S1326 Proton-Pump Inhibitors as Primary Prophylaxis for Corticosteroid Use: A Systematic Review and Meta-Analysis

Introduction: Corticosteroid use increases the risk of peptic ulcers and upper gastrointestinal bleeding (UGIB). Proton-pump inhibitors (PPIs) are commonly prescribed to manage these complications and are often used prophylactically for patients on corticosteroids. However, evidence supporting this remains limited. Systematic reviews are necessary to provide robust data regarding the efficacy of PPIs as primary prophylaxis in preventing UGIB compared to no PPI. Methods: We did a comprehensive literature search in PubMed and Embase from inception to April 2025. We selected randomized-controlled trials (RCTs), cohort studies, or case-control studies that studied the rate of UGIB in patients using corticosteroids between those with PPIs primary prophylaxis versus no PPI prophylaxis. Other interventions, such as histamine-2 receptor antagonists, are included in the non-PPI group. The outcome of interest was UGIB rate. We conducted this meta-analysis and reported the pooled odds ratio (OR) with 95% confidence intervals (CI) using a random-effects model. Results: A total of 4 studies met the inclusion criteria, including one RCT, 1 cohort study, and 2 case-control studies. The PPI dosages that were reported were pantoprazole 40 mg daily and omeprazole 20-40 mg daily with varying follow-up durations from one to 6 months. The durations of the PPI given were not specific, but either stated or implied from data that the patients were given PPI throughout the corticosteroid treatment or longer. The final analysis comprised a total of 4,334 patients (1,264 in the PPI group and 3,070 in the non-PPI group). Patients with PPI primary prophylaxis had a lower risk of UGIB than those without PPIs (OR, 0.66 [95% CI, 0.50, 0.87], P = 0.003). Conclusion: Our study showed that primary prophylaxis with PPIs significantly reduced the risk of UGIB in patients using corticosteroids.