3児の親さん薬剤師のブログ

とある薬剤師です。感染症治療を考える素材をちょこっと提供。noteもあります https://note.com/twin1980

Do proton pump inhibitors influence SARS-CoV-2 related outcomes? A meta-analysis

Gutからの報告です

 

gut.bmj.com

 

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?

 

 

レジデントのための感染症診療マニュアル 第4版

レジデントのための感染症診療マニュアル 第4版

  • 作者:青木 眞
  • 発売日: 2020/11/30
  • メディア: 単行本