Patients requiring invasive mechanical ventilation who are given either proton pump inhibitors or histamine-2 receptor blockers for stress ulcer prophylaxis had similar rates of in-hospital mortality, according to the results of a study published in JAMA.

In this international, open-label, cluster crossover randomized clinical trial (ANZCTR Identifier: ACTRN12616000481471), researchers compared 2 stress ulcer prophylaxis treatments by giving either proton pump inhibitors or histamine-2 receptor blockers to patients receiving invasive mechanical ventilation. The primary study outcome was the rate of all-cause mortality within 90 days during index hospitalization. Secondary outcomes included clinically important upper gastrointestinal bleeding, Clostridioides difficile infection, and lengths of stay.

Among the 26,982 patients who were enrolled, 154 opted out, and the remaining 26,828 participants’ results were analyzed. Among these 26,828 participants, 13,415 were in the proton pump inhibitor group and 13,356 were in the histamine-2 receptor blocker group. By day 90 at the hospital, 2459 patients (18.3%) in the proton pump inhibitor group died and 2333 patients (17.5%) in the histamine-2 receptor blocker group died.


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Clinically meaningful upper gastrointestinal bleeding occurred in 1.3% of the proton pump inhibitor group and 1.8% of the histamine-2 receptor blocker group. C difficile infections occurred in 0.30% of the proton pump inhibitor group and 0.43% of the histamine-2 receptor blocker group. There were no statistically significant differences in lengths of stay.

Although there was not a statistically significant difference between treatments for in-hospital mortality, the researchers noted that this interpretation may be limited by crossover in medication use.

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

The PEPTIC Investigators for the Australian and New Zealand Intensive Care Society Clinical Trials Group, Alberta Health Services Critical Care Strategic Clinical Network, the Irish Critical Care Trials Group. Effect of stress ulcer prophylaxis with proton pump inhibitors vs histamine-2 receptor blockers on in-hospital mortality among ICU patients receiving invasive mechanical ventilation: the PEPTIC randomized clinical trial [published online January 17, 2020]. JAMA. doi:10.1001/jama.2019.22190