PPIs and H2RAs have same impact on mortality, finds study

Canada: PPIs and H2RAs more or less have a similar effect on mortality compared to no treatment, suggests a recent study in the journal Intensive Care Medicine. However, based on low certainty evidence the possibility of slightly increased mortality associated with PPI use cannot be excluded. 

Proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) use help to achieve reductions in gastrointestinal bleeding. The greater benefit of PPIs over H2RAs may be important for patients with higher bleeding risk.

Based on findings from the PEPTIC trial that has raised the issue of increased mortality with PPI use over H2RAs, Ying Wang, McMaster University, Hamilton, Canada, and colleagues updated their prior systematic review and network meta-analysis (NMA) that addressed the impact of pharmacological gastrointestinal bleeding prophylaxis in critically ill patients.

The researchers searched for randomized controlled trials that examined the safety and efficacy of gastrointestinal bleeding treatment with PPIs, H2RAs, or sucralfate versus one another or placebo or no prophylaxis in adult critically ill patients. They performed Bayesian random-effects NMA and conducted analyses using all PEPTIC data. Also, they performed a restricted analysis using only PEPTIC data from high compliance centers. The GRADE approach was used to quantify absolute effects and assess the certainty of evidence.