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Acid suppressant use in association with incidence and severe outcomes of COVID-19: a systematic review and meta-analysis

PURPOSE: Several observational studies have presented conflicting results on the association between the use of proton pump inhibitors (PPIs) or histamine H2 receptor antagonist (H2RA) and the risk of coronavirus disease 2019 (COVID-19). This systematic review and meta-analysis aimed to examine this...

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Autores principales: Kim, Hong-Bae, Kim, Jung-Ha, Wolf, Bethany J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611395/
https://www.ncbi.nlm.nih.gov/pubmed/34817624
http://dx.doi.org/10.1007/s00228-021-03255-1
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author Kim, Hong-Bae
Kim, Jung-Ha
Wolf, Bethany J.
author_facet Kim, Hong-Bae
Kim, Jung-Ha
Wolf, Bethany J.
author_sort Kim, Hong-Bae
collection PubMed
description PURPOSE: Several observational studies have presented conflicting results on the association between the use of proton pump inhibitors (PPIs) or histamine H2 receptor antagonist (H2RA) and the risk of coronavirus disease 2019 (COVID-19). This systematic review and meta-analysis aimed to examine this association. METHODS: In July 2021, PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched for articles investigating the relationship between the two main acid suppressants and COVID-19. Studies showing the effect estimates as hazard ratio (HR) for severe outcomes or incidence of COVID-19 were evaluated using a random-effects model. RESULTS: A total of 15 retrospective cohort studies with 18,109 COVID-19 cases were included in the current meta-analysis. PPI use was significantly associated with severe outcomes of COVID-19 (hazard ratio [HR] = 1.53; 95% confidence interval [CI]: 1.20–1.95) but not with the incidence of COVID-19, whereas H2RA use was significantly associated with decreased incidence (HR = 0.86, 95% CI: 0.76–0.97). For subgroup analyses of PPIs, increased severe outcomes of COVID-19 were observed in < 60 years, active use, in-hospital use, and Asians. For subgroup analyses of H2RAs, decreased severe outcomes of COVID-19 were observed in > 60 years, while in-hospital use and use in Asia were associated with higher disease severity. CONCLUSIONS: Close observation can be considered for COVID-19 patients who use PPIs to prevent severe outcomes. However, caution should be taken because of substantial heterogeneity and plausible protopathic bias. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00228-021-03255-1.
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spelling pubmed-86113952021-11-24 Acid suppressant use in association with incidence and severe outcomes of COVID-19: a systematic review and meta-analysis Kim, Hong-Bae Kim, Jung-Ha Wolf, Bethany J. Eur J Clin Pharmacol Review PURPOSE: Several observational studies have presented conflicting results on the association between the use of proton pump inhibitors (PPIs) or histamine H2 receptor antagonist (H2RA) and the risk of coronavirus disease 2019 (COVID-19). This systematic review and meta-analysis aimed to examine this association. METHODS: In July 2021, PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science were searched for articles investigating the relationship between the two main acid suppressants and COVID-19. Studies showing the effect estimates as hazard ratio (HR) for severe outcomes or incidence of COVID-19 were evaluated using a random-effects model. RESULTS: A total of 15 retrospective cohort studies with 18,109 COVID-19 cases were included in the current meta-analysis. PPI use was significantly associated with severe outcomes of COVID-19 (hazard ratio [HR] = 1.53; 95% confidence interval [CI]: 1.20–1.95) but not with the incidence of COVID-19, whereas H2RA use was significantly associated with decreased incidence (HR = 0.86, 95% CI: 0.76–0.97). For subgroup analyses of PPIs, increased severe outcomes of COVID-19 were observed in < 60 years, active use, in-hospital use, and Asians. For subgroup analyses of H2RAs, decreased severe outcomes of COVID-19 were observed in > 60 years, while in-hospital use and use in Asia were associated with higher disease severity. CONCLUSIONS: Close observation can be considered for COVID-19 patients who use PPIs to prevent severe outcomes. However, caution should be taken because of substantial heterogeneity and plausible protopathic bias. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00228-021-03255-1. Springer Berlin Heidelberg 2021-11-24 2022 /pmc/articles/PMC8611395/ /pubmed/34817624 http://dx.doi.org/10.1007/s00228-021-03255-1 Text en © The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Review
Kim, Hong-Bae
Kim, Jung-Ha
Wolf, Bethany J.
Acid suppressant use in association with incidence and severe outcomes of COVID-19: a systematic review and meta-analysis
title Acid suppressant use in association with incidence and severe outcomes of COVID-19: a systematic review and meta-analysis
title_full Acid suppressant use in association with incidence and severe outcomes of COVID-19: a systematic review and meta-analysis
title_fullStr Acid suppressant use in association with incidence and severe outcomes of COVID-19: a systematic review and meta-analysis
title_full_unstemmed Acid suppressant use in association with incidence and severe outcomes of COVID-19: a systematic review and meta-analysis
title_short Acid suppressant use in association with incidence and severe outcomes of COVID-19: a systematic review and meta-analysis
title_sort acid suppressant use in association with incidence and severe outcomes of covid-19: a systematic review and meta-analysis
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8611395/
https://www.ncbi.nlm.nih.gov/pubmed/34817624
http://dx.doi.org/10.1007/s00228-021-03255-1
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