Proton pump inhibitors and risk of gastric cancer: population-based cohort study
Proton pump inhibitors and risk of gastric cancer: population-based cohort study
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DOI：
10.1136/gutjnl-2021-325097
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发表时间：
2021-07-05
期刊：
影响因子：
24.5
通讯作者：
Azoulay, Laurent
中科院分区：
文献类型：
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作者：
Abrahami, Devin;McDonald, Emily Gibson;Azoulay, Laurent
目的为了确定是否质子泵抑制剂（PPI）的新用户在胃癌的风险增加相比，新用户的组胺-2受体拮抗剂（H2RAs.Design使用英国临床实践研究Datalink，我们进行了一项基于人群的队列研究，使用新用户的活性对照设计。从1990年1月1日至2018年4月30日，我们确定了973281名PPI新用户和193306名H2 RA新用户。拟合考克斯比例风险模型以估计胃癌的HR和95%CI，并使用Kaplan-Meier方法估计需要伤害的数量。使用日历时间特异性倾向评分，使用标准化死亡率比权重对模型进行加权。二次分析评估的持续时间和剂量反应association.Results后，中位数随访5.0年，使用质子泵抑制剂与胃癌的风险增加45%，使用H2 RAs相比（HR 1.45，95%CI 1.06至1.98）。治疗开始后5年和10年，需要伤害的人数分别为2121人和1191人。HR随累积持续时间、累积奥美拉唑当量和自治疗开始后的时间而增加。结果是一致的，在几个敏感性analysis.Conclusion这个大的人群为基础的队列研究的结果表明，使用质子泵抑制剂与胃癌的风险增加相比，使用H2 RAs，虽然绝对风险仍然很低。
Objective To determine whether new users of proton pump inhibitors (PPIs) are at an increased risk of gastric cancer compared with new users of histamine-2 receptor antagonists (H2RAs).Design Using the UK Clinical Practice Research Datalink, we conducted a population-based cohort study using a new-user active comparator design. From 1 January 1990 to 30 April 2018, we identified 973 281 new users of PPIs and 193 306 new users of H2RAs. Cox proportional hazards models were fit to estimate HRs and 95% Cls of gastric cancer, and the number needed to harm was estimated using the Kaplan-Meier method. The models were weighted using standardised mortality ratio weights using calendar time-specific propensity scores. Secondary analyses assessed duration and dose-response associations.Results After a median follow-up of 5.0 years, the use of PPIs was associated with a 45% increased risk of gastric cancer compared with the use of H2RAs (HR 1.45, 95% CI 1.06 to 1.98). The number needed to harm was 2121 and 1191 for five and 10 years after treatment initiation, respectively. The HRs increased with cumulative duration, cumulative omeprazole equivalents and time since treatment initiation. The results were consistent across several sensitivity analyses.Conclusion The findings of this large population-based cohort study indicate that the use of PPIs is associated with an increased risk of gastric cancer compared with the use of H2RAs, although the absolute risk remains low.