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Pacheco T, Costa-Moreira P, Pinto J, Silva J. Pantoprazole-induced enteropathy - An unexpected cause of seronegative villous atrophy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2025. [PMID: 40418055 DOI: 10.17235/reed.2025.11314/2025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2025]
Abstract
Seronegative villous atrophy (SNVA) presents a diagnostic challenge with a wide range of possible etiologies. This report details a 67-year-old woman who developed chronic watery diarrhea and weight loss following the initiation of pantoprazole for gastroesophageal reflux disease. Duodenal biopsies showed villous atrophy associated with intraepithelial lymphocytosis, while celiac serologies and HLA-DQ2/DQ8 gene testing were negative. Discontinuation of pantoprazole led to the resolution of symptoms, and follow-up biopsies showed normalizes duodenal villous architecture without inflammatory infiltrates. This case represents an association between pantoprazole and the development of seronegative villous atrophy, underscoring the need to consider medications as potential causes of enteropathy.
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Affiliation(s)
- Tatiana Pacheco
- Gastroenterology, Centro Hospitalar do Tâmega e Sousa, Portugal
| | | | - Joana Pinto
- Gastroenterology, Centro Hospitalar do Tâmega e Sousa
| | - Jorge Silva
- Gastroenterology, Centro Hospitalar do Tâmega e Sousa
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2
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Andersson P, Brisander M, Liljebris C, Jesson G, Lennernäs H. Severe Impact of Omeprazole Timing on pH-Sensitive Dasatinib Absorption: Unveiling Substantial Drug-Drug Interaction. J Clin Pharmacol 2025; 65:588-597. [PMID: 39726232 PMCID: PMC12034913 DOI: 10.1002/jcph.6173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2024] [Accepted: 11/06/2024] [Indexed: 12/28/2024]
Abstract
The absorption and bioavailability of most tyrosine kinase inhibitors are affected by gastrointestinal pH as they are weak basic lipophilic drugs. Hence, concomitant use of acid reducing agents (ARAs) is frequently restricted. Particularly comedication of crystalline dasatinib (Sprycel) and proton-pump inhibitors (PPIs) should be avoided. Drug-drug interaction (DDI) studies with PPIs report approximately 40%-80% bioavailability reduction of dasatinib. Limitations in the design of these studies do not allow for assessing the near maximum DDI as timing of PPI dosing was either not reported or 22 h prior to dasatinib intake. We conducted a DDI study of crystalline dasatinib and omeprazole in healthy, fasted participants, investigating the impact of PPI comedication on dasatinib plasma exposure at a time point when the near maximum DDI effect is expected. Participants were administered omeprazole (day 2-5) to reach steady state. On day 6, a single dose of crystalline dasatinib was given. Crystalline dasatinib dosing alone on day 1 served as control (single dose). The dosing interval between omeprazole administration and crystalline dasatinib was 10 h (median [range: 9-10 h]). Dasatinib Cmax and AUC0-24 were reduced by 96% and 89% by omeprazole comedication. Cmax was 224.6 ± 104.7 ng/mL (mean ± SD) and 8.0 ± 4.5 ng/mL (P < .0001) and AUC0-24 was 797.6 ± 274.5 and 90.6 ± 38.1 h·ng/mL (P < .0001) without and with omeprazole. T1/2 was 5.7 ± 1.5 h (mean ± SD) with crystalline dasatinib dosing alone and could not be reliably calculated with comedication. To ensure optimal patient outcome, it is vital to investigate bioavailability of pH-sensitive drugs at the maximal DDI effect of ARAs to understand the worst-case influence for efficient clinical management.
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Affiliation(s)
| | | | | | | | - Hans Lennernäs
- Department of Pharmaceutical Biosciences, Translational Drug Discovery and DevelopmentUppsala UniversityUppsalaSweden
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Phillips AE, Brownell JN, Tindall A, Kiernan BD, Patel D, Gelfond D, Stallings VA. Proton-Pump Inhibitors and Fat Absorption in Cystic Fibrosis and Pancreatic Insufficiency: A Randomized Crossover Pilot Trial. Dig Dis Sci 2025; 70:968-977. [PMID: 39537890 PMCID: PMC11920344 DOI: 10.1007/s10620-024-08728-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 10/30/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Dietary fat malabsorption contributes to poor nutritional status in patients with cystic fibrosis (CF) and exocrine pancreatic insufficiency (EPI). Prescribing gastric acid-reducing agents such as proton-pump inhibitors (PPI) as an adjunct to pancreatic enzyme replacement therapy (PERT) to improve dietary fat absorption has been accepted in clinical practice despite limited evidence. AIMS This was a pilot randomized, double-blind, placebo-controlled crossover trial of subjects aged 12 and older with CF and EPI assessed on placebo and omeprazole to determine if PPI improved the efficacy of PERT as indicated by measures of dietary fat absorption. METHODS Fat malabsorption via stool coefficient of fat absorption (CFA) and malabsorption blood test (MBT), gastrointestinal pH (wireless motility capsule [WMC]), and quality of life (QOL) were assessed after 14 days on both placebo or PPI (omeprazole). RESULTS Total 19 subjects enrolled, 13 were randomized, and 9 provided paired results on placebo and PPI. The 3 subject results for CFA were as follows: 1 increased, 1 decreased, and 1 was within the reference range in both tests for fat absorption. For 9 MBT subjects, 7 decreased and 2 increased fat absorption. For the 4 WMC studies, no change in transit times, nor in pH profiles were noted. No differences were seen in the domains of the two QOL questionnaires comparing placebo and PPI. CONCLUSIONS These limited descriptive pilot study results in participants with CF and EPI on PERT evaluated by stool, blood, and QOL tests did not suggest improvement in fat absorption attributable to PPI.
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Affiliation(s)
- Anna Evans Phillips
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jefferson N Brownell
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, 3500 Civic Center Blvd., Philadelphia, PA, 19104, USA.
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Alyssa Tindall
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, 3500 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Bridget Dowd Kiernan
- Division of Gastroenterology, Hepatology, and Nutrition, New York University, New York, NY, USA
| | - Dhiren Patel
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Daniel Gelfond
- WNY Pediatric Gastroenterology and Nutrition, DGRD, Buffalo, NY, USA
| | - Virginia A Stallings
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, 3500 Civic Center Blvd., Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Wu R, Hong G, Cheng X, Zhu Y. The association between use of proton pump inhibitors and frailty index among middle-aged and older adults. Br J Clin Pharmacol 2025; 91:210-219. [PMID: 39305011 DOI: 10.1111/bcp.16260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 09/01/2024] [Accepted: 09/04/2024] [Indexed: 12/28/2024] Open
Abstract
AIMS This study aimed to investigate the association between use of proton pump inhibitors (PPI) and frailty index (FI), and to assess the causality relationship using Mendelian randomization (MR). METHODS A total of 9756 middle-aged and older adults from the National Health and Nutrition Examination Survey were included. The FI was evaluated using a previously validated 49-item deficit model to assess frailty status, which is one of the common approaches to measure overall health burden. We performed weighted multivariable-adjusted linear regression to assess the association between PPI use and FI, and conducted a two-sample MR to evaluate causality, employing various sensitivity analyses for robustness. The inverse variance weighted (IVW) method was used as the primary analysis. RESULTS Multiple linear regression analysis revealed a positive association between PPI use and FI (β = 0.048, 95% confidence interval [CI]: 0.042-0.054, P < .001). This association was observed in both short-term (≤ 1 year) and long-term (> 1 year) PPI users (P for trend < 0.001). The MR study also revealed a positive association between PPI use and FI based on the IVW method (β = 1.183, 95% CI: 0.474-1.892, P = .001). CONCLUSIONS While our findings suggest a potential link between PPI use and FI, they should be interpreted with caution due to the study's limitations. Although the MR analysis suggests a causal relationship, further research, particularly longitudinal studies, is needed to confirm these findings and better establish temporality.
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Affiliation(s)
- Rui Wu
- Hefei Ion Medical Center, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China
| | - Guojun Hong
- Department of Pharmacy, Nanjing Gaochun People's Hospital, Nanjing, Jiangsu Province, China
| | - Xiankun Cheng
- Department of Pharmacy, Maanshan People's Hospital, Maanshan, Anhui Province, China
| | - Yue Zhu
- Hefei Ion Medical Center, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui Province, China
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Watson AC, Watson DI. Antireflux surgeries and hiatal repair: keys to success. Expert Rev Gastroenterol Hepatol 2025; 19:181-195. [PMID: 39910806 DOI: 10.1080/17474124.2025.2464039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2024] [Revised: 01/20/2025] [Accepted: 02/04/2025] [Indexed: 02/07/2025]
Abstract
INTRODUCTION Gastroesophageal reflux is common, and when medical therapy is ineffective, alternative treatments should be considered. Nissen fundoplication controls reflux but can be followed by side effects such as dysphagia and flatulence. To improve outcomes, modifications have been advocated. AREAS COVERED Modifications to Nissen fundoplication and newer procedures for gastroesophageal reflux aim to improve overall outcome. Randomized controlled trials (RCTs) and long-term outcomes from large cohorts are prioritized to consider the optimal procedure for reflux and hiatus hernia. EXPERT OPINION Fundoplication is an effective treatment for gastroesophageal reflux, with success rates of >80% reported at 18-20-year follow-up. RCTs confirm that Nissen fundoplication delivers better reflux control than medication. However, some patients are troubled by side effects. Anterior and posterior partial fundoplication variants have been proposed as procedures that offer equally good reflux control, but fewer side effects, and RCTs have confirmed this with follow-up to 20 years. Which partial fundoplication is better is debated. Alternative laparoscopic or endoscopic approaches require expensive implants or equipment and deliver less reliable reflux control than partial fundoplication. Currently, level I evidence confirms that laparoscopic partial fundoplication delivers the optimal outcome in fit patients with reflux that is not well controlled by medication.
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Affiliation(s)
- Abigail Claire Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - David Ian Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Tahlan S, Singh S, Pandey KC, Singh K. An Outline on Benzimidazole Containing Marketed Drugs with Proton Pump Inhibitor and H 1 Receptor Antagonist Activities. Mini Rev Med Chem 2025; 25:440-462. [PMID: 39779557 DOI: 10.2174/0113895575329633240928163509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Revised: 07/25/2024] [Accepted: 08/20/2024] [Indexed: 01/11/2025]
Abstract
Heterocyclic compounds are increasingly used in medicinal chemistry because they are the main components of many biological processes and materials. Benzimidazole remains the core center of the heterocyclic chemical group, with essential traits such as six-five-member connected rings and two nitrogen atoms at the 1,3 position in a six-membered benzene and five-membered imidazole- fused ring system. Molecules with benzimidazole derivatives serve important functions as therapeutic agents and have shown excellent results in clinical and biological research. In this comprehensive review, we summarize marketed medications that include the benzimidazole moiety. Here, we discuss two topics: PPIs and H1 receptor antagonists. Benzimidazole derivatives are important in all fields because they have the same isostructural pharmacophore as that of naturally occurring active biomolecules. While PPIs and H1 receptor antagonists are generally safe in the short term, accumulating data suggest that their long-term use may pose concerns. This systematic review aimed to assess global PPI use in the general population. This will help researchers, medicinal chemists, and pharmaceutical scientists to create breakthrough benzimidazole-based drugs. This review can help identify novel lead compounds and optimize existing benzimidazole derivatives to improve medicinal efficacy. Benzimidazole has attracted significant interest because of its high bioavailability, stability, and biological efficiency. This page reveals and discusses typical synthesis processes for marketed pharmaceuticals in the benzimidazole class of scaffolds, MOA, and therapeutic uses.
