Comparative risk of incidence and clinical outcomes of COVID-19 among proton pump inhibitor and histamine-2 receptor antagonist short-term users: a nationwide retrospective cohort study
Jimyung Park, Seng Chan You, Jaehyeong Cho, Chan Hyuk Park, Woon Geon Shin, Rae Woong Park, Seung In Seo
BMC Pharmacology and Toxicology, doi:10.1186/s40360-022-00549-7
Background: This study aimed to evaluate incidence risk and adverse clinical outcomes in COVID-19 disease among short-term users of acid-suppressants in South Korea. Methods: This retrospective cohort study, conducted using a nationwide claims database for South Korea, used data from patients with COVID-19 tested between January 1 and May 15, 2020. Patients aged over 18 years and prescribed proton pump inhibitors (PPI) or histamine-2 receptor antagonist (H 2 RA) for more than 7 days were identified. Primary outcome was COVID-19 while secondary outcomes were all-cause mortality, hospitalization with respiratory disease, or intensive respiratory intervention. Large-scale propensity scores were used to match patients, while the Cox proportional hazard model was utilized to evaluate any association between exposure and outcome(s). The risk estimates were calibrated by using 123 negative control outcomes. Results: We identified 26,166 PPI users and 62,117 H 2 RA users. After propensity score matching, compared to H 2 RA use, PPI use was not significantly associated with lower risk of COVID-19 (calibrated hazard ratio [HR], 0.81 [95% confidence interval (CI), 0.30-2.19]); moreover, PPI use was not associated with adverse clinical outcomes in COVID-19, namely, hospitalization with respiratory disease (calibrated HR, 0.88 [95% CI, 0.72-1.08]), intensive respiratory interventions (calibrated HR, 0.92 [95% CI,), except for all-cause mortality (calibrated HR, 0.54 [95% CI, 0.31-0.95]).
Supplementary Information The online version contains supplementary material available at https://doi. org/10.1186/s40360-022-00549-7.
Additional file 1. Authors' contributions JP, SCY, JC, RWP, SIS, CHP, WGS contributed study concept and design. JP contributed statistical analysis of the study. JP, SCY, JC, SIS, and RWP contributed analysis and interpretation of data, drafting of the manuscript. RWP, SIS, WGS contributed obtaining funding. RWP and SIS contributed supervision of the study. JP and SCY contributed equally to this work. RWP and SIS contributed equally to this work. All author(s) read and approved the final manuscript.
Declarations Ethics and approval and consent to participate The Institutional review board of the Kangdong Sacred Heart Hospital has approved study and informed consent waiver. All methods were carried out in accordance with relevant guidelines and regulations.
Consent for publication Not applicable.
Competing interests The authors declare that they have no competing interests.
Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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