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We read the recent articles published in Gut on the relationship between proton pump inhibitor (PPI) use and outcomes in COVID-19 with great interest.1 2 In the meta-analysis, the authors found that current or regular PPI users were more likely to have severe outcomes of COVID-19 than non-users, but no significant association was observed for previous PPI use.2 The reason may be reduced secretion of gastric acid that can neutralise the SARS-CoV-2. By contrast, the use of famotidine, another medication for gastric ulcers or gastro-oesophageal reflux disease, was associated with better clinical outcomes in some studies,3 4 but not others.5 6
Given these conflicting findings, we conducted this territory-wide study to investigate whether PPI or famotidine use was associated with a higher risk of severe disease using propensity score matching. The detailed methodology of the present analyses is shown in the online supplemental appendix. A total of 4445 patients (median age 44.8 years old, 95% CI: (28.9 to 60.8)); 50% male) were diagnosed with the COVID-19 infection between 1 January 2020 and 22 August 2020 in Hong Kong public hospitals or their associated ambulatory/outpatient facilities. On follow-up until 8 September 2020, a total of …
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