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Affiliation(s)
- Sumit Tahlan
- ICMR-National Institute of Malaria Research, New Delhi, 11007, India
| | - Sucheta Singh
- Department of Pharmaceutical Sciences, Maharshi Dayanand University, Rohtak, 124001, India
| | - Kailash C Pandey
- ICMR-National Institute of Malaria Research, New Delhi, 11007, India
| | - Kuldeep Singh
- Department of Chemistry, Kurukshetra University, Kurukshetra, 136119, India
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Zhang YJ, Duan DD, Tian QY, Wang CE, Wei SX. A pharmacovigilance study of the association between proton pump inhibitors and tumor adverse events based on the FDA adverse event reporting system database. Front Pharmacol 2024; 15:1524903. [PMID: 39749203 PMCID: PMC11694325 DOI: 10.3389/fphar.2024.1524903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2024] [Accepted: 12/10/2024] [Indexed: 01/04/2025] Open
Abstract
Background Proton pump inhibitors (PPIs) are effective treatments for acid-related disorders but may pose tumor risks with long-term use. Current research on PPI-associated tumor adverse events (TAEs) is limited and inconclusive. This study aims to comprehensively analyze the relationship between PPIs and TAEs. Methods We analyzed PPI adverse reaction reports from the FDA Adverse Event Reporting System (FAERS) database spanning from 2004 to 2024, focusing on five commonly used PPIs: esomeprazole, pantoprazole, lansoprazole, omeprazole, and rabeprazole. We conducted a disproportionality analysis utilizing the Reporting Odds Ratio (ROR) to identify potential TAEs associated with PPIs. We conducted univariate logistic regression analysis to explore the influencing factors. Results A total of 3,133 TAEs were identified, representing 2.36% of all PPI-related adverse events (AEs). The most common TAEs were gastric cancer (19.05%) and malignant neoplasm (7.23%). Disproportionality analysis revealed ten significant TAEs associated with PPIs, including gastric adenocarcinoma and renal cell carcinoma. The median age of those reporting TAEs was 59 (interquartile range [IQR]: 51-70), and 29.70% of them resulted in a fatality. TAEs associated with PPIs were less likely to occur in elderly patients (65-75: OR = 0.91 [0.87-0.95], p < 0.001; >75: OR = 0.93 [0.89-0.98], p < 0.01). Conclusion TAEs constitute a small but significant fraction of PPI-related AEs. This study highlights the need for cautious long-term use of PPIs and further research to understand the underlying mechanisms and risk factors. Clinicians should be aware of the potential tumor risks associated with prolonged PPI treatment.
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Affiliation(s)
- Ya-Jun Zhang
- Department of Pharmacy, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Dan-Dan Duan
- Department of Pharmacy, Henan Provincial Corps Hospital of Chinese People’s Armed Police Force, Zhengzhou, China
| | - Qian-Yu Tian
- Department of Pharmacy, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Cai-E. Wang
- Department of Pharmacy, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Shu-Xun Wei
- Department of Vascular Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University/Second Military Medical University, Shanghai, China
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Gangwani MK, Ahmed Z, Ishtiaq R, Aziz M, Rani A, Dahiya DS, Priyanka F, Arif SF, Lee-Smith W, Sohail AH, Inamdar S, Hassan M. Hepatic encephalopathy with proton pump inhibitor use in post tips patients: a systematic review and meta-analysis. Minerva Gastroenterol (Torino) 2024; 70:353-358. [PMID: 37889110 DOI: 10.23736/s2724-5985.23.03422-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Hepatic encephalopathy (HE) after Trans-jugular intrahepatic portosystemic shunt (TIPS) is a common clinical problem. According to recent studies, Proton pump inhibitor (PPI) use can serve as an independent risk factor for HE. We performed a systematic review and meta-analysis to analyze the association between HE with PPI use versus without PPI use in patients undergoing TIPS. EVIDENCE ACQUISITION We conducted a comprehensive literature search from inception through February 15th, 2022 on MEDLINE, EMBASE, Cochrane Register of Controlled Trials, and Web of Science databases. Odds ratio (OR) was calculated when comparing dichotomous variables of patients with HE vs. no HE in PPI use versus no PPI use in post TIPS patients. A 95% confidence interval (CI) and P values (<0.05 considered significant) were also generated. EVIDENCE SYNTHESIS The search strategy yielded a total of 27 articles. We finalized four studies with a total of 825 patients. There was statistically significant difference in TIPS patients with HE in PPI users versus non-PPI users (OR 3.39 [1.79-6.43], P<0.01, I2=55.5%). Pooled mean average days to hospitalization was 215.2 days to hospitalization for hepatic encephalopathy in non-PPI users compared to 139.5 days in PPI users. CONCLUSIONS Our study determines that there is a higher risk of post-TIPS HE in patients on PPI therapy vs. patients not receiving PPI therapy. We recommend using PPIs at a lower tolerable dose where necessary. Larger studies are needed to draw stronger conclusions.
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Affiliation(s)
- Manesh K Gangwani
- Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA -
| | - Zohaib Ahmed
- Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Rizwan Ishtiaq
- Department of Medicine, St. Francis Hospital, Hartford, CT, USA
| | - Muhammad Aziz
- Department of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA
| | - Anooja Rani
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Dushyant S Dahiya
- Department of Medicine, Central Michigan University College of Medicine, Saginaw, MI, USA
| | - Fnu Priyanka
- Division of Medicine, Shaheed Mohtarma Benazir Bhutto University, Larkana, Pakistan
| | - Syeda F Arif
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Wade Lee-Smith
- Department of Medicine, Alleghany General Hospital, Pittsburgh, PA, USA
| | - Amir H Sohail
- University of Toledo Libraries, University of Toledo, Toledo, OH, USA
| | - Sumant Inamdar
- Department of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mona Hassan
- Department of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA
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Wu B, Xiao M, Wu F, Xu T. Signal of dementia with proton pump inhibitor after minimizing competition bias: an updated disproportionality analysis. Expert Opin Drug Saf 2024:1-8. [PMID: 39082094 DOI: 10.1080/14740338.2024.2387314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2024] [Accepted: 06/27/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVE The association between proton pump inhibitor (PPI) and dementia was controversial. The aim of the current study was to perform an updated pharmacovigilance analysis of the association between dementia event and PPI treatment after minimizing competition bias. METHODS We gathered cases reported with PPI treatment based on the United States Food and Drug Administration Adverse Event Reporting System database from 2004 to 2023. We employed disproportionality algorithms, including reporting odds ratio (ROR) and the information component (IC), to detect the association between dementia event and PPI. We investigated the affection of event competition bias on the current disproportionality signal detection. RESULTS We finally included a total of 776,191 PPI cases, and 1813 cases in the dementia group. Analyzing primary suspect PPIs, we detected a significant association between dementia and PPI (ROR = 1.38, 95%CI 1.22 to 1.56; IC = 0.46, 95%CI 0.04 to 0.86). After excluding the PPI case with renal injury events, the strength of the dementia signal increased. Omeprazole (589 cases), pantoprazole (514 cases), and esomeprazole (386 cases) were the top three PPI reported with dementia events. CONCLUSION The current pharmacovigilance study identified a significant association between dementia and PPIs, except vonoprazan and tegoprazan, especially taking competition bias into account. Further high-quality prospective study still needed.
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Affiliation(s)
- Bin Wu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China
| | - Min Xiao
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Fengbo Wu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ting Xu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- West China School of Pharmacy, Sichuan University, Chengdu, Sichuan, China
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Ortonobes S, Herranz S, Lleal M, Sevilla-Sánchez D, Jordana R, Mascaró O, Ferrández O, de Jaime E, Estrada R, Nazco GJ, Baré M. Multidisciplinary medication review during older patient hospitalization according to STOPP/START criteria reduces potentially inappropriate prescriptions: MoPIM cohort study. BMC Geriatr 2024; 24:584. [PMID: 38978009 PMCID: PMC11232270 DOI: 10.1186/s12877-024-05185-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 06/28/2024] [Indexed: 07/10/2024] Open
Abstract
PURPOSE Multimorbidity and polypharmacy in older adults converts the detection and adequacy of potentially inappropriate drug prescriptions (PIDP) in a healthcare priority. The objectives of this study are to describe the clinical decisions taken after the identification of PIDP by clinical pharmacists, using STOPP/START criteria, and to evaluate the degree of accomplishment of these decisions. METHODS Multicenter, prospective, non-comparative cohort study in patients aged 65 and older, hospitalized because of an exacerbation of their chronic conditions. Each possible PIDP was manually identified by the clinical pharmacist at admission and an initial decision was taken by a multidisciplinary clinical committee. At discharge, criteria were re-applied and final decisions recorded. RESULTS From all patients (n = 674), 493 (73.1%) presented at least one STOPP criteria at admission, significantly reduced up to 258 (38.3%) at discharge. A similar trend was observed for START criteria (36.7% vs. 15.7%). Regarding the top 10 most prevalent STOPP criteria, the clinical committee initially agreed to withdraw 257 (34.2%) prescriptions and to modify 93 (12.4%) prescriptions. However, the evaluation of final clinical decisions revealed that 503 (67.0%) of those STOPP criteria were ultimately amended. For the top 10 START criteria associated PIDP, the committee decided to initiate 149 (51.7%) prescriptions, while a total of 198 (68.8%) were finally introduced at discharge. CONCLUSIONS The clinical committee, through a pharmacotherapy review, succeeded in identifying and reducing the degree of prescription inadequacy, for both STOPP and START criteria, in older patients with high degree of multimorbidity and polypharmacy. TRIAL REGISTRATION NCT02830425.
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Affiliation(s)
- Sara Ortonobes
- Pharmacy Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08208, Sabadell, Spain.
| | - Susana Herranz
- Acute Care Geriatric Unit, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08208, Sabadell, Catalonia, Spain
- Research Network On Health Services in Chronic Patients (REDISSEC), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | - Marina Lleal
- Clinical Epidemiology and Cancer Screening Department, Parc Taulí Hospital Universitari, Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08208, Sabadell, Spain
- Department of Paediatrics, Obstetrics and Gynaecology, Preventive Medicine and Public Health, Autonomous University of Barcelona (UAB), 08193, Bellaterra, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Instituto de Salud Carlos III, 28029, Madrid, Spain
| | | | - Rosa Jordana
- Internal Medicine Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 08208, Sabadell, Spain
| | - Oscar Mascaró
- Internal Medicine Department, University Hospital of Vic, Multidisciplinary Inflamation Research Group (MIRG), Facultat de Medicina, Universitat de Vic, Universitat Central de Catalunya, 08500, Vic, Spain
| | - Olivia Ferrández
- Pharmacy Department, Consorci Parc de Salut Mar, 08003, Barcelona, Spain
| | - Elisabet de Jaime
- Geriatrics Department, Consorci Parc de Salut Mar, 08003, Barcelona, Spain
| | - Rafael Estrada
- Internal Medicine, Hospital Galdakao-Usansolo, 48960, Galdakao, Spain
| | - Gloria Julia Nazco
- Pharmacy Department, Hospital Universitario de Canarias, 38320, La Laguna, Spain
| | - Marisa Baré
- Research Network On Health Services in Chronic Patients (REDISSEC), Instituto de Salud Carlos III, 28029, Madrid, Spain.
