S441 The Association Between Chronic PPI Use and COVID-19 Infection

Abstract

Introduction: Proton pump inhibitors (PPIs) are well-tolerated antisecretory agents used to treat acid-peptic disorders, but chronic use has been associated with increased risk of gastrointestinal (GI) infections. Novel coronavirus is a respiratory illness that causes COVID-19, but has also been shown to infect the GI tract. Recent work has supported an association between COVID-19 and PPI use. Our study aimed to validate the association between PPI use and increased risk of COVID-19 and to investigate the severity of infection in these patients. Methods: Patients from a large community hospital aged 18 and older with a positive COVID-19 test (cases) (n = 299) were compared with those who tested negative (controls) (n = 601). Age, gender, race, BMI, history of tobacco or alcohol use, and certain comorbidities (diabetes mellitus, asthma, chronic obstructive pulmonary disease, cirrhosis, chronic kidney disease, and malignancy) were matched using propensity score matching (PSM) to minimize confounding variables. The rate of positive COVID-19 tests versus negative COVID-19 tests was compared among those using only chronic PPI (greater than 3 months), only H2-receptor antagonist use (H2RA), and combination therapy of PPI and H2RA. Subgroup analysis was also performed among positive COVID-19 cases to assess the rate of hospitalization, intensive care unit needs, ventilator dependence, and death. Results: Chronic PPI use showed no increased risk of COVID-19 (OR 0.42, 95% CI 0.3384-0.5096, P = 0.0805) (Table 1). H2RA therapy as well as combination therapy also did not have an increased risk of testing positive for COVID-19 (OR 0.37, 95% CI 0.2445-05170, P = 0.0823 and OR 0.55, 95% CI 0.3807-0.7151, P = 0.5455, respectively) (Figure 1). Among patients with COVID-19 who took PPI and/or H2RA, 14.46% were hospitalized, 16.67% required mechanical ventilation, 41.67% required intensive care, and there was 8.33% mortality. Patients on PPI and/or H2RA therapy were not more likely to be hospitalized, require mechanical ventilation or intensive care, or have increased risk of mortality compared with those who did not take either medication (P = 0.6813, P = 0.3679, P = 0.6703, P = 0.0654). Conclusion: Chronic PPI use (with or without H2RA use) does not increase the risk of COVID -19. Patients who did test positive for COVID-19 while on chronic PPI were not more likely to be hospitalized and did not require higher levels of care. PPIs should continue to be used in the proper patients regardless if they are positive for COVID-19.Table 1.: Comparison of chronic PPI use, H2RA, and combination therapy in those who tested positive for COVID-19 and those who tested negative.Figure 1.: Comparison of chronic PPI use, H2RA, and combination therapy in those who tested positive for COVID-19 and those who tested negative.