahul Sethia, Shalimar, 2 weeks of endoscopy. This risk of trans- Sanchit Sharma, Amit Anurag Singh, Manas Vaishnav, mission should be viewed in the context Sudheer Kumar Vuyurru. Post Graduate Institute of Medical Educations and Research, Chandigarh, India: of the high transmission phase (4.5%– Usha Dutta, Rakesh Kochhar, Harshal S Mandavdhare, 5.1% swab positivity rate in the commu- Gaurav Muktesh, Praveer Rai, Jayanta Samanta, Vishal Sharma, Jayendra Shukla. Christian Medical College, nity)5 6 in India during that period The zero risk of cross- infection in Vellore, India: Kaushik Chatterjee, Sudipta Dhar Chowdhury, Amit Kumar Dutta, John Titus George, the UK study could be due to multiple Rajeeb Jaleel, Anjilivelil Joseph, Ebby George Simon. reasons: (1) deceleration phase of infec- Sanjay Gandhi Post Graduate Institute, Lucknow, India: tion, (2) 42% of patients were tested Ptaviva Chandra, Samir Mohindra, Vivek Saraswat, Jimil based on SCOTS criteria (telephone Shah. Gobind Ballabh Pant Hospital, New Delhi, India: screen questions around Symptoms, Roshan George, Arpan Jain, Anurag Mishra, Sanjeev Sachdeva, Alok Kumar Singh. infectious Contacts, Occupational risk, Travel risk and Shielding status) and only Contributors SJ, AA, DG, SDC, VS, SS, RK and AS: study design, critical inputs, collection of data..

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