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Instituto de Salud Carlos III, 28029, Madrid, Spain.
- Primary Care Center, CAP Can Rull, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), 08206, Sabadell, Spain.
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Ito T, Ramos-Alvarez I, Jensen RT. Long-Term Proton Pump Inhibitor-Acid Suppressive Treatment Can Cause Vitamin B 12 Deficiency in Zollinger-Ellison Syndrome (ZES) Patients. Int J Mol Sci 2024; 25:7286. [PMID: 39000391 PMCID: PMC11242121 DOI: 10.3390/ijms25137286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 06/26/2024] [Accepted: 06/28/2024] [Indexed: 07/16/2024] Open
Abstract
Whether the long-term treatment of patients with proton pump inhibitors (PPIs) with different diseases [GERD, Zollinger-Ellison syndrome (ZES), etc.] can result in vitamin B12 (VB12) deficiency is controversial. In this study, in 175 patients undergoing long-term ZES treatment with anti-acid therapies, drug-induced control acid secretory rates were correlated with the presence/absence of VB12 deficiency, determined by assessing serum VB12 levels, measurements of VB12 body stores (blood methylmalonic acid (MMA) and total homocysteine[tHYC]), and other features of ZES. After a mean of 10.2 yrs. of any acid treatment (5.6 yrs. with PPIs), 21% had VB12 deficiency with significantly lower serum and body VB12 levels (p < 0.0001). The presence of VB12 deficiency did not correlate with any feature of ZES but was associated with a 12-fold lower acid control rate, a 2-fold higher acid control pH (6.4 vs. 3.7), and acid control secretory rates below those required for the activation of pepsin (pH > 3.5). Over a 5-yr period, the patients with VB12 deficiency had a higher rate of achlorhydria (73% vs. 24%) and a lower rate of normal acid secretion (0% vs. 49%). In conclusion, in ZES patients, chronic long-term PPI treatment results in marked acid hyposecretion, resulting in decreased serum VB12 levels and decreased VB12-body stores, which can result in VB12 deficiency.
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Affiliation(s)
- Tetsuhide Ito
- Neuroendocrine Tumor Centra, Fukuoka Sanno Hospital, International University of Health and Welfare, 3-6-45 Momochihama, Sawara-Ku, Fukuoka 814-0001, Japan
| | | | - Robert T Jensen
- Digestive Diseases Branch, NIDDK, NIH, Bethesda, MD 20892-1804, USA
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Kim H, Nzabarushimana E, Huttenhower C, Chan AT, Nguyen LH. Altered Microbial Transcription in Long-term Proton Pump Inhibitor Use: Findings From a United States Cohort Study. Gastroenterology 2024; 167:405-408.e3. [PMID: 38521094 PMCID: PMC11193639 DOI: 10.1053/j.gastro.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Hanseul Kim
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Etienne Nzabarushimana
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Curtis Huttenhower
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Broad Institute of MIT and Harvard University, Cambridge, Massachusetts; The Harvard Chan Microbiome in Public Health Center, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Department of Immunology and Infectious Diseases, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Long H Nguyen
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Division of Gastroenterology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
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13
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Fan W, Liu H, Shen Y, Hong K. The Association of Proton Pump Inhibitors and QT Interval Prolongation in Critically Ill Patients. Cardiovasc Drugs Ther 2024; 38:517-525. [PMID: 36625987 DOI: 10.1007/s10557-023-07425-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/31/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Drug-induced QT interval prolongation has been reported to be related to life-threatening polymorphic ventricular tachycardia (torsade de pointes). Proton pump inhibitors (PPIs) are prescribed widely for hospitalized patients; the QT interval prolongation and torsade de pointes caused by PPIs were reported. We conducted a study to determine the association between PPI treatment and QT interval prolongation in critically ill patients. METHODS This study included patients with electrocardiography (ECG) reports from the Medical Information Mart for Intensive Care III database (MIMIC-III). Patients younger than 18 years, missing baseline laboratories and with QT interval prolongation before intensive care unit (ICU) admission were excluded. The end point was the diagnosis of QT interval prolongation reported by ECG. RESULTS This study included 24,512 ICU patients. Of them, 11,327 patients were treated with PPIs, 4181 with histamine 2 receptor antagonists (H2RAs) and 6351 without acid suppression therapy (non-AST); the incidence of QT interval prolongation were 8.5%, 3.3% and 3.4% respectively. After adjustment for demographics, electrolytes, comorbidities and medications, PPIs were associated a higher risk of QT interval prolongation compared with H2RAs (OR 1.66, 95% CI 1.36 - 2.03) and non-AST (OR 1.54, 95% CI 1.31 - 1.82), while there was not significant difference between H2RAs and non-AST (OR 0.93, 95% CI 0.73 - 1.17). In the propensity score matching population, the results were consistent. Pantoprazole (OR 2.14, 95% CI 1.52 - 3.03) and lansoprazole (OR 1.80, 95% CI: 1.18 - 2.76) showed a higher QT prolongation risk than omeprazole. Several drugs caused higher QT prolongation risk when used in combination with PPIs. CONCLUSION In ICU patients, the association between PPI prescription and increased risk of QT interval prolongation was independent of known QT-prolonging factors; pantoprazole and lansoprazole had a higher risk compared with omeprazole. The combination of PPIs and other QT-prolonging drugs should be avoided.
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Affiliation(s)
- Weiguo Fan
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, NO 1 Mingde Road, Nanchang, Jiangxi, China
| | - Hualong Liu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, NO 1 Mingde Road, Nanchang, Jiangxi, China
| | - Yang Shen
- Jiangxi Key Laboratory of Molecular Medicine, Nanchang, Jiangxi, China
- Department of Genetic Medicine, the Second Affiliated Hospital of Nanchang University, NO 1 Mingde Road, Nanchang, Jiangxi, China
| | - Kui Hong
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, NO 1 Mingde Road, Nanchang, Jiangxi, China.
- Jiangxi Key Laboratory of Molecular Medicine, Nanchang, Jiangxi, China.
- Department of Genetic Medicine, the Second Affiliated Hospital of Nanchang University, NO 1 Mingde Road, Nanchang, Jiangxi, China.
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14
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Wolffenbuttel BHR, McCaddon A, Ahmadi KR, Green R. A Brief Overview of the Diagnosis and Treatment of Cobalamin (B12) Deficiency. Food Nutr Bull 2024; 45:S40-S49. [PMID: 38987879 DOI: 10.1177/03795721241229500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
BACKGROUND An increasing number of adult individuals are at risk of vitamin B12 deficiency, either from reduced nutritional intake or impaired gastrointestinal B12 absorption. OBJECTIVE This study aims to review the current best practices for the diagnosis and treatment of individuals with vitamin B12 deficiency. METHODS A narrative literature review of the diagnosis and treatment of vitamin B12 deficiency. RESULTS Prevention and early treatment of B12 deficiency is essential to avoid irreversible neurological consequences. Diagnosis is often difficult due to diverse symptoms, marked differences in diagnostic assays' performance and the unreliability of second-line biomarkers, including holo-transcobalamin, methylmalonic acid and total homocysteine. Reduced dietary intake of B12 requires oral supplementation. In B12 malabsorption, oral supplementation is likely insufficient, and parenteral (i.e. intramuscular) supplementation is preferred. There is no consensus on the optimal long-term management of B12 deficiency with intramuscular therapy. According to the British National Formulary guidelines, many individuals with B12 deficiency due to malabsorption can be managed with 1000 µg intramuscular hydroxocobalamin once every two months after the initial loading. Long-term B12 supplementation is effective and safe, but responses to treatment may vary considerably. Clinical and patient experience strongly suggests that up to 50% of individuals require individualized injection regimens with more frequent administration, ranging from daily or twice weekly to every 2-4 weeks, to remain symptom-free and maintain a normal quality of life. 'Titration' of injection frequency based on measuring biomarkers such as serum B12 or MMA should not be practiced. There is currently no evidence to support that oral/sublingual supplementation can safely and effectively replace injections. CONCLUSIONS This study highlights the interindividual differences in symptomatology and treatment of people with B12 deficiency. Treatment follows an individualized approach, based on the cause of the deficiency, and tailored to help someone to become and remain symptom-free.
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Affiliation(s)
| | - Andrew McCaddon
- Faculty of Social and Life Sciences, Wrexham University, Wrexham, United Kingdom
| | - Kourosh R Ahmadi
- School of Biosciences and Medicine, University of Surrey, Guildford, United Kingdom
| | - Ralph Green
- University of California Davis, Sacramento, CA, USA
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Liu J, Jiang J, Xu Q, Xu Y, Guo M, Hu Y, Wang Y, Wang Y. Xuanfu Daizhe Tang alleviates reflux esophagitis in rats by inhibiting the STAT1/TREM-1 pathway. JOURNAL OF ETHNOPHARMACOLOGY 2024; 326:117903. [PMID: 38342154 DOI: 10.1016/j.jep.2024.117903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/13/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Reflux esophagitis (RE) is a common chronic inflammatory disease of the esophageal mucosa with a high prevalence and recurrence rate, for which a satisfactory therapeutic strategy is still lacking. Chinese medicine has its characteristics and advantages in treating RE, and the clinical application of Xuanfu Daizhe Tang (XDT) in treating RE has achieved sound therapeutic effects. However, there needs to be more research on its mechanism of action. AIM OF THE STUDY The present work aimed to investigate the mechanism of XDT action in RE through the Signal Transducer and Activator of Transcription 1 (STAT1)/Triggering Receptor Expressed on Myeloid cells-1 (TREM-1) pathway. MATERIALS AND METHODS The main active components of XDT were analyzed by ultra-performance liquid chromatography-mass spectrometer (UPLC-MS). The effect of XDT on RE was evaluated in a rat model of RE induced by "Cardioplasty + pyloric ligation + Roux-en-Y esophagojejunostomy". Each administration group was treated by gavage. The degree of damage to the esophageal mucosa was evaluated by visual observation, and the Potential of Hydrogen (PH) method and Hematoxylin-eosin staining (HE) staining were performed. Serum levels of Interleukin-1β (IL-1β), Interleukin-6 (IL-6), Tumor Necrosis Factor alpha (TNF-α), and Inducible Nitric Oxide Synthase (iNOS) were measured by ELISA. Quantitative Real-time PCR (qPCR), Western Blot (WB), and Immunofluorescence (IF) methods were used to detect Claudin-4, Claudin-5, TREM-1, and p-STAT1 in esophageal tissues for studying the mechanism of action and signaling pathway of XDT. Immunohistochemistry (IHC) analysis was used to detect the expression of TREM-1 and CD68 in esophageal tissues. Flow Cytometry (FC) was used to detect the polarization of macrophages in the blood. After conducting preliminary experiments to verify our hypothesis, we performed molecular docking between the active component of XDT and STAT1 derived from rats and parallel experiments with STAT1 inhibitor. The selective increaser of STAT1 transcription (2-NP) group was used to validate the mechanism by which XDT acts. RESULTS XDT alleviated esophageal injury and attenuated histopathological changes in RE rats. XDT also inhibited the inflammatory response and decreased serum IL-1β, IL-6, TNF-α, and iNOS levels in RE rats. qPCR and WB results revealed that XDT inhibited the expression of Claudin-4, Claudin-5, TREM-1, and STAT1 in the esophageal mucosa of RE rats. IHC and FC results showed that XDT reduced TREM-1 levels in esophageal tissues and polarized macrophages toward M2. The molecular docking results showed that rat-derived STAT1 can strongly bind to Isochronogenic acid A in XDT. The parallel experimental results of STAT1 inhibitor showed that XDT has anti-inflammatory effects similar to STAT1 inhibitors. The 2-NP group confirmed that XDT exerts its therapeutic effect on reflux esophagitis through the STAT1/TREM-1 pathway, with STAT1 as the upstream protein. CONCLUSIONS This study suggests that XDT may treat reflux esophagitis by modulating the STAT1/TREM-1 pathway.
