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PPI and the risk of hospitalization for community-acquired pneumonia

The latest issue of Gut examines PPI and the risk of hospitalization for community-acquired pneumonia.

News image

Previous observational studies suggest that the use of proton pump inhibitors (PPIs) may increase the risk of hospitalization for community-acquired pneumonia.

However, the potential presence of confounding and protopathic biases limits the conclusions that can be drawn from these studies. Our objective was, therefore, to examine the risk of hospitalization for community-acquired pneumonia with PPIs prescribed prophylactically in new users of non-steroidal anti-inflammatory drugs (NSAIDs).

Dr Kristian Filion and colleagues formed 8 restricted cohorts of new users of NSAIDs, aged ≥40 years, using a common protocol in 8 databases.

This specific patient population was studied to minimize bias due to unmeasured confounders.

2% also started a PPI
Gut

The research team used high-dimensional propensity scores to estimate site-specific adjusted ORs (aORs) for hospitalization for community-acquired pneumonia at 6 months in PPI patients compared with unexposed patients.

Fixed-effects meta-analytic models were used to estimate overall effects across databases.

Of the 4,238,504 new users of NSAIDs, 2% also started a PPI.

The team found that the cumulative 6-month incidence of hospitalization for community-acquired pneumonia was 0.17% among patients prescribed PPIs and 0.12% in unexposed patients.

After adjustment, PPIs were not associated with an increased risk of hospitalization for community-acquired pneumonia.

Histamine-2 receptor antagonists yielded similar results.

Dr Filion's team commented, "Our study does not support the proposition of a pharmacological effect of gastric acid suppressors on the risk of hospitalization for community-acquired pneumonia."

Gut 2014; 63: 552-558 
06 March 2014

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