Acid suppressant therapy and risk of COVID-19 infection: rational use through lessons learnt during a pandemic
Abstract
Recently there have been many concerns regarding the use of acid suppression therapy in the setting of the COVID-19 pandemic. We review the biological plausibility, the evidence and the recommendations for acid suppressant use in the present COVID-19 pandemic. On review of recent literature, after adjusting for confounding factors, PPI use, especially twice-daily dosing, seem to be associated with acquiring COVID-19 infection and worse outcomes among patients with COVID-19 compared to non-users. PPI induced hypochlorhydria may be responsible for the observed effects. Famotidine protects against clinical deterioration among hospitalised patients and improves patient-reported outcomes among non-hospitalised patients with COVID-19 compared to non-users. Famotidine interfering maturation of SARS-CoV-2 and reducing inflammation may be responsible for the observed effect. A more recent propensity score-matched study using medication data on UK Biobank subjects and subsequent meta-analysis using prior studies on acid suppressants and the risk of COVID-19 indicated that neither PPI nor H2RA use was associated with the risk of SARS-CoV-2 infection and death in patients with COVID-19. The knowledge from the recent studies could help by reminding PPI users to be especially vigilant about following public health practices and protective health behaviours and could undoubtedly help encourage physicians to prescribe PPIs rationally during the pandemic and beyond. Twice a day, PPI should…
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