Read on Twitter
Interesting new paper showing an association between current use of proton pump inhibitors (like omeprazole & pantoprazole) and bad #COVID19 (ICU, death).
A really neat observational study- but, as always, with some caveats: https://gut.bmj.com/content/70/1/76
A really neat observational study- but, as always, with some caveats: https://gut.bmj.com/content/70/1/76
They do provide a strong physiologic explanation for why PPIs might worsen outcomes.
Maybe it increases viral load (by decreasing gastric acidity or changing receptors) or cytokines.
Maybe it increases susceptibility to pneumonia (as has been theorized for bacterial pneumonia).
Maybe it increases viral load (by decreasing gastric acidity or changing receptors) or cytokines.
Maybe it increases susceptibility to pneumonia (as has been theorized for bacterial pneumonia).
And they do a nice job of using national-level data (so, fewer concerns about bias in the dataset) and of using a few different methods of propensity score matching (to try to ensure that the people who took PPIs, and those who didn't, are similar).
Nonetheless, it's highly possible that the observed association is explained by a "confounder" - by another, intermediate variable.
Why?
Because the association was ONLY seen for "short-term" PPI use (1-30 days), not for "long-term" use (>30 days).
This suggests that there's something different about people who STARTED PPIs.
Because the association was ONLY seen for "short-term" PPI use (1-30 days), not for "long-term" use (>30 days).
This suggests that there's something different about people who STARTED PPIs.
Sure, it could be that PPIs have the greatest effect on susceptibility to severe COVID in their first 30 days. But if the reason for the effect on the disease is (suppressed acid, suppressed cytokines, whatever) why would it not continue?
.... and:
some studies suggest that early GI symptoms correlate with worse #COVID19 outcomes.
So - quite plausibly - people who are going to have bad COVID19, have upset stomachs, and start a PPI because they think it will help their heartburn. https://journals.lww.com/ajg/fulltext/2020/10001/s1358_gastrointestinal_symptoms_predict_the.1359.aspx
some studies suggest that early GI symptoms correlate with worse #COVID19 outcomes.
So - quite plausibly - people who are going to have bad COVID19, have upset stomachs, and start a PPI because they think it will help their heartburn. https://journals.lww.com/ajg/fulltext/2020/10001/s1358_gastrointestinal_symptoms_predict_the.1359.aspx
In other words, I find it highly likely that (despite their complex propensity score matching), there's another intermediary factor to explain this relationship.
So what will I tell patients on long-term PPIs, who are diagnosed with COVID?
Based on this data: I will not tell them to stop it.
And for those who just started?
I will explore why, rather than just saying "stop".
Looking forward to seeing more high-quality studies on this.
Based on this data: I will not tell them to stop it.
And for those who just started?
I will explore why, rather than just saying "stop".
Looking forward to seeing more high-quality studies on this.
