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Song HJ, Seo HJ, Jiang X, Jeon N, Lee YJ, Ha IH. Proton pump inhibitors associated with an increased risk of mortality in elderly: a systematic review and meta-analysis. Eur J Clin Pharmacol 2024; 80:367-382. [PMID: 38147074 DOI: 10.1007/s00228-023-03606-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 12/10/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE The increased use of proton pump inhibitors (PPIs) in the elderly has raised concerns about potential severe adverse effects. Our systematic review investigated the mortality associated with PPI use in elderly populations. METHODS We searched MEDLINE, EMBASE, and the Cochrane Library for relevant publications until August 2022. We included randomized controlled trials (RCTs), quasi-RCTs, and observational studies on the association between proton pump inhibitors and mortality in the elderly. To estimate the pooled relative risk (RR) and 95% confidence interval (CI), the inverse-variance random effect model was used. Heterogeneity was assessed using the I2 test. Subgroup analyses were performed by follow-up period, population, and study design. RESULTS A total of 4 RCTs and 36 cohort studies were included in the meta-analysis. Four RCTs showed that there was no significant association between PPIs and the risk of death. From 23 observational studies (26 cohorts), the use of proton pump inhibitors was not significantly associated with increased mortality in the elderly (RR 1.14; 95% CI, 0.90-1.45). However, when controlling for covariates from 33 observational studies (41 cohorts), proton pump inhibitors in older adults aged 50 years or more were significantly associated with a 15% higher risk of mortality compared to nonusers (RR 1.15; 95% CI, 1.10-1.20). CONCLUSIONS Our meta-analysis of RCTs found that PPIs did not show a significant association with increased mortality risk in older adults. However, the meta-analysis of cohort studies and long-term follow-up studies showed a higher increased risk of death with PPI use in older adults. The prescription of PPIs in patients aged 50 years or older should be carefully considered.
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Affiliation(s)
- Hyun Jin Song
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea.
- College of Pharmacy, University of Florida, Gainesville, FL, USA.
| | - Hyun-Ju Seo
- College of Nursing, Chungnam National University, Daejeon, South Korea
| | - Xinyi Jiang
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Nakyung Jeon
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, South Korea
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Blanc F, Waechter C, Vogel T, Schorr B, Demuynck C, Hunyadi CM, Meyer M, Mutelica D, Bougaa N, Fafi-Kremer S, Calabrese L, Schmitt E, Imperiale D, Jehl C, Boussuge A, Suna C, Weill F, Matzinger A, Muller C, Karcher P, Kaltenbach G, Sauleau E. Therapeutic prevention of COVID-19 in elderly: a case-control study. GeroScience 2021; 43:2333-2343. [PMID: 34273049 PMCID: PMC8285285 DOI: 10.1007/s11357-021-00397-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 05/31/2021] [Indexed: 12/11/2022] Open
Abstract
COVID-19 is a particularly aggressive disease for the elderly as 86% of deaths related to COVID-19 occur in people over 65 years of age. Despite the urgent need for a preventive treatment, there are currently no serious leads, other than the vaccination. The aim of this retrospective case-control study is to find a pharmacological preventive treatment of COVID-19 in elderly patients. One-hundred-seventy-nine patients had been in contact with other COVID-19 patients at home or in hospital, of whom 89 had tested RT-PCR-positive (COVID-pos) for the virus and 90 had tested RT-PCR-negative (COVID-neg). Treatments within 15 days prior to RT-PCR (including antihypertensive drugs, antipsychotics, antibiotics, nonsteroidal anti-inflammatory drugs, proton pump inhibitors (PPIs), oral antidiabetics (OADs), corticosteroids, immunosuppressants), comorbidities, symptoms, laboratory values, and clinical outcome were all collected. COVID-pos patients more frequently had a history of diabetes (P = .016) and alcoholism (P = .023), a lower leukocyte count (P = .014) and a higher mortality rate - 29.2% versus 14.4% - (P = .014) when compared to COVID-neg patients. Patients on PPIs were 2.3 times less likely (odds ratio [OR] = 0.4381, 95% confidence interval [CI] [0.2331, 0.8175], P = .0053) to develop COVID-19 infection, compared to those not on PPIs. No other treatment decreased or increased this risk. COVID-pos patients on antipsychotics (P = .0013) and OADs (P = .0153), particularly metformin (P = .0237), were less likely to die. Thus, patients on treatment with PPI were less likely to develop COVID-19 infection, and those on antipsychotics or metformin had a lower risk of mortality. However, prospective studies, including clinical trials, are needed to confirm or not these findings.
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Affiliation(s)
- Frederic Blanc
- ICube Laboratory, UMR 7357 and CNRS, University of Strasbourg, Strasbourg, France.
| | - Cedric Waechter
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Thomas Vogel
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Benoit Schorr
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Catherine Demuynck
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Catherine Martin Hunyadi
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Maxence Meyer
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Denata Mutelica
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Nadjiba Bougaa
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Samira Fafi-Kremer
- Virology Department, University Hospital of Strasbourg, Strasbourg, France
| | - Lidia Calabrese
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Elise Schmitt
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Delphine Imperiale
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Catherine Jehl
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Alexandre Boussuge
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Carmen Suna
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - François Weill
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Alexia Matzinger
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Candice Muller
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Patrick Karcher
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Georges Kaltenbach
- Pôle de Gériatrie, La Robertsau Geriatric Hospital, University Hospital of Strasbourg, Strasbourg, France
| | - Erik Sauleau
- ICube Laboratory, UMR 7357 and CNRS, University of Strasbourg, Strasbourg, France
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Cetin H, Sun J, Almqvist C, Reichardt B, Tomschik M, Zimprich F, Fang F, Ingre C. No association between proton pump inhibitor use and ALS risk: a nationwide nested case-control study. Sci Rep 2020; 10:13371. [PMID: 32770128 PMCID: PMC7414209 DOI: 10.1038/s41598-020-70373-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/10/2020] [Indexed: 12/19/2022] Open
Abstract
The use of proton pump inhibitors (PPIs) has been proposed as a potential risk factor for neurodegenerative diseases, but little is known regarding its role in amyotrophic lateral sclerosis (ALS). We therefore aimed to assess the association of PPI use with the subsequent risk of ALS, and performed a register-based nationwide nested case–control study, including 2,484 ALS cases diagnosed during July 2006–December 2013 in Sweden and 10 population controls per case that were individually matched to the case by sex, age, and area of residence. Dispenses and cumulative defined daily doses (cDDDs) of PPIs were extracted from the Swedish Prescribed Drug Register. The association of PPI use with the risk of ALS was assessed using conditional logistic regression, after applying different lag windows to avoid reverse causation. ALS patients were more likely to be dispensed with PPIs before diagnosis than controls. However, previous PPI use was not associated with an increased risk of ALS (OR = 1.08, 95% CI 0.97–1.19), and there was no dose–response relationship between cDDDs of PPIs and ALS risk (p = 0.0874), after excluding dispenses during the year before ALS diagnosis. The results were similar after excluding dispenses during the 2 or 3 years before ALS diagnosis.
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Affiliation(s)
- Hakan Cetin
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jiangwei Sun
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, 17177, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | | | - Matthias Tomschik
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Fang Fang
- Institute of Environmental Medicine, Karolinska Institutet, Box 210, 17177, Stockholm, Sweden.
| | - Caroline Ingre
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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