Proton pump inhibitors therapy and the risk of pneumonia: a systematic review and meta-analysis of randomized controlled trials and observational studies.

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  • Additional Information
    • Source:
      Publisher: Taylor & Francis Country of Publication: England NLM ID: 101163027 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1744-764X (Electronic) Linking ISSN: 14740338 NLM ISO Abbreviation: Expert Opin Drug Saf Subsets: MEDLINE
    • Publication Information:
      Publication: 2015- : Abingdon, Oxford : Taylor & Francis
      Original Publication: London : Ashley Publications, c2002-
    • Subject Terms:
      Models, Statistical*; Pneumonia/*epidemiology ; Proton Pump Inhibitors/*administration & dosage; Anti-Inflammatory Agents, Non-Steroidal/administration & dosage ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Data Interpretation, Statistical ; Humans ; Pneumonia/etiology ; Proton Pump Inhibitors/adverse effects ; Publication Bias ; Randomized Controlled Trials as Topic ; Research Design
    • Abstract:
      Objective: We aimed to summarize the current evidence regarding the risk of pneumonia associated with proton pump inhibitors (PPI) treatment.
      Methods: We searched PubMed, Embase, and CENTRAL from the 1970 through December 2017. We included both randomized controlled trials (RCTs) and observational studies. We used random-effect model to calculate the summary effect estimates and quantified the heterogeneity by I 2 statistics.
      Results: A total of 7,643,982 patients from 10 RCTs and 48 observational studies were included in this meta-analysis. The primary meta-analysis demonstrated PPIs use was significantly associated with increased risk of pneumonia, but the heterogeneity was high (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.30-1.57; I 2 , 95.4%). The sensitivity analysis indicated PPIs were not statistically associated with increased risk of pneumonia among patients concomitantly taking nonsteroidal anti-inflammatory drugs (OR, 1.11; 95% CI, 0.94-1.31; I 2 , 5.8%). The funnel plot demonstrated significant publication bias, especially for observational studies.
      Conclusions: The presence of significant between-study heterogeneity and publication bias raised concerns regarding the validity of the primary meta-analytic result. Protopathic bias, or reverse causality, may cause overestimated association. Studies that adopted a design to account for protopathic bias did not show a significant association between PPI use and risk of pneumonia.
    • Contributed Indexing:
      Keywords: Meta-analysis; pneumonia; proton pump inhibitors; protopathic bias
    • Accession Number:
      0 (Anti-Inflammatory Agents, Non-Steroidal)
      0 (Proton Pump Inhibitors)
    • Publication Date:
      Date Created: 20190202 Date Completed: 20190410 Latest Revision: 20190410
    • Publication Date:
      20231215
    • Accession Number:
      10.1080/14740338.2019.1577820
    • Accession Number:
      30704306