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Affiliation(s)
- Ju Liu
- Office of Science and Technology Administration, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - Jiaxin Jiang
- Nanjing University of Chinese Medicine, Nanjing, 210023, China
| | - Qianfei Xu
- Department of Spleen, Stomach and Hepatobiliary, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - Yunyan Xu
- Preventive Treatment Department, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - Manman Guo
- Pharmaceutical Department, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - Yun Hu
- Department of Spleen, Stomach and Hepatobiliary, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - Yan Wang
- Nanjing University of Chinese Medicine, Nanjing, 210023, China.
| | - Yi Wang
- Pharmaceutical Department, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China.
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Rosa Júnior IA, Almeida DDS, Napolitano HB, Peixoto JDC, Rosseto LP, Hungria Pinto EM, Dias LD, Fajemiroye JO, Costa EA, Vieira RP, Martins JLR. Evaluation of Gastroprotective Activity of the Methanolic Extract of Justicia pectoralis Jacq. (Acanthaceae). Nutrients 2024; 16:1430. [PMID: 38794668 PMCID: PMC11123913 DOI: 10.3390/nu16101430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/19/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Justicia pectoralis Jacq. is traditionally applied in folk medicine in Brazil and in several Latin American countries. The leaves are used in tea form, especially in the treatment of respiratory disorders, acting as an expectorant. It also has activity in gastrointestinal disorders, and it is anti-inflammatory, antioxidant, sedative, and estrogenic, among others. AIMS To investigate the gastroprotective activity of the methanol extract of the leaves of Justicia pectoralis Jacq. (MEJP) in different experimental models of gastric ulcers. MATERIALS AND METHODS The adult leaves of Justicia pectoralis Jacq. were collected and cultivated in beds, with an approximate spacing of 40 × 40 cm, organic fertilization, irrigation with potable water and without shelter from light. The MEJP was prepared from the dried and pulverized leaves and concentrated under reduced pressure in a rotary evaporator. For the experimental model of gastric ulcer, Swiss male albino mice were used. The inputs used in the experiment were MEJP at three different concentrations (250, 500 and 1000 mg/kg p.o.), cimetidine (50 mg/kg p.o.), indomethacin (50 mg/kg s.c.) and vehicle (10 mL/kg p.o.). RESULTS MEJP (250, 500 and 1000 mg/kg p.o.) demonstrated gastroprotective activity, with levels of protection of 45.65%, 44.80% and 40.22%, respectively, compared to the control (vehicle). Compared with cimetidine (48.29%), MEJP showed similar gastroprotective activity. CONCLUSIONS This study demonstrated the gastroprotective activity of MEJP and contributes to validate the traditional use the species for gastric disorders and provides a pharmacological basis for its clinical potential.
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Affiliation(s)
- Ismael Aureliano Rosa Júnior
- Postgraduate Program in Pharmaceutical Sciences, Pharmacology and Therapeutics, Evangelical University of Goiás—Unievangélica, University Avenue Km 3,5, Anápolis 75083-515, GO, Brazil; (I.A.R.J.); (H.B.N.); (J.d.C.P.); (L.P.R.); (E.M.H.P.); (L.D.D.); (J.O.F.); (R.P.V.)
- Instituto de Ciência, Tecnologia e Qualidade—ICTQ, Anápolis 75023-085, GO, Brazil
| | - Dionys de Souza Almeida
- Institute of Biological Sciences, Department of Pharmacology, Federal University of Goiás, Campus Samambaia, Campus Street, Goiânia 74001-97, GO, Brazil; (D.d.S.A.); (E.A.C.)
| | - Hamilton Barbosa Napolitano
- Postgraduate Program in Pharmaceutical Sciences, Pharmacology and Therapeutics, Evangelical University of Goiás—Unievangélica, University Avenue Km 3,5, Anápolis 75083-515, GO, Brazil; (I.A.R.J.); (H.B.N.); (J.d.C.P.); (L.P.R.); (E.M.H.P.); (L.D.D.); (J.O.F.); (R.P.V.)
- Campus Central, State University of Goiás, Anápolis 75132-400, GO, Brazil
| | - Josana de Castro Peixoto
- Postgraduate Program in Pharmaceutical Sciences, Pharmacology and Therapeutics, Evangelical University of Goiás—Unievangélica, University Avenue Km 3,5, Anápolis 75083-515, GO, Brazil; (I.A.R.J.); (H.B.N.); (J.d.C.P.); (L.P.R.); (E.M.H.P.); (L.D.D.); (J.O.F.); (R.P.V.)
- Campus Central, State University of Goiás, Anápolis 75132-400, GO, Brazil
| | - Lucimar Pinheiro Rosseto
- Postgraduate Program in Pharmaceutical Sciences, Pharmacology and Therapeutics, Evangelical University of Goiás—Unievangélica, University Avenue Km 3,5, Anápolis 75083-515, GO, Brazil; (I.A.R.J.); (H.B.N.); (J.d.C.P.); (L.P.R.); (E.M.H.P.); (L.D.D.); (J.O.F.); (R.P.V.)
| | - Emerith Mayra Hungria Pinto
- Postgraduate Program in Pharmaceutical Sciences, Pharmacology and Therapeutics, Evangelical University of Goiás—Unievangélica, University Avenue Km 3,5, Anápolis 75083-515, GO, Brazil; (I.A.R.J.); (H.B.N.); (J.d.C.P.); (L.P.R.); (E.M.H.P.); (L.D.D.); (J.O.F.); (R.P.V.)
- Campus Central, State University of Goiás, Anápolis 75132-400, GO, Brazil
| | - Lucas Danilo Dias
- Postgraduate Program in Pharmaceutical Sciences, Pharmacology and Therapeutics, Evangelical University of Goiás—Unievangélica, University Avenue Km 3,5, Anápolis 75083-515, GO, Brazil; (I.A.R.J.); (H.B.N.); (J.d.C.P.); (L.P.R.); (E.M.H.P.); (L.D.D.); (J.O.F.); (R.P.V.)
| | - James Oluwagbamigbe Fajemiroye
- Postgraduate Program in Pharmaceutical Sciences, Pharmacology and Therapeutics, Evangelical University of Goiás—Unievangélica, University Avenue Km 3,5, Anápolis 75083-515, GO, Brazil; (I.A.R.J.); (H.B.N.); (J.d.C.P.); (L.P.R.); (E.M.H.P.); (L.D.D.); (J.O.F.); (R.P.V.)
- Institute of Biological Sciences, Department of Pharmacology, Federal University of Goiás, Campus Samambaia, Campus Street, Goiânia 74001-97, GO, Brazil; (D.d.S.A.); (E.A.C.)
| | - Elson Alves Costa
- Institute of Biological Sciences, Department of Pharmacology, Federal University of Goiás, Campus Samambaia, Campus Street, Goiânia 74001-97, GO, Brazil; (D.d.S.A.); (E.A.C.)
| | - Rodolfo P. Vieira
- Postgraduate Program in Pharmaceutical Sciences, Pharmacology and Therapeutics, Evangelical University of Goiás—Unievangélica, University Avenue Km 3,5, Anápolis 75083-515, GO, Brazil; (I.A.R.J.); (H.B.N.); (J.d.C.P.); (L.P.R.); (E.M.H.P.); (L.D.D.); (J.O.F.); (R.P.V.)
- Postgraduate Program in Human Movement and Rehabilitation, Evangelical University of Goiás—Unievangélica, University Avenue Km 3,5, Anápolis 75083-515, GO, Brazil
| | - José Luis Rodrigues Martins
- Postgraduate Program in Pharmaceutical Sciences, Pharmacology and Therapeutics, Evangelical University of Goiás—Unievangélica, University Avenue Km 3,5, Anápolis 75083-515, GO, Brazil; (I.A.R.J.); (H.B.N.); (J.d.C.P.); (L.P.R.); (E.M.H.P.); (L.D.D.); (J.O.F.); (R.P.V.)
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Division of Gastroenterohepatology, Faculty of Medicine, Universitas Airlangga/Dr. Soetomo General Academic Teaching Hospital, Surabaya, Indonesia, Maimunah U, Kurniawan AA, Department of Internal Medicine, Faculty of Medicine Universitas Airlangga/Dr. Soetomo General Academic Teaching Hospital, Surabaya, Indonesia, Palayukan A, Department of Internal Medicine, Faculty of Medicine Universitas Airlangga/Dr. Soetomo General Academic Teaching Hospital, Surabaya, Indonesia. Adverse Effects of Long-term Proton Pump Inhibitors in Chronic Liver Disease Patients – A Preliminary Article Review. REVIEW OF CLINICAL PHARMACOLOGY AND PHARMACOKINETICS - INTERNATIONAL EDITION 2024; 38:87-97. [DOI: 10.61873/wway6273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Abstract
Background: Proton pump inhibitors (PPIs) are widely prescribed medications for the management of gastroesophageal reflux disease (GERD) and peptic ulcer disease. Despite their efficacy, concerns have emerged regarding their potential adverse effects, particularly in patients with chronic liver disease (CLD). CLD patients often experience gastrointestinal symptoms and may be prescribed PPIs, but the impact of PPI use on liver function and disease progression remains uncertain. Scope: This study aims to evaluate the adverse effects of PPIs on CLD patients through a review of available literature. The scope encompasses a review of studies examining the association between PPI use and liver-related outcomes, including hepatic encephalopathy, hepatic decompensation, liver cirrhosis progression, and mortality, among CLD patients. Method: A scoping review of relevant literature were conducted to identify studies investigating the adverse effects of PPIs in CLD patients. Databases including PubMed and Google Scholar were searched for articles published up to January, 1 2023. Eligible studies were selected based on predefined inclusion criteria. Results: The review identified 27 studies meeting the inclusion criteria, comprising observational studies and meta-analysis. The review revealed a significant association between PPI use and adverse liver outcomes in CLD patients. Specifically, PPI use was associated with increased risk of SBP based on studies reviewed, while other complications remained inconclusive. Conclusion: The findings suggest that PPI use may have detrimental effects on disease progression in CLD patients, Long-term use of PPIs can lead to higher risk of SBP in CLD patients. Clinicians should exercise caution when prescribing PPIs to this vulnerable population and consider alternative treatment options or minimize PPI use to mitigate potential adverse outcomes. Further research is warranted to elucidate the underlying mechanisms, confirm the effect of PPIs toward other complications of CLD and establish guidelines for PPI use in CLD patients.
