October 27, 2004

ULCER, HEARTBURN DRUGS ASSOCIATED WITH INCREASED RISK OF PNEUMONIA

Current use of a proton pump inhibitor or an H2-receptor antagonist (H2RA) was associated with an approximate two-fold increased risk of pneumonia in a large study conducted in The Netherlands.

The authors noted that PPIs and H2RAs, which are used to treat ulcers and heartburn, increase susceptibility to infection by reducing gastric acid secretion. In order to assess the effect of these pharma brands on pneumonia risk, they examined data from the Integrated Primary Care Information project, a database containing patient records from approximately 150 general practitioners in The Netherlands.

Included in the study were 364,683 individuals who had at least one year of valid database history prior to study initiation. These patients were followed for an average of 2.7 additional years, resulting in 5,551 first occurrences of pneumonia.

Data showed that current users of PPIs (esomeprazole, lansoprazole, omeprazole, pantoprazole or rabeprazole) or H2RAs (cimetidine, famotidine, nizatidine, ranitidine or roxatidine) developed pneumonia 4.5 times more often than those who had never used one of the drugs. Furthermore, current PPI users were 1.89 times as likely to develop pneumonia as compared with those who had previously used a PPI but had discontinued therapy, and current H2RA users were 1.63 times as likely as those who had discontinued use.

A significant dose response was observed among current PPI users, but not among H2RA users.

"To avoid the calculated excess pneumonia, patients with asthma or chronic obstructive lung disease, immunocompromised persons, children and elderly persons should be treated with acid-suppressive drugs only when necessary and with the lowest possible dose," the study authors concluded.

In an accompanying editorial, Dr. James Gregor of the University of Western Ontario noted that the data indicate exposure to PPIs or H2RAs adds approximately one case of pneumonia for every 100 years of patient exposure.

"Of interest is that this risk is roughly comparable in magnitude to the risk of upper gastrointestinal bleeding attributed to nonsteroidal anti-inflammatory drugs, a problem that has been the subject of considerable clinical research," he commented.

The study and the editorial appeared in the Oct. 27 issue of JAMA.