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Proton pump inhibitors and the risk of severe COVID-19: a post-hoc analysis from the Korean nationwide cohort
  1. Seung Won Lee1,
  2. Jee Myung Yang2,
  3. In Kyung Yoo3,
  4. Sung Yong Moon1,
  5. Eun Kyo Ha4,
  6. Abdullah Özgür Yeniova5,
  7. Joo Young Cho3,
  8. Min Seo Kim6,
  9. Jae Il Shin7,
  10. Dong Keon Yon8,9
  1. 1Department of Data Science, Sejong University, Seoul, Korea (the Republic of)
  2. 2Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
  3. 3Department of Gastroenterology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea (the Republic of)
  4. 4Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea (the Republic of)
  5. 5Division of Gastroenterology, Department of Internal Medicine, Tokat Gaziosmanpaşa University Faculty of Medicine, Tokat, Turkey
  6. 6Genomics and Digital Health, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, Korea (the Republic of)
  7. 7Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
  8. 8Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea (the Republic of)
  9. 9Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  1. Correspondence to Dr. Dong Keon Yon, Seoul National University College of Medicine, Seoul 03080, Korea (the Republic of); yonkkang{at}gmail.com

https://doi.org/10.1136/gutjnl-2020-323672

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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 2 …

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    Footnotes

    • SWL, JMY and IKY are joint first authors.

    • Contributors Dr DKY had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version before submission. Conception and design: SWL and DKY; analysis and interpretation of the data: SWL, JMY and DKY; drafting of the article: JMY, IKY, AÖY and DKY; critical revision of the article for important intellectual content: SWL, JMY, IKY, EKH, JYC, MSK, JIS and DKY; final approval of the article: all authors; statistical expertise: SYM, SWL and DKY; administrative, technical or logistic support: SWL and DKY; collection and assembly of data: DKY. DKY is guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (NRF2019R1G1A109977912).

    • Disclaimer The funders had no role in the design, analyses or interpretation of the study.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Ethics approval The study protocol was approved by the institutional review board of Sejong University (SJU-HR-E-2020–003).

    • Provenance and peer review Not commissioned; internally peer reviewed.