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Kahrilas P, Anastasiou F, Bredenoord AJ, El Serag HB, Labenz J, Mendive J, Savarino EV, Sifrim D, Udrescu M, Yadlapati R, Hungin AP. Proton Pump Inhibitors: Rational Use and Use-Reduction - The Windsor Workshop. Dig Dis 2024; 42:211-220. [PMID: 38513623 DOI: 10.1159/000538399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Despite deprescribing initiatives to curb overutilization of proton pump inhibitors (PPIs), achieving meaningful reductions in PPI use is proving a challenge. SUMMARY An international group of primary care doctors and gastroenterologists examined the literature surrounding PPI use and use-reduction to clarify: (i) what constitutes rational PPI prescribing; (ii) when and in whom PPI use-reduction should be attempted; and (iii) what strategies to use when attempting PPI use-reduction. KEY MESSAGES Before starting a PPI for reflux-like symptoms, patients should be educated on potential causes and alternative approaches including dietary and lifestyle modification, weight loss, and relaxation strategies. When commencing a PPI, patients should understand the reason for treatment, planned duration, and review date. PPI use at hospital discharge should not be continued without a recognized indication for long-term treatment. Long-term PPI therapy should be reviewed at least annually. PPI use-reduction should be based on the lack of a rational indication for long-term PPI use, not concern for PPI-associated adverse events. PPI use-reduction strategies involving switching to on-demand PPI or dose tapering, with rescue therapy for rebound symptoms, are more likely to succeed than abrupt cessation.
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Affiliation(s)
- Peter Kahrilas
- Division of Gastroenterology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Foteini Anastasiou
- 4th Local Primary Care Team, Municipality Practice and Academic Practice of Heraklion, Crete, Greece
| | - Albert J Bredenoord
- Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Hashem B El Serag
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Joachim Labenz
- Department of Internal Medicine, Jung-Stilling-Hospital, Siegen, Germany
| | - Juan Mendive
- La Mina Primary Care Academic Centre, Catalan Health Institute, University of Barcelona, Barcelona, Spain
| | - Edoardo V Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Daniel Sifrim
- Wingate Institute of Neurogastroenterology, Queen Mary University of London, London, UK
| | | | - Rena Yadlapati
- Division of Gastroenterology, University of California San Diego, La Jolla, California, USA
| | - A Pali Hungin
- Faculty of Medical Sciences, Professor Emeritus, Primary Care and General Practice, Newcastle University, Newcastle upon Tyne, UK
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Zou S, Ouyang M, Cheng Q, Shi X, Sun M. Acid-suppressive drugs: A systematic review and network meta-analysis of their nocturnal acid-inhibitory effect. Pharmacotherapy 2024; 44:171-183. [PMID: 38049205 DOI: 10.1002/phar.2899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND AND AIMS Acid-suppressive drugs (ASDs) are widely used in many gastric acid-associated diseases. Nocturnal acid breakthrough has been a common problem of many ASDs, such as proton-pump inhibitors (PPIs) and H2 -receptor antagonists (H2RAs). Potassium-competitive acid blockers (P-CABs) are expected to solve this continuing conundrum. This article examined major ASDs and compared them with placebo in terms of nocturnal acid-inhibitory effects, using a network meta-analysis of randomized controlled trials (RCTs). METHODS To compare the effectiveness of major ASDs, a Bayesian network meta-analysis (NMA) was applied to process data extracted from RCTs. The plausible ranking for each regimen and some subgroups were assessed by surface under the cumulative ranking curves (SUCRA). RESULTS Fifty-five RCTs were conducted with 2015 participants. In terms of nocturnal acid-inhibitory effects, the overall results showed that tegoprazan (SUCRA 91.8%) and vonoprazan (SUCRA 91.0%) had the best performance, followed by new PPIs (including tenatoprazole and ilaprazole) (SUCRA 76.6%), additional H2RAs once at bedtime (AHB) (SUCRA 61.3%), isomer PPIs (including esomeprazole and dexlansoprazole) (SUCRA 38.6%), revaprazan (SUCRA 34.7%), traditional PPIs (including omeprazole, rabeprazole, pantoprazole, lansoprazole) (SUCRA 32.6%), H2RAs (SUCRA 23.1%), and placebo (SUCRA 0.3%). In some subgroups, the nocturnal acid-inhibitory effect of vonoprazan or tegoprazan was better than most of the other regimens, even new PPIs and AHB. CONCLUSIONS This is the first study to compare the effect of ASDs on inhibiting nocturnal acid breakthrough. Overall, in terms of nocturnal acid-inhibitory effect, vonoprazan and tegoprazan had an advantage against other regimens including H2RAs, isomer PPIs, traditional PPIs, AHB, and new PPIs. Even in some subgroups, such as language classification (English), types of study design (crossover-RCT), age (≤40 years), BMI (18.5-24.9 kg/m2 ), continent (Asia and North America), disease status (health), the duration of therapy (2 weeks), and time of administration (at daytime or at night-time), the nocturnal acid-inhibitory effect of vonoprazan or tegoprazan were better than most regimens, even AHB and new PPIs.
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Affiliation(s)
- Shupeng Zou
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Mengling Ouyang
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Qian Cheng
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xuan Shi
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Minghui Sun
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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Casal GL, Bittner EA. Pump the Breaks on the Slide to Harm From Nonindicated Proton Pump Inhibitors After Critical Illness! Crit Care Med 2024; 52:334-337. [PMID: 38240512 DOI: 10.1097/ccm.0000000000006126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
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21
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Higinbotham AS, Kilbane CW. The gastrointestinal tract and Parkinson's disease. Front Cell Infect Microbiol 2024; 13:1158986. [PMID: 38292855 PMCID: PMC10825967 DOI: 10.3389/fcimb.2023.1158986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 12/14/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Alissa S. Higinbotham
- Parkinson's disease and Movement Disorders Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Camilla W. Kilbane
- Parkinson's disease and Movement Disorders Center, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
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22
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Bhatnagar MS, Choudhari S, Pawar D, Sharma A. Long-Term Use of Proton-Pump Inhibitors: Unravelling the Safety Puzzle. Cureus 2024; 16:e52773. [PMID: 38389608 PMCID: PMC10882567 DOI: 10.7759/cureus.52773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
Globally, over 25% of the population suffers from acid-related disorders such as dyspepsia or gastroesophageal reflux disease (GERD), and around 7.6% of Indians report having GERD symptoms on a frequent enough basis to warrant a diagnosis. Over the past three decades, proton-pump inhibitors (PPIs) have been the mainstay of medical therapy for acid-peptic diseases like GERD, etc. Additionally, they are frequently prescribed for prophylactic purposes and in conjunction with non-steroidal anti-inflammatory drugs. PPIs are generally prescribed for four to eight weeks. However, it may be prescribed for patients with comorbidities and multiple medications for a longer period of time. While this remains true in terms of effectiveness, concerns have been raised about the safety of long-term PPI use and the serious adverse effects that may result. Some of the observational and population-based cohort studies have shown an association between long-term use of PPIs and an increased risk of pneumonia, major cardiovascular events, dementia, vitamin B12 deficiency, bone fractures, gastric cancer, and kidney injury, among others. This review analyzes the clinical data supporting the long-term use of PPIs and takes a deep dive into whether these several emerging long-term concerns apply to the currently available PPIs in India. We have summarized a vast array of studies, including randomized trials, cohort studies, and meta-analyses, that report low or high incidences of major health risks linked with PPIs and have assessed their appropriateness over a given period.
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Eduin B, Roubille C, Badiou S, Cristol JP, Fesler P. Association between Elevated Plasma Vitamin B12 and Short-Term Mortality in Elderly Patients Hospitalized in an Internal Medicine Unit. Int J Clin Pract 2023; 2023:6652671. [PMID: 38146346 PMCID: PMC10749720 DOI: 10.1155/2023/6652671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 10/14/2023] [Accepted: 11/25/2023] [Indexed: 12/27/2023] Open
Abstract
Background The prognostic value of vitamin B12 blood levels remains controversial. An association between elevated vitamin B12 and mortality has been reported, particularly among elderly patients with cancers and liver or blood diseases. The present study explored the relationship between mortality and elevated vitamin B12 levels in a population of unscheduled inpatients in an internal medicine unit. Methods This retrospective observational analysis was conducted between August 2014 and December 2018. We compared 165 patients with elevated plasma vitamin B12 levels (>600 pmol/l) with a random sample of 165 patients with normal B12 levels who were hospitalized during the same period. Demographic, clinical, and biological characteristics were assessed during hospitalization. The primary endpoint was all-cause death at 1 year. Results Patients with elevated B12 were younger, with a lower body mass index and lower plasma albumin than those with normal B12 (75 ± 16 years vs 79 ± 13 years, p = 0.047; 23 ± 5 vs 26 ± 7 kg/m2, p < 0.001; and 33 ± 5 vs 35 ± 5 g/l, p < 0.001, respectively). The prevalence of auto-immune disease and referral from an intensive care unit was higher among patients with elevated B12 (11% vs 5%, p = 0.043 and 36% vs 10%, p < 0.001, respectively). After 1 year of follow-up, 64 (39%) patients with elevated B12 had died compared to 43 (26%) patients with normal B12 (p = 0.018). Multivariate analysis using the Cox proportional hazards regression model adjusted for age, gender, body mass index, intensive care unit hospitalization, albumin level, and the presence of solid cancer or autoimmune disease revealed elevated B12 to be associated with a significant risk of death in the first year of follow-up (hazard ratio: 1.71 [1.08-2.7], p = 0.022). Conclusion Elevated B12 is an early warning indicator of increased short-term mortality, such as independently of age, cancer, or comorbidities, in patients hospitalized in an internal medicine department.
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Affiliation(s)
- Benjamin Eduin
- Department of Internal Medicine, University Hospital of Montpellier, Montpellier, France
| | - Camille Roubille
- Department of Internal Medicine, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, University Hospital of Montpellier, Montpellier, France
| | - Stéphanie Badiou
- PhyMedExp, University of Montpellier, INSERM, CNRS, University Hospital of Montpellier, Montpellier, France
- Department of Biochemistry and Hormonology, University Hospital of Montpellier, Montpellier, France
| | - Jean Paul Cristol
- PhyMedExp, University of Montpellier, INSERM, CNRS, University Hospital of Montpellier, Montpellier, France
- Department of Biochemistry and Hormonology, University Hospital of Montpellier, Montpellier, France
| | - Pierre Fesler
- Department of Internal Medicine, University Hospital of Montpellier, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, University Hospital of Montpellier, Montpellier, France
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Paudel Y, Najam B, Desai HN, Illango J, Seffah KD, Kumar M, Naveen N, Pachchipulusu VK, Penumetcha SS. Use of Proton Pump Inhibitors and Risk of Fracture in Adults: A Review of Literature. Cureus 2023; 15:e49872. [PMID: 38170137 PMCID: PMC10760937 DOI: 10.7759/cureus.49872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/03/2023] [Indexed: 01/05/2024] Open
Abstract
Proton pump inhibitors (PPIs) are commonly used medications for various gastrointestinal disorders and are reported to be associated with bone fractures. A literature review was performed, which showed PPI to be associated with a shorter time to first fracture in adults aged 25 or older. There was an overall increased risk of fractures with PPI use in adults; however, such risk was not significantly higher in women over 80 years of age and adult patients with rheumatoid arthritis. In healthy adult males aged 18-50 years, PPI use was not associated with significant changes in calcium and bone metabolism with PPI use. The lack of increased risk among elderly women aged more than 80 and rheumatoid arthritis patients raises the possible confounding or effect modification by factors that affect the fracture risk with PPI use. We concluded that although observational studies show an increased risk of fractures with PPI use, warranting their use with caution in some patients, experimental evidence explaining the risk is still lacking.
