PPIs increase the risk of community-acquired pneumonia?
The authors of this study note that there is some previous trial evidence to suggest that proton pump inhibitor (PPI) therapy may be associated with a dose-dependant increased risk of community-acquired pneumonia (CAP). This relationship was also seen with histamine 2 receptor antagonists (H2RA), therefore it was postulated that the effect may be related to acid suppression per se.
In this population-based case-control study, the authors sought to confirm the possible association between PPI use and CAP, to identify risk factors, and to evaluate potential non-causal associations between the use of PPIs and CAP. They used data from four databases in Denmark, and identified 7,642 cases of CAP (discharge diagnosis) during 2000 through 2004. A total of 34,176 controls were randomly selected, and matched by age (in 10-year bands) and sex to the cases with a 4:1 ratio. Exposure status (i.e. use of PPIs) of the cases and the control subjects was determined from prescription data extracted from a pharmacoepidemiological database. Individuals were defined as a current user if they had redeemed a prescription for a PPI during the past 90 days before the index date; past users were those who had redeemed a prescription for a PPI more than 90 days before the index date. The primary endpoint was any admission with a discharge diagnosis of CAP.
The analysis found that:
- A total of 817 (10.7%) of the cases and 1584 (4.6%) of the controls were current users of PPIs; the adjusted odds ratio (OR) associating current use of PPIs with CAP was 1.5 (95% CI, 1.3-1.7). No dose-response relationship was found.
- Use of H2RAs (OR, 1.10; 95% CI, 0.8-1.3), and past use of PPIs (OR, 1.2; 95% CI, 0.9-1.6) were not associated with an increased risk of CAP.
- Analyses found that groups seeming to be at particular risk include those who had recently initiated PPI therapy (OR, 5.0; 95% 2.1-11.7), and those below 40 years of age (OR, 2.3; 95% CI, 1.3-4.0)
Arch Intern Med 2007; 167: 950-5 (link to abstract)
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