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We appreciate the comment and discussion from Dr Roulet1 on our original article.2 The author criticised that (1) our study did not consider the dose-dependent exposure to proton pump inhibitors (PPIs); (2) our study did not investigate the relationship of PPI use in hospitalised patients with COVID-19 during treatment for COVID-19 and (3) although our study accounted for protopathic bias by excluding new non-steroidal anti-inflammatory drug users, protopathic bias occurred in patients who responded to the early digestive symptoms of COVID-19. We acknowledge that plausible academic concerns have been raised, which might improve the original discussion and extend the insight into the association between PPI usage and COVID-19.1 We have performed a post-hoc analysis from the Korean nationwide cohort, addressing these concern.
Data were obtained from the Korean nationwide cohort study, which includes patients (≥18 years) who underwent SARS-CoV-2 testing between 1 January and 15 May 2020.2–4 We performed propensity score matching between current PPI users (prehospitalisation PPI usage) and non-users among patients with laboratory-confirmed COVID-19 (n=4785), as previously described.2 Posthospitalisation PPI usage was defined as in-hospital PPI use in general wards, not intensive care units. The outcomes were a composite endpoint 1 (requirement of oxygen therapy, intensive care unit admission, administration of invasive ventilation or death) and a composite endpoint …