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Affiliation(s)
- Yubraj Paudel
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Beenish Najam
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Heet N Desai
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Janan Illango
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Kofi D Seffah
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Piedmont Athens Regional Medical, Athens, USA
| | - Mahendar Kumar
- Anaesthesia, Our Lady of Lourdes Hospital, Drogheda, IRL
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Namballa Naveen
- Emergency Medicine, Steel Authority of India (SAIL) Hospital, Dhanbad, IND
- Cardiology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | | | - Sai Sri Penumetcha
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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Fazio TN, Healy L, Heise T, Inwood A, Manolikos C, Rahman Y, Woerle HJ, Hendriksz CJ. Pharmacodynamics, safety, tolerability and pharmacokinetics of a single oral dose of an engineered phenylalanine ammonia-lyase in patients with phenylketonuria. Mol Genet Metab Rep 2023; 37:101012. [PMID: 38053938 PMCID: PMC10694774 DOI: 10.1016/j.ymgmr.2023.101012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 12/07/2023] Open
Abstract
The cornerstone treatment of hyperphenylalaninemia (HPA) and phenylketonuria (PKU) is a lifelong low-protein diet with phenylalanine (Phe) free L-amino acid supplements. However, the PKU diet has significant shortcomings, and there is a clinically unmet need for new therapeutics to improve patient outcomes. CDX-6114 is a modified phenylalanine ammonia-lyase (PAL) enzyme obtained by a mutation in the Anabaena variabilis PAL sequence. CodeEvolver® protein engineering technology has been applied to improve the degradation resistance of the enzyme. In our first phase I trial, 19 patients were given a single oral dose of CDX-6114 at 7.5 g, 2.5 g, 0.7 g, or placebo in a cross-over design. After an overnight fast, patients received a standardised breakfast of 20 g of protein, thus exceeding the dietary recommendations for a single meal in patients with PKU. Plasma levels of Phe and cinnamic acid (CA) were measured over a 5-h period following CDX-6114 dosing. During the development of CDX-6114, a stability assessment using reverse-phase high-performance liquid chromatography (HPLC) assay revealed two peaks. The second peak was identified as CA. It was not previously known that as part of the mechanism of action, the CA remained associated with the protein following the conversion of Phe. Thus, recalculating the historical PAL enzyme amounts in CDX-6114 bulk substance was necessary. An updated extinction coefficient was achieved by applying a correction factor of 0.771 to previously reported doses. Postprandial plasma levels of Phe increased in all dose cohorts over time between 10% and 30% from baseline, although the actual peak of Phe levels was not achieved within the 5-h observation. When accounting for the interquartile ranges, these concentrations were similar to the placebo. As plasma levels of Phe were no longer a reliable marker for pharmacodynamics, the consistently detectable amount of CA seen in all patients who received CDX-6114 provided proof of the enzymatic activity of CDX-6114 in metabolising gastrointestinal Phe. Peak levels of CA were seen shortly after CDX-6114 intake, with a rapid decline, and remained low compared with the plasma Phe levels. This pattern indicates a short half-life, possibly due to the liquid formulation or the inability to withstand the lower pH in the human stomach compared with animal models in earlier studies. This was the first trial in patients with PKU to establish the safety and tolerability of CDX-6114. A single dose of CDX-6114 was safe and well tolerated, with no serious adverse events or presence of anti-drug antibodies detected. Efficacy will be explored in future trials using an optimised formulation.
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Affiliation(s)
- Timothy Nicholas Fazio
- Royal Melbourne Hospital, Melbourne, Victoria, Australia; Melbourne Medical School, University of Melbourne, Parkville, Victoria, Australia
| | - Louise Healy
- Metabolic Dietary Disorders Association, PO Box 33, Montrose, Victoria, 3765, Australia
| | | | - Anita Inwood
- Queensland Lifespan Metabolic Medicine Service, Brisbane, Queensland, Australia
| | | | - Yusof Rahman
- Department of Genetic Medicine, Westmead Hospital, Sydney, Australia
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Wang D, Zhou D, Liu X, Xu Z, Bai T, Hou X. Different dosages of vonoprazan for gastroesophageal reflux disease: study protocol for a pragmatic, crossover-cluster, randomized controlled trial with patient preference arms. Trials 2023; 24:778. [PMID: 38041136 PMCID: PMC10691065 DOI: 10.1186/s13063-023-07760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/27/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Vonoprazan results in more potent acid suppression for gastroesophageal reflux disease (GERD) than proton pump inhibitors. It has only been approved for treating erosive esophagitis in China, but 30-40% of GERD patients cannot achieve the goal of treatment with vonoprazan 20 mg daily. This study aims to investigate whether vonoprazan could relieve the symptoms of Chinese patients with non-erosive reflux disease (NERD) and whether increased dosage or different times of dosing could increase the response rate of GERD. METHODS This study is a pragmatic, open-label, crossover-cluster, randomized controlled trial with patient preference arms. Two thousand eight hundred eighty patients with GERD from 48 hospitals in China will be enrolled. These hospitals will be divided into a compulsory randomization cluster (24 hospitals) and a patient preference cluster (24 hospitals). Patients in the compulsory randomization cluster will be randomized to three regimens according to the crossover-cluster randomization. Patients in the patient preference cluster may choose to receive any regimen if they have a preference; otherwise, patients will be randomly assigned. The three treatment regimens will last 4 weeks, including (1) vonoprazan 20 mg p.o. after breakfast, (2) vonoprazan 20 mg p.o. after dinner, and (3) vonoprazan 20 mg p.o. after breakfast and after dinner. Patients will attend a baseline visit, a 4-week e-diary, a fourth-week visit, and a sixth-month visit online. The primary outcome is the symptom relief rate of all patients after 4-week therapy. Secondary outcomes include the healing rate of EE patients, the severity of symptoms, compliance with the therapy at the fourth-week follow-up visit, recurrent symptoms, and the frequency of self-conscious doctor visits at the sixth-month follow-up visit. DISCUSSION This trial will explore the effectiveness of different regimens of vonoprazan that will be implemented with GERD patients in China. The randomization with patient preferences considered and the crossover-cluster component may improve the robustness and extrapolation of study conclusions. TRIAL REGISTRATION https://www.chictr.org.cn ChiCTR2300069857. Registered on 28 March 2023. PROTOCOL VERSION February 18, 2023, Version 2.
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Affiliation(s)
- Dongke Wang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Zhou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinghuang Liu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiyue Xu
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Bai
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xiaohua Hou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Kongkam P, Khongkha W, Lopimpisuth C, Chumsri C, Kosarussawadee P, Phutrakool P, Khamsai S, Sawanyawisuth K, Sura T, Phisalprapa P, Buamahakul T, Siwamogsatham S, Angsusing J, Poonniam P, Wanaratna K, Teerachaisakul M, Pongpirul K. Curcumin and proton pump inhibitors for functional dyspepsia: a randomised, double blind controlled trial. BMJ Evid Based Med 2023; 28:399-406. [PMID: 37696679 DOI: 10.1136/bmjebm-2022-112231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 09/13/2023]
Abstract
OBJECTIVE To compare the efficacy of curcumin versus omeprazole in improving patient reported outcomes in people with dyspepsia. DESIGN Randomised, double blind controlled trial, with central randomisation. SETTING Thai traditional medicine hospital, district hospital, and university hospitals in Thailand. PARTICIPANTS Participants with a diagnosis of functional dyspepsia. INTERVENTIONS The interventions were curcumin alone (C), omeprazole alone (O), or curcumin plus omeprazole (C+O). Patients in the combination group received two capsules of 250 mg curcumin, four times daily, and one capsule of 20 mg omeprazole once daily for 28 days. MAIN OUTCOME MEASURES Functional dyspepsia symptoms on days 28 and 56 were assessed using the Severity of Dyspepsia Assessment (SODA) score. Secondary outcomes were the occurrence of adverse events and serious adverse events. RESULTS 206 patients were enrolled in the study and randomly assigned to one of the three groups; 151 patients completed the study. Demographic data (age 49.7±11.9 years; women 73.4%), clinical characteristics and baseline dyspepsia scores were comparable between the three groups. Significant improvements were observed in SODA scores on day 28 in the pain (-4.83, -5.46 and -6.22), non-pain (-2.22, -2.32 and -2.31) and satisfaction (0.39, 0.79 and 0.60) categories for the C+O, C, and O groups, respectively. These improvements were enhanced on day 56 in the pain (-7.19, -8.07 and -8.85), non-pain (-4.09, -4.12 and -3.71) and satisfaction (0.78, 1.07, and 0.81) categories in the C+O, C, and O groups, respectively. No significant differences were observed among the three groups and no serious adverse events occurred. CONCLUSION Curcumin and omeprazole had comparable efficacy for functional dyspepsia with no obvious synergistic effect. TRIAL REGISTRATION NUMBER TCTR20221208003.
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Affiliation(s)
- Pradermchai Kongkam
- Department of Internal Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Chawin Lopimpisuth
- Department of Internal Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chitsanucha Chumsri
- Department of Preventive and Social Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
- Center of Excellence in Preventive & Integrative Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
| | - Prach Kosarussawadee
- Department of Internal Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Phanupong Phutrakool
- Center of Excellence in Preventive & Integrative Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
- Chula Data Management Centre, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
| | | | | | - Thanyachai Sura
- Ramathibodi Hospital, Mahidol University Faculty of Medicine, Bangkok, Thailand
| | | | | | - Sarawut Siwamogsatham
- Department of Internal Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
- King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Jaenjira Angsusing
- Department of Thai Traditional and Alternative Medicine, Royal Thai Government Ministry of Public Health, Bangkok, Thailand
| | - Pratchayanan Poonniam
- Department of Thai Traditional and Alternative Medicine, Royal Thai Government Ministry of Public Health, Bangkok, Thailand
| | - Kulthanit Wanaratna
- Department of Thai Traditional and Alternative Medicine, Royal Thai Government Ministry of Public Health, Bangkok, Thailand
| | - Monthaka Teerachaisakul
- Department of Thai Traditional and Alternative Medicine, Royal Thai Government Ministry of Public Health, Bangkok, Thailand
| | - Krit Pongpirul
- Department of Preventive and Social Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
- Center of Excellence in Preventive & Integrative Medicine, Chulalongkorn University Faculty of Medicine, Bangkok, Thailand
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Infection Biology & Microbiomes, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
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Miao J, Herrmann SM. Immune checkpoint inhibitors and their interaction with proton pump inhibitors-related interstitial nephritis. Clin Kidney J 2023; 16:1834-1844. [PMID: 37915905 PMCID: PMC10616479 DOI: 10.1093/ckj/sfad109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Indexed: 11/03/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy and outcomes, leading to an expanding use in millions of patients worldwide. However, they can cause a spectrum of immune-related adverse events (irAEs). Essentially, any organs can be affected by irAEs, which have emerged as therapy-limiting side effects. In the kidneys, ICI-associated acute interstitial nephritis (ICI-AIN) leads to acute kidney injury (AKI) in 2%-5% of patients on ICI therapy. AKI associated with ICI therapy pathologically presents with AIN in nearly 90% of the cases, but the pathophysiology of ICI-AIN remains to be defined. The generation of autoreactive T cells in patients receiving AIN-inducible drugs, such as proton pump inhibitors (PPIs), is one of the leading theories, supported by a higher incidence of ICI-AIN in patients on these AIN-inducible drugs. In this review, we will discuss our understanding of the incidence, potential pathophysiological mechanisms, clinical presentations, risk factors, diagnosis, and management of PPI-related AIN and its interaction with ICI therapy.
