Department of Family Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea.
Department of Family Medicine, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul, Republic of Korea.
Eur J Clin Pharmacol. 2022 Mar;78(3):383-391. doi: 10.1007/s00228-021-03255-1. Epub 2021 Nov 24.
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.
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.
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.
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.
几项观察性研究对质子泵抑制剂（PPIs）或组胺 H2 受体拮抗剂（H2RA）的使用与 2019 年冠状病毒病（COVID-19）风险之间的关系得出了相互矛盾的结果。本系统评价和荟萃分析旨在研究这种关联。
2021 年 7 月，检索了 PubMed、Embase、Cochrane 对照试验中心注册库和 Web of Science，以查找调查两种主要抑酸剂与 COVID-19 之间关系的文章。使用随机效应模型评估显示严重结局或 COVID-19 发生率的效应估计值为危害比（HR）的研究。
本荟萃分析共纳入了 15 项回顾性队列研究，包含 18109 例 COVID-19 病例。PPI 的使用与 COVID-19 的严重结局显著相关（HR=1.53；95%置信区间[CI]：1.20-1.95），但与 COVID-19 的发生率无关，而 H2RA 的使用与发生率降低显著相关（HR=0.86，95%CI：0.76-0.97）。对于 PPI 的亚组分析，在 < 60 岁、正在使用、住院使用和亚洲人群中观察到 COVID-19 的严重结局增加。对于 H2RA 的亚组分析，在 > 60 岁的人群中观察到 COVID-19 的严重结局降低，而住院使用和在亚洲的使用与更高的疾病严重程度相关。
对于使用 PPI 预防严重结局的 COVID-19 患者，可以考虑密切观察。但是，由于存在大量的异质性和可能的前馈偏差，应谨慎对待。
