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All Studies   Meta Analysis       

Proton-pump inhibitor use is not associated with severe COVID-19-related outcomes: a propensity score-weighted analysis of a national veteran cohort

Oct 2021  
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Mortality 3% Improvement Relative Risk Ventilation -21% ICU admission -13% Hospitalization -5% PPIs for COVID-19  Shah et al.  Prophylaxis Is prophylaxis with PPIs beneficial for COVID-19? Retrospective 14,958 patients in the USA (January - May 2020) Higher ventilation with PPIs (not stat. sig., p=0.063) c19early.org Shah et al., Gut, October 2021 FavorsPPI Favorscontrol 0 0.5 1 1.5 2+
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
Retrospective 14,958 US veterans who tested positive for SARS-CoV-2, showing no significant difference in severe COVID-19 outcomes (mechanical ventilation, death, ICU admission, or hospitalization) with proton pump inhibitor (PPI) use compared to non-use in a propensity score weighted analysis.
risk of death, 3.0% lower, OR 0.97, p = 0.66, treatment 6,262, control 8,696, propensity score weighting, RR approximated with OR.
risk of mechanical ventilation, 21.0% higher, OR 1.21, p = 0.06, treatment 6,262, control 8,696, propensity score weighting, RR approximated with OR.
risk of ICU admission, 13.0% higher, OR 1.13, p = 0.06, treatment 6,262, control 8,696, propensity score weighting, RR approximated with OR.
risk of hospitalization, 5.0% higher, OR 1.05, p = 0.26, treatment 6,262, control 8,696, propensity score weighting, RR approximated with OR.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Shah et al., 18 Oct 2021, retrospective, USA, peer-reviewed, 16 authors, study period January 2020 - May 2020. Contact: s6shah@health.ucsd.edu.
This PaperPPIsAll
Abstract: U.S. Department of Veterans Affairs Public Access Author manuscript Gut. Author manuscript; available in PMC 2023 July 01. Published in final edited form as: Gut. 2022 July ; 71(7): 1447–1450. doi:10.1136/gutjnl-2021-325701. VA Author Manuscript Proton pump inhibitor use is not associated with severe COVID-19 related outcomes: A propensity score weighted analysis of a national veteran cohort Shailja C. Shah, MD, MPH*,1,2, Alese E. Halvorson, MS3, Brandon McBay, BA4, Chad Dorn, MS5, Otis Wilson, BA6,7, Jason Denton, BS5, Sony Tuteja, PharmD, MS6,7, Kyong-Mi Chang, MD6,7, Kelly Cho, PhD, MPH8, Richard L. Hauger, MD9,10, Ayako Suzuki, MD, PhD, MSc11,12, Christine M. Hunt, MD, MPH11,12, Edward Siew, MD, MSCI13,14, Michael E. Matheny, MD, MS, MPH5,13,14, Adriana Hung, MD, MPH13,15, Robert A. Greevy Jr., PhD3,15, Christianne L. Roumie, MD, MPH15,16,17 1Gastroenterology Section, VA San Diego Healthcare System, San Diego, CA VA Author Manuscript 2Division of Gastroenterology, University of California, San Diego, San Diego, CA 3Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN 4Department of Public Health, Harvard T.H. Chan School of Public Health, Boston, MA 5Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 6The Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 7University of Pennsylvania Perelman School of Medicine, Philadelphia PA 8VA Boston Healthcare System & Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 9Department of Psychiatry, University of California San Diego, La Jolla, CA 10Center of Excellence for Stress & Mental Health, VA San Diego Healthcare System, San Diego, VA Author Manuscript CA 11Division of Gastroenterology, Duke University Medical Center, Durham, NC 12Gastroenterology Section, Durham VA Health Care System, Durham, NC 13Division of Nephrology & Hypertension, Vanderbilt University Medical Center, Nashville, TN 14VA Tennessee Valley, Health Services Research and Development * Corresponding Author: Shailja C Shah, MD MPH, 3350 La Jolla Village Drive, 3-South (GI Section), Mail Code 111D, San Diego, CA 92161, Phone: 619-854-9550 / Fax: None, s6shah@health.ucsd.edu. Author Contributions: SCS: Study concept, study design, dataset verification, interpretation of data and statistical analysis, drafting of initial manuscript, critical revision of manuscript; AEH, RAG: study design, primary statistical analysis, dataset verification, interpretation of data and statistical analysis, critical revision of manuscript, methodological oversight; CD, OW, JD: dataset creation and stewardship; BM, ST, KC, AS, CMH, ES, MEM, AH: manuscript revision; CLR: study design, interpretation of data and statistical analysis, methodological and study oversight, critical revision of manuscript. All authors approved the final version of the manuscript. Disclosures/conflicts of interest: The authors report no conflicts of interest that are relevant to this article. Dr. Shah is an ad hoc consultant for Phathom Pharmaceuticals. Shah et al. Page 2 15VA Tennessee Valley, Clinical Services Research and Development 16Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 17VA Geriatrics Research Education and Clinical Center (GRECC), VA Tennessee Valley Health System, Nashville, TN VA Author Manuscript Keywords coronavirus; gastric acid suppression; antihistamine-2 receptor antagonists; population-based analysis Dear..
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