Association Between Vonoprazan and the Risk of Gastric Cancer After Helicobacter pylori Eradication

医学 幽门螺杆菌 养生 入射(几何) 危险系数 克拉霉素 质子抑制剂泵 内科学 胃肠病学 累积发病率 置信区间 阿莫西林 人口 抗生素 队列 环境卫生 物理 光学 微生物学 生物
作者
Junya Arai,Atsushi Miyawaki,Tomonori Aoki,Ryota Niikura,Yoku Hayakawa,Hiroaki Fujiwara,Sozaburo Ihara,Mitsuhiro Fujishiro,Masato Kasuga
出处
期刊:Clinical Gastroenterology and Hepatology [Elsevier BV]
卷期号:22 (6): 1217-1225.e6 被引量:14
标识
DOI:10.1016/j.cgh.2024.01.037
摘要

Background and Aims Potassium-competitive acid blockers (PCABs) have been increasingly used to treat upper gastrointestinal disorders, replacing proton pump inhibitors (PPIs). While PPIs are associated with an increased risk of gastric cancer (GC) after Helicobacter pylori (Hp) eradication, it is uncertain whether PCABs carry the same risk. Methods Using a population-based claims database in Japan, we identified patients who were prescribed a clarithromycin-based first regimen of Hp eradication between 2015 and 2018. Patients who failed this regimen and those diagnosed with GC before or within one year after Hp eradication were excluded. We compared GC incidence between PCAB users and histamine type-2 receptor antagonist (H2RA) users, matching them based on propensity scores calculated with considerations for age, sex, smoking, alcohol consumption, comorbidities, and co-administered medications. PCABs included only Vonoprazan in this study. Results Among 54055 patients, 568 (1.05%) developed GC during the follow-up period (mean 3.65 years). The cumulative incidence of GC was 1.64% at 3 years, 2.02% at 4 years, and 2.36% at 5 years in PCAB users; 0.71% at 3 years, 1.04% at 4 years, and 1.22% at 5 years in H2RA users. The use of PCABs was associated with a higher GC risk (matched HR 1.92; 95%CI 1.13 to 3.25, P = .016). Longer PCAB use and high-dose PCAB use were significantly associated with a higher incidence of GC. Sensitivity analyses showed the risk of GC incidence among PCAB users was comparable to that of PPI users. Conclusions The use of PCABs was associated with an increased risk of GC among Hp-eradicated patients, with duration/dose response effects.
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