质子泵抑制剂的使用与严重 COVID-19 风险：美国医疗保险受益人的病例对照研究。

Use of proton pump inhibitors and risk of severe COVID-19: A case-control study in United States Medicare beneficiaries.

机构信息

Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA.

Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA.

出版信息

Pharmacotherapy. 2024 Oct;44(10):803-810. doi: 10.1002/phar.4614. Epub 2024 Oct 18.

DOI:10.1002/phar.4614

PMID:39425479

Abstract

BACKGROUND

Concerns have been raised regarding proton pump inhibitor (PPI) use and risk of severe coronavirus disease 2019 (COVID-19). Observational studies have yielded heterogeneous results and were subject to important methodological limitations.

AIMS

To examine the association between the receipt of PPIs and risk of COVID-19 hospitalizations and severe in-hospital outcomes or death.

METHODS

Case-control study among Medicare fee-for-service beneficiaries 66+ years old with gastroesophageal reflux disorder (GERD). Within this population, we identified cases by an incident hospital discharge diagnosis of COVID-19 from April 1 to December 11, 2020, using the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) U07.1, and randomly selected up to 10 controls per case, matched on date and neighborhood. We defined PPI use as a prescription providing ≥15 days of supply in the 30 days before admission, with H2-receptor antagonist (H2RA) use as the reference to account for indication. We analyzed uncomplicated hospitalizations and hospitalizations with severe outcomes (intensive/coronary care unit admission, invasive mechanical ventilation, or death), estimating odds ratios (ORs), and 95% confidence intervals (CIs) with multinomial conditional logistic regression adjusted for demographics, comorbidities, chronic medications, and health care utilization.

RESULTS

We matched 25,867 uncomplicated and 12,954 severe hospitalized COVID-19 cases to 146,972 and 73,104 controls, respectively. Cases tended to be older and have more comorbidities. Relative to H2RA use, we found no association of PPI use with uncomplicated COVID-19 hospitalization (OR 0.99, 95% CI 0.93-1.06) or severe COVID-19 hospitalization (OR 1.00, 95% CI 0.91-1.10).

CONCLUSIONS

Relative to H2RA use, PPI use was not associated with uncomplicated or severe COVID-19 hospitalizations among Medicare beneficiaries with GERD.

摘要

背景

人们对质子泵抑制剂（PPI）的使用与 2019 年冠状病毒病（COVID-19）的严重程度之间的关系表示担忧。观察性研究得出的结果存在差异，并且存在重要的方法学局限性。

目的

研究接受质子泵抑制剂（PPIs）与 COVID-19 住院风险以及严重住院结局或死亡之间的关联。

方法

这是一项针对医疗保险全服费用受益人的 66 岁及以上胃食管反流病（GERD）患者的病例对照研究。在该人群中，我们通过使用国际疾病分类，第十次修订版，临床修正（ICD-10-CM）U07.1，确定了 2020 年 4 月 1 日至 12 月 11 日期间因 COVID-19 而发生的医院出院诊断的病例，随机选择了每个病例最多 10 名对照，按照日期和社区进行匹配。我们将 PPI 的使用定义为在入院前 30 天内提供至少 15 天供应量的处方，将 H2 受体拮抗剂（H2RA）的使用作为参考，以说明适应症。我们分析了单纯性住院和伴有严重结局的住院（重症监护/冠心病监护病房入院、有创机械通气或死亡），使用多项条件逻辑回归估计比值比（OR）和 95%置信区间（CI），并进行了调整，以考虑人口统计学、合并症、慢性药物和医疗保健利用情况。

结果

我们将 25867 例单纯性 COVID-19 住院和 12954 例严重 COVID-19 住院的病例分别与 146972 例和 73104 例对照相匹配。病例组往往年龄较大，合并症较多。与 H2RA 相比，我们发现 PPI 的使用与单纯性 COVID-19 住院（OR 0.99，95%CI 0.93-1.06）或严重 COVID-19 住院（OR 1.00，95%CI 0.91-1.10）之间没有关联。