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COVID-19 Resource Center
Source/Disclosures
Disclosures: Almario reports he has a stock option grant in My Total Health, has served on advisory boards for Bayer Healthcare and Synergy Pharmaceuticals, has served as a consultant for Alnylam Pharmaceuticals and Arena Pharmaceuticals, and received a one-time speaker’s fee from Takeda Pharmaceuticals. Spiegel reports he has served on advisory boards for Alnylam Pharmaceuticals, Arena Pharmaceuticals, Ironwood Pharmaceuticals, Salix Pharmaceuticals, Synergy Pharmaceuticals, and Takeda Pharmaceuticals, and has received research funding to his institution from Alnylam Pharmaceuticals, Ironwood Pharmaceuticals, Shire Pharmaceuticals, and Takeda Pharmaceuticals. Please see the study for all other authors’ relevant financial disclosures.
July 07, 2020
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Proton pump inhibitor use doubles risk for COVID-19

Source/Disclosures
Disclosures: Almario reports he has a stock option grant in My Total Health, has served on advisory boards for Bayer Healthcare and Synergy Pharmaceuticals, has served as a consultant for Alnylam Pharmaceuticals and Arena Pharmaceuticals, and received a one-time speaker’s fee from Takeda Pharmaceuticals. Spiegel reports he has served on advisory boards for Alnylam Pharmaceuticals, Arena Pharmaceuticals, Ironwood Pharmaceuticals, Salix Pharmaceuticals, Synergy Pharmaceuticals, and Takeda Pharmaceuticals, and has received research funding to his institution from Alnylam Pharmaceuticals, Ironwood Pharmaceuticals, Shire Pharmaceuticals, and Takeda Pharmaceuticals. Please see the study for all other authors’ relevant financial disclosures.
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An independent, dose-response relationship was seen between proton pump inhibitor use and COVID-19 positivity, according to a study published in the American Journal of Gastroenterology.

“We found that PPI use, particularly twice-daily dosing, is associated with increased odds for reporting a positive COVID-19 test, even after accounting for a wide range of sociodemographic, lifestyle, and clinical variables,” Christopher V. Almario, MD, MSHPM, from the department of Medicine at Cedars-Sinai Medical Center in Los Angeles, told Healio Gastroenterology. “Our findings continue to emphasize that PPIs should only be used when clinically indicated at the lowest effective dose.”

PPI use, in particular  twice-daily dosing was correlated with increased odds for reporting a positive COVID-19 test.

Researchers performed a population-based, online survey of 53,130 patients from May 3 to June 24, 2020 to determine if PPIs increased the risk for COVID-19 among community-dwelling Americans. They used multivariable logistic regression to report on a positive COVID-19 test to adjust for confounding factors.

Chistopher ALmario headshot 
Christopher Almario
Brennan Spiegel 
Brennan M.R. Spiegel

Of those surveyed, 3,386 patients reported a positive COVID-19 test. Investigators noted a significantly increased odds for reporting a positive COVID-19 test in patients who used PPIs either once daily (OR = 2.15; 95% CI, 1.9–2.44) or twice daily (OR = 3.67; 95% CI, 2.93–4.6) compared with those who did not use PPIs. An elevated risk was not seen among patients who took histamine-2 receptor antagonists (H2RAs).

According to researchers, 3,267 patients who tested positive were symptomatic and 647 patients said they experienced a new onset of abdominal pain, diarrhea and nausea/vomiting. Results from regression analysis demonstrated patients who took lower-dose PPIs (n = 266, 10.9%; OR = 0.62; 95% CI, 0.49–0.78) had a lower chance for reporting GI COVID-19 symptoms compared with patients not on PPIs (n = 297, 39.5%).

“This study does not mean that people on PPIs should just stop their medicines,” Brennan M.R. Spiegel, MD, MSHS, professor-in-residence of medicine and public health at Cedars-Sinai Medical Center, David Geffen School of Medicine at UCLA and UCLA Fielding School of Public Health, told Healio Gastroenterology. “PPIs work and, in most cases, their benefits outweigh the risks. As always, the decision about whether, when, and how to modify PPI dosing should be based on a thoughtful assessment of the risk-benefit ratio for individual patients. As with any medication, the lowest effective dose should be used when clinically indicated, and, when appropriate and consistent with best-practice guidelines, H2RAs may also be considered as an alternative treatment for acid-related conditions.”