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Affiliation(s)
- Jing Miao
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Sandra M Herrmann
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
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Lee H, Kim S, Lee D, Chae Y, Yun T, Yang MP, Kang BT, Kim S, Kim H. Case report: Fundic gland polyps caused by long-term omeprazole use in a Maltese dog. Front Vet Sci 2023; 10:1287335. [PMID: 37937150 PMCID: PMC10625905 DOI: 10.3389/fvets.2023.1287335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/06/2023] [Indexed: 11/09/2023] Open
Abstract
Long-term use of proton-pump inhibitors can induce fundic gland polyps in the human stomach. However, this phenomenon has not been described in the veterinary literature. A 5-year-old intact female Maltese dog was referred to our hospital with chronic intermittent vomiting. The dog had been administered omeprazole (0.7-1.0 mg/kg PO q24 h) for the management of hydrocephalus for over 4 years; the omeprazole dose was increased to 10 mg/kg PO q24 h 8 months prior to presentation at referring hospital. Abdominal ultrasonography revealed marked thickening of the gastric wall with multi-lobulated, thickened folds. Subsequent endoscopy revealed marked polypoid lesions, and histological examination of the biopsy samples was consistent with the fundic gland polyps associated with proton-pump inhibitor use in humans. The lesions resolved after cessation of omeprazole, as assessed by ultrasonography. This report describes a case of fundic gland polyps following the long-term administration of omeprazole in a dog.
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Affiliation(s)
- Haemin Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Sanggu Kim
- Laboratory of Veterinary Pathology and Platelet Signaling, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Dohee Lee
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Taesik Yun
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Mhan-Pyo Yang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Soochong Kim
- Laboratory of Veterinary Pathology and Platelet Signaling, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Hakhyun Kim
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
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Lv F, Wang J, Mao L, Zhou X, Zhang T, Zhou S. Whether long-term use of proton pump inhibitor increases the risk of precancerous lesions in the stomach: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e35062. [PMID: 37747015 PMCID: PMC10519510 DOI: 10.1097/md.0000000000035062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/18/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND To evaluate through meta-analysis whether long-term use of proton pump inhibitor (PPI) increases the risk of precancerous lesions in the stomach. METHODS Randomized controlled trials that compared the occurrence and progression of precancerous lesions in patients receiving PPI treatment versus non-PPI treatment were retrieved from CNKI, VIP, Wanfang, CBM, Pubmed, Embase, Web of Science, and Cochrane Library databases (from database inception to May 1, 2023). The Revman 5.3 and STATA 17.0 software were used for analysis, and subgroup analysis was conducted based on follow-up time (≤12 months and > 12 months) and lesion type (atrophic gastritis, intestinal metaplasia, and epithelial dysplasia). RESULTS Six randomized controlled trials with a total of 1623 cases were included, including 1015 cases in the experimental group and 608 cases in the control group. The meta-analysis results showed that the overall abnormal lesion rate combined with statistical relative risk (RR) = 1.31 (0.85-2.02), P = .23. Subgroup analysis showed that the follow-up time > 12 months combined result was RR = 2.21 (1.47-3.33), P = .0001, the intestinal metaplasia group combined result was RR = 1.96 (0.91-2.47), P = .04. CONCLUSION SUBSECTIONS During long-term follow-up, patients using PPI exhibited a significantly higher incidence of overall abnormal lesions compared to the control group, particularly with a higher risk observed for intestinal metaplasia. However, there were no statistically significant differences between the 2 groups in terms of short-term follow-up and other types of lesions. It is important to exercise caution when interpreting these findings due to the limited number of nominated investigations included in the meta-analysis.
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Affiliation(s)
- Fangyi Lv
- Department of the First Clinical Medical, Guizhou University of Traditional Chinese Medicine, Guizhou, China
| | - Jincheng Wang
- Department of the First Clinical Medical, Guizhou University of Traditional Chinese Medicine, Guizhou, China
| | - Leiming Mao
- Department of the First Clinical Medical, Guizhou University of Traditional Chinese Medicine, Guizhou, China
| | - Xiangyu Zhou
- Department of the First Clinical Medical, Guizhou University of Traditional Chinese Medicine, Guizhou, China
| | - Taiwei Zhang
- Department of Obstetrics, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guizhou, China
| | - Sufang Zhou
- Department of Gastroenterology, the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guizhou, China
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He Q, Huang C, Qin X, Yu Y, Tang D, Huang J, Kuo ZC, Ling Y, Mao D, Xia B, Li W, Lu K, Yang M, He Y, Meng W, Yuan J, Pan Y. Confounded association between proton pump inhibitor use and risk of biliary tract cancer: Result from three cohorts. Int J Cancer 2023; 153:942-949. [PMID: 37232081 DOI: 10.1002/ijc.34572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/17/2023] [Accepted: 04/27/2023] [Indexed: 05/27/2023]
Abstract
Recent epidemiological studies suggested that proton pump inhibitor (PPI) use was associated with an increased risk of biliary tract cancer (BTC), however, confounders were not adequately controlled. Our study aimed to evaluate PPI use and subsequent risk of BTC and its subtypes in three well-established cohorts. We conducted a pooled analysis of the subjects free of cancers in UK Biobank (n = 463 643), Nurses' Health Study (NHS, n = 80 235) and NHS II (n = 95 869). Propensity score weighted Cox models were used to estimate marginal HRs of PPIs use on BTC risk, accounting for potential confounders. We documented 284 BTC cases in UK Biobank (median follow-up: 7.6 years), and 91 cases in NHS and NHS II cohorts (median follow-up: 15.8 years). In UK biobank, PPI users had a 96% higher risk of BTC compared to nonusers in crude model (HR 1.96, 95% CI 1.44-2.66), but the effect was attenuated to null after adjusting for potential confounders (HR 0.95, 95% CI 0.60-1.49). PPI use was not associated with risk of BTC in the pooled analysis of three cohorts (HR 0.93, 95% CI 0.60-1.43). We also observed no associations between PPI use with risk of intrahepatic (HR 1.00, 95% CI 0.49-2.04), extrahepatic bile duct (HR 1.09, 95% CI 0.52-2.27) and gallbladder cancers (HR 0.66, 95% CI 0.26-1.66) in UK Biobank. In summary, regular use of PPIs was not associated with the risk of BTC and its subtypes.
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Affiliation(s)
- Qiangsheng He
- Big Data Center, Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Guangdong Provincial Key Laboratory of Gastroenterology, Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Chongfei Huang
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Xiwen Qin
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Science, Monash University, Melbourne, Australia
- Victorian Heart Institute, Monash University, Melbourne, Australia
- Laboratory of Data Discovery for Health (D24H), The University of Hong Kong, Pokfulam, Hong Kong
| | - Yuanyuan Yu
- Department of surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Di Tang
- Department of surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Junjie Huang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Zi Chong Kuo
- Guangdong Provincial Key Laboratory of Gastroenterology, Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yuyao Ling
- School of Clinical Medicine, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Deli Mao
- Guangdong Provincial Key Laboratory of Gastroenterology, Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Bin Xia
- Big Data Center, Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Guangdong Provincial Key Laboratory of Gastroenterology, Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Wenjing Li
- Big Data Center, Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Kuiqing Lu
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Man Yang
- Guangdong Provincial Key Laboratory of Gastroenterology, Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yulong He
- Big Data Center, Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Guangdong Provincial Key Laboratory of Gastroenterology, Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Wenbo Meng
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Jinqiu Yuan
- Big Data Center, Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Clinical Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Guangdong Provincial Key Laboratory of Gastroenterology, Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
| | - Yihang Pan
- Big Data Center, Scientific Research Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- Guangdong Provincial Key Laboratory of Gastroenterology, Center for Digestive Disease, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
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Uchida AM, Burk CM, Rothenberg ME, Furuta GT, Spergel JM. Recent Advances in the Treatment of Eosinophilic Esophagitis. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2654-2663. [PMID: 37391018 PMCID: PMC10530275 DOI: 10.1016/j.jaip.2023.06.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 07/02/2023]
Abstract
Eosinophilic esophagitis is an increasingly common inflammatory allergic disease of the esophagus characterized by esophageal eosinophilia and symptoms of esophageal dysfunction. The therapeutic landscape has rapidly evolved for this emerging type 2 inflammatory disorder. We review traditional therapies including updates and expert opinions in addition to promising therapies on the horizon and the history of therapies that failed to meet end points and highlight knowledge gaps for future investigations.
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Affiliation(s)
- Amiko M Uchida
- Division of Gastroenterology, Hepatology and Nutrition, University of Utah School of Medicine, Salt Lake City, Utah
| | - Caitlin M Burk
- Food Allergy Center and Division of Pediatric Allergy and Immunology, and Center for Immunology and Inflammatory Diseases, Massachusetts General Hospital, Boston, Mass.
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Glenn T Furuta
- Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Digestive Health Institute, Children's Hospital Colorado, Aurora, Colo
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
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Abstract
Cancer cells originate from a series of acquired genetic mutations that can drive their uncontrolled cell proliferation and immune evasion. Environmental factors, including the microorganisms that colonize the human body, can shift the metabolism, growth pattern and function of neoplastic cells and shape the tumour microenvironment. Dysbiosis of the gut microbiome is now recognized as a hallmark of cancer by the scientific community. However, only a few microorganisms have been identified that directly initiate tumorigenesis or skew the immune system to generate a tumour-permissive milieu. Over the past two decades, research on the human microbiome and its functionalities within and across individuals has revealed microbiota-focused strategies for health and disease. Here, we review the evolving understanding of the mechanisms by which the microbiota acts in cancer initiation, promotion and progression. We explore the roles of bacteria in gastrointestinal tract malignancies and cancers of the lung, breast and prostate. Finally, we discuss the promises and limitations of targeting or harnessing bacteria in personalized cancer prevention, diagnostics and treatment.
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Affiliation(s)
- Geniver El Tekle
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- The Harvard T. H. Chan Microbiome in Public Health Center, Boston, MA, USA
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Wendy S Garrett
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
- The Harvard T. H. Chan Microbiome in Public Health Center, Boston, MA, USA.
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Medicine, Harvard Medical School, Boston, MA, USA.
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
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Huang Y, Chen S, Yao Y, Wu N, Xu M, Du H, Yin Z, Zhao Y, Tu Y. Ovotransferrin Inhibits TNF-α Induced Inflammatory Response in Gastric Epithelial Cells via MAPK and NF-κB Pathway. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2023; 71:12474-12486. [PMID: 37566483 DOI: 10.1021/acs.jafc.3c00950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/13/2023]
Abstract
Ovotransferrin (OVT) has been confirmed to have anti-inflammatory activity. However, its effect and mechanism on gastric inflammation are unclear. In this study, the effect and mechanism of the OVT on the tumor necrosis factor-α (TNF-α) induced inflammatory response in gastric epithelial cells (GES-1) were investigated. The enzyme linked immunosorbent assay (ELISA) was used to determine the levels of inflammation cytokines, followed by RNA sequencing to explore the potential pathways of its anti-inflammatory effect, and then it was validated by Western blotting and pathways inhibitors. Results showed that the OVT at concentrations of 50-400 μg/mL displayed nontoxicity against GES-1 cells. Additionally, 100 μg/mL of OVT obviously reduced the secretion of interleukin (IL)-8, IL-6, and TNF-α by 63.02% (630.09/1703.98), 35.53% (935.81/1451.43), and 36.19% (964.60/1511.63), respectively. The results of RNA sequencing exhibited that the OVT significantly influences the activation of mitogen-activated protein kinase (MAPK) and the nuclear factor kappa-light-chain enhancer of activated B cell (NF-κB) pathways, which was verified by the levels of p-IKK, p-IκB, p-P65, p-ERK, p-JNK, and p-P38 protein. IL-8 contents released by GES-1 cells after incubation with inhibitors of NF-κB and MAPK pathways further confirmed that OVT hindered activation of these two pathways. Collectively, these results suggested that OVT was a natural protein with the potential to treat gastric inflammation.
