Proton Pump Inhibitor Therapy Is Associated With a Higher Number of Hospitalizations for Cystic Fibrosis Exacerbation

Abstract

Introduction: Proton pump inhibitors (PPI) are among the most commonly prescribed medications in clinical practice. Studies have suggested that PPI use may increase the risk for community-acquired pneumonia. With a reported prevalence of gastroesophageal reflux disease (GERD) higher than controls, patients with cystic fibrosis (CF) are a particularly vulnerable to the adverse effects of PPIs. We sought to identify whether use of PPI was associated with a higher number of hospitalizations for cystic fibrosis exacerbations. Methods: We performed a retrospective review of patients with a diagnosis of cystic fibrosis seen at the University of Florida Adult Cystic Fibrosis Center in 2016. Patients >18 years of age with a confirmed diagnosis of cystic fibrosis with at least 1 year of follow up were included. Baseline characteristics, comorbidities, number of hospitalizations for CF exacerbations in past year, FEV1% predicted, use of a PPI for >6 months and dose of PPI were collected. The associations between PPI use and number of hospitalizations were evaluated using student's t-test for univariate analysis and general linear regression for multivariate analysis. Results: 115 patients meeting inclusion criteria were included. 58 males (50.9%), mean age 32.2 (± 11.01) years, mean FEV1% predicted 57.03% (± 26.32%). 74 patients (64.9%) had a diagnosis of GERD, 23 (20.2%) CF liver disease, 47 (41.2%) CF related diabetes, 80 (70.2%) pseudomonas aeruginosa colonization. 59 patients (51.7%) were hospitalized at least once in past year, mean number of hospitalizations was 2.17 (± 1.9). 59 (51.8%) were on PPI therapy for >6 months, mean total daily PPI dose 36.3 mg (±15.9). In univariate analysis, PPI use for >6 months was associated with a significantly higher mean number of hospitalizations (1.7 versus 2.6, p = 0.028). In a multivariate regression model; PPI use remained significantly associated with a higher number of hospitalizations (p = 0.044) while controlling for FEV1%, pseudomonas colonization, CF related diabetes, CF liver disease. Conclusion: GERD and PPI use is highly prevalent in CF patients. Use of a PPI is independently associated with a higher number of hospitalizations for CF exacerbation. Providers should consider the risks and benefits of initiating PPI therapy in this patient population. Future studies are needed to better understand the nature and clinical implications of this association.