Gutからの報告です
気になっていたCOVID-19とPPIのメタアナ
Abstract
Objective
The adverse effects of proton pump inhibitors (PPIs) have been documented for pneumonia; however, there is no consensus regarding whether the use of PPIs might be harmful regarding the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In this regard, we aimed to measure the potential associations of the current use of PPIs with the infection rates of COVID-19 among patients who underwent SARS-CoV-2 testing.
Design
Data were derived from a Korean nationwide cohort study with propensity score matching. We included 132 316 patients older than 18 years who tested for SARS-CoV-2 between 1 January and 15 May 2020. Endpoints were SARS-CoV-2 positivity (primary) and severe clinical outcomes of COVID-19 (secondary: admission to intensive care unit, administration of invasive ventilation or death).
Results
In the entire cohort, there were 111 911 non-users, 14 163 current PPI users and 6242 past PPI users. After propensity score matching, the SARS-CoV-2 test positivity rate was not associated with the current or past use of PPIs. Among patients with confirmed COVID-19, the current use of PPIs conferred a 79% greater risk of severe clinical outcomes of COVID-19, while the relationship with the past use of PPIs remained insignificant. Current PPI use starting within the previous 30 days was associated with a 90% increased risk of severe clinical outcomes of COVID-19.
Conclusion
Patients taking PPIs are at increased risk for severe clinical outcomes of COVID-19 but not susceptible to SARS-CoV-2 infection. This suggests that physicians need to assess benefit–risk assessments in the management of acid-related diseases amid the COVID-19 pandemic.
どうでしょうか？
私の大好きNEJM Journal Watchでは、以下のようなコメントをしています。
https://www.jwatch.org/na52813/2020/11/17/proton-pump-inhibitors-and-covid-19-severity
A causal relation between PPI use and susceptibility to SARS-CoV-2 or worse COVID-19 outcomes has not been proven. However, a plausible biological mechanism exists: The gut can be a portal of entry for SARS-CoV-2, and acidic gastric pH might impair the virus's infectivity. Therefore, during this latest spike in COVID-19 cases, I have pushed a bit harder than usual in advising chronic PPI users to taper off these medications when they have no compelling indication to continue them.
どうでしょうか？
リスク上昇の可能性あるとしても、ステロイド使用する全身管理において
PPIを使わないとする決断は選択しづらいかも。
まずは使わないで初めて、全身管理が長期になるようなら使うみたいなプロセスでしょうか？
