PMID- 30704306
OWN - NLM
STAT- MEDLINE
DCOM- 20190410
LR  - 20190410
IS  - 1744-764X (Electronic)
IS  - 1474-0338 (Linking)
VI  - 18
IP  - 3
DP  - 2019 Mar
TI  - Proton pump inhibitors therapy and the risk of pneumonia: a systematic review and 
      meta-analysis of randomized controlled trials and observational studies.
PG  - 163-172
LID - 10.1080/14740338.2019.1577820 [doi]
AB  - 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.
FAU - Wang, Chih-Hung
AU  - Wang CH
AD  - a Department of Emergency Medicine , National Taiwan University Hospital , Taipei 
      , Taiwan.
AD  - b Department of Emergency Medicine, College of Medicine , National Taiwan 
      University , Taipei , Taiwan.
FAU - Li, Cheng-Han
AU  - Li CH
AD  - c College of Medicine , National Taiwan University , Taipei , Taiwan.
FAU - Hsieh, Ronan
AU  - Hsieh R
AD  - d Department of Medicine , Albert Einstein Medical Center , Philadelphia , PA , 
      USA.
FAU - Fan, Cheng-Yi
AU  - Fan CY
AD  - c College of Medicine , National Taiwan University , Taipei , Taiwan.
FAU - Hsu, Tze-Chun
AU  - Hsu TC
AD  - a Department of Emergency Medicine , National Taiwan University Hospital , Taipei 
      , Taiwan.
FAU - Chang, Wei-Che
AU  - Chang WC
AD  - c College of Medicine , National Taiwan University , Taipei , Taiwan.
FAU - Hsu, Wan-Ting
AU  - Hsu WT
AD  - e Department of Epidemiology , Harvard School of Public Health , Boston , MA , 
      USA.
FAU - Lin, Yu-Ya
AU  - Lin YY
AD  - f Department of Pharmacy , E-Da hospital , Kaohsiung , Taiwan.
FAU - Lee, Chien-Chang
AU  - Lee CC
AUID- ORCID: 0000-0002-1243-2463
AD  - a Department of Emergency Medicine , National Taiwan University Hospital , Taipei 
      , Taiwan.
AD  - b Department of Emergency Medicine, College of Medicine , National Taiwan 
      University , Taipei , Taiwan.
AD  - e Department of Epidemiology , Harvard School of Public Health , Boston , MA , 
      USA.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20190222
PL  - England
TA  - Expert Opin Drug Saf
JT  - Expert opinion on drug safety
JID - 101163027
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Anti-Inflammatory Agents, Non-Steroidal/administration & dosage/adverse effects
MH  - Data Interpretation, Statistical
MH  - Humans
MH  - *Models, Statistical
MH  - Pneumonia/*epidemiology/etiology
MH  - Proton Pump Inhibitors/*administration & dosage/adverse effects
MH  - Publication Bias
MH  - Randomized Controlled Trials as Topic
MH  - Research Design
OTO - NOTNLM
OT  - Meta-analysis
OT  - pneumonia
OT  - proton pump inhibitors
OT  - protopathic bias
EDAT- 2019/02/02 06:00
MHDA- 2019/04/11 06:00
CRDT- 2019/02/02 06:00
PHST- 2019/02/02 06:00 [pubmed]
PHST- 2019/04/11 06:00 [medline]
PHST- 2019/02/02 06:00 [entrez]
AID - 10.1080/14740338.2019.1577820 [doi]
PST - ppublish
SO  - Expert Opin Drug Saf. 2019 Mar;18(3):163-172. doi: 10.1080/14740338.2019.1577820. 
      Epub 2019 Feb 22.