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Affiliation(s)
- Yan Huang
- Jiangxi Key Laboratory of Natural Products and Functional Food, Jiangxi Agricultural University, Nanchang 330045, China
- Agricultural Products Processing and Quality Control Engineering Laboratory of Jiangxi, Jiangxi Agricultural University, Nanchang 330045, China
- Nanchang Key Laboratory of Egg Safety Production and Processing Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Shuping Chen
- Jiangxi Key Laboratory of Natural Products and Functional Food, Jiangxi Agricultural University, Nanchang 330045, China
- Agricultural Products Processing and Quality Control Engineering Laboratory of Jiangxi, Jiangxi Agricultural University, Nanchang 330045, China
- Nanchang Key Laboratory of Egg Safety Production and Processing Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Yao Yao
- Jiangxi Key Laboratory of Natural Products and Functional Food, Jiangxi Agricultural University, Nanchang 330045, China
- Agricultural Products Processing and Quality Control Engineering Laboratory of Jiangxi, Jiangxi Agricultural University, Nanchang 330045, China
- Nanchang Key Laboratory of Egg Safety Production and Processing Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Na Wu
- Jiangxi Key Laboratory of Natural Products and Functional Food, Jiangxi Agricultural University, Nanchang 330045, China
- Agricultural Products Processing and Quality Control Engineering Laboratory of Jiangxi, Jiangxi Agricultural University, Nanchang 330045, China
- Nanchang Key Laboratory of Egg Safety Production and Processing Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Mingsheng Xu
- Jiangxi Key Laboratory of Natural Products and Functional Food, Jiangxi Agricultural University, Nanchang 330045, China
- Agricultural Products Processing and Quality Control Engineering Laboratory of Jiangxi, Jiangxi Agricultural University, Nanchang 330045, China
- Nanchang Key Laboratory of Egg Safety Production and Processing Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Huaying Du
- Jiangxi Key Laboratory of Natural Products and Functional Food, Jiangxi Agricultural University, Nanchang 330045, China
- Agricultural Products Processing and Quality Control Engineering Laboratory of Jiangxi, Jiangxi Agricultural University, Nanchang 330045, China
- Nanchang Key Laboratory of Egg Safety Production and Processing Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Zhongping Yin
- Jiangxi Key Laboratory of Natural Products and Functional Food, Jiangxi Agricultural University, Nanchang 330045, China
- Agricultural Products Processing and Quality Control Engineering Laboratory of Jiangxi, Jiangxi Agricultural University, Nanchang 330045, China
- Nanchang Key Laboratory of Egg Safety Production and Processing Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Yan Zhao
- Jiangxi Key Laboratory of Natural Products and Functional Food, Jiangxi Agricultural University, Nanchang 330045, China
- Agricultural Products Processing and Quality Control Engineering Laboratory of Jiangxi, Jiangxi Agricultural University, Nanchang 330045, China
- Nanchang Key Laboratory of Egg Safety Production and Processing Engineering, Jiangxi Agricultural University, Nanchang 330045, China
| | - Yonggang Tu
- Jiangxi Key Laboratory of Natural Products and Functional Food, Jiangxi Agricultural University, Nanchang 330045, China
- Agricultural Products Processing and Quality Control Engineering Laboratory of Jiangxi, Jiangxi Agricultural University, Nanchang 330045, China
- Nanchang Key Laboratory of Egg Safety Production and Processing Engineering, Jiangxi Agricultural University, Nanchang 330045, China
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Renaud A, Jirka A, Durant C, Connault J, Espitia O, Takoudju C, Agard C. [Gastrointestinal tract involvement in systemic sclerosis]. Rev Med Interne 2023; 44:410-422. [PMID: 37270380 DOI: 10.1016/j.revmed.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 04/17/2023] [Accepted: 05/08/2023] [Indexed: 06/05/2023]
Abstract
Gastrointestinal tract involvement in systemic sclerosis concerns more than 90% of patients but is of heterogeneous clinical expression. It can involve the entire intestinal tract and be responsible for multifactorial malnutrition, which is frequent in this disease. It is a major source of deterioration in the quality of life and can even be life-threatening. Management is complex and multidisciplinary, ranging from simple hygienic and dietary measures, to specialized endoscopic or surgical interventional procedures, also including medical treatments, particularly proton pump inhibitors and prokinetics, with potential side effects. Ongoing research for new diagnostic and therapeutic tools promises to improve the management and prognosis of these patients.
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Affiliation(s)
- A Renaud
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
| | - A Jirka
- Service d'hépato-gastro-entérologie, Nantes université, CHU de Nantes, 44000 Nantes, France
| | - C Durant
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - J Connault
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - O Espitia
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
| | - C Takoudju
- Service d'hépato-gastro-entérologie, Nantes université, CHU de Nantes, 44000 Nantes, France
| | - C Agard
- Service de médecine interne, Nantes université, CHU de Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France
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Ohori K, Yano T, Katano S, Nagaoka R, Numazawa R, Yamano K, Fujisawa Y, Kouzu H, Koyama M, Nagano N, Fujito T, Nishikawa R, Ohwada W, Furuhashi M. Independent Association Between Use of Proton Pump Inhibitors and Muscle Wasting in Patients with Heart Failure: A Single-Center, Ambispective, Observational Study. Drugs Aging 2023:10.1007/s40266-023-01035-3. [PMID: 37328671 DOI: 10.1007/s40266-023-01035-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Although proton pump inhibitors (PPIs) play a pivotal role in the prevention and treatment of gastric acid-related diseases and gastrointestinal adverse events caused by antiplatelet therapies, the safety of long-term use of PPIs has been questioned. OBJECTIVE The aim of this study was to determine the effects of use of PPIs on muscle mass and bone mineral density in heart failure (HF) patients. METHODS This was a single-center, ambispective (combined retrospective and prospective), observational study. HF patients (n = 747; 72 years of age; males, 54%) who received a dual-energy x-ray absorptiometry scan were enrolled. Muscle wasting was defined as appendicular skeletal muscle mass index (ASMI) < 7.0 kg/m2 in males and <5.4 kg/m2 in females. Propensity scores for the use of PPIs were calculated using a multivariate logistic regression model to minimize selection bias. RESULTS Before propensity score matching, ASMI was significantly lower in patients receiving PPIs than in patients not receiving PPIs, resulting in a higher prevalence of muscle wasting in the PPI group. Such a relationship between use of PPIs and muscle wasting remained after propensity score matching. In multivariate Cox regression analyses, use of PPIs was independently associated with presence of muscle wasting (hazard ratio 1.68, 95% confidence interval 1.05-2.69) after adjustment for established risk factors of sarcopenia. On the other hand, there were no differences in bone mineral density between the PPI group and the no-PPI group. CONCLUSION Use of PPIs is associated with a high risk of muscle wasting in HF patients. Caution is warranted when long-term PPI treatment is performed in sarcopenic HF patients and HF patients with several risk factors for muscle wasting.
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Affiliation(s)
- Katsuhiko Ohori
- Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Satoshi Katano
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Ryohei Nagaoka
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Ryo Numazawa
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Kotaro Yamano
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Yusuke Fujisawa
- Division of Rehabilitation, Sapporo Medical University Hospital, Sapporo, Japan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masayuki Koyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Nobutaka Nagano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Ryo Nishikawa
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Wataru Ohwada
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masato Furuhashi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
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Ngwenya S, Simin J, Brusselaers N. Maintenance Proton Pump Inhibitor Use Associated with Increased All-Cause and Cause-Specific Mortality in Sweden. Dig Dis Sci 2023; 68:2252-2263. [PMID: 36629968 PMCID: PMC10188584 DOI: 10.1007/s10620-023-07820-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/31/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Proton pump inhibitor (PPI) use has increased over the last decades and has been associated with multiple adverse events and potentially even overall survival. AIMS We aimed to investigate the association between proton pump inhibitor maintenance use and all-cause and cause-specific mortality, addressing confounding by indication and duration of use. METHODS This Swedish population-based cohort study included all adult (N = 935,236) PPI and histamine-2 receptor antagonist maintenance users (≥ 180 days use) during 2005-2014. Standardised mortality ratios (SMRs) and 95% confidence intervals were calculated for all-cause and cause-specific mortality comparing the risk among PPI/H2RA users to that of the Swedish background population, stratified by age, sex, calendar period, indication and duration of use. Multivariable Poisson regression models were used to compare PPI use to H2RA use, expressed as incidence rate ratios and 95% confidence intervals. RESULTS PPI and histamine-2 receptor antagonist use were associated with an increased risk of all-cause mortality (SMR = 1.35; 1.34-1.36; SMR = 1.31; 1.27-1.36, respectively). The highest SMRs were found in the youngest age groups. In direct comparison, PPI use showed a higher mortality risk than histamine-2 receptor antagonist use (incidence rate ratios = 1.42; 1.38-1.46). PPIs were related to increased cancer (SMR = 1.21; 1.20-1.22), and cardiovascular mortality (SMR = 1.36; 1.35-1.37). Increased SMRs were observed for most indications. Longer duration of use was associated with a higher mortality among PPI users but not among histamine-2 receptor antagonist users. CONCLUSION Maintenance PPI use was associated with an increased risk of all-cause and cause-specific mortality, and the risk increased with prolonged duration.
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Affiliation(s)
- Sharon Ngwenya
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 171 65 Stockholm, Sweden
- Department of Family Medicine and Population Health, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Johanna Simin
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 171 65 Stockholm, Sweden
| | - Nele Brusselaers
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Biomedicum A8, Solnavägen 9, 171 65 Stockholm, Sweden
- Department of Family Medicine and Population Health, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
- Department of Head and Skin, Ghent University, Corneel Heymanslaan 10, 9000 Ghent, Belgium
- Centre for Translational Microbiome Research, Solnavägen 9, 171 76 Stockholm, Sweden
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ANDERLONI A, the Study Group on Gastroesophageal Reflux, SAVARINO E, ZAGARI RM, ARAGONA SE, CIPRANDI G. The practical management of patients with gastroesophageal reflux: an Italian survey. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2023; 182. [DOI: 10.23736/s0393-3660.23.05039-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
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Miqdad MA, Kosaraju K, Mohamad A, Hulwi H, Rais U, Taleb M, Aloreibi T. Clostridium difficile Infection: Risk and Poor Prognostic Factors at a Tertiary Hospital in the Eastern Region of Saudi Arabia. Cureus 2023; 15:e39193. [PMID: 37378089 PMCID: PMC10291994 DOI: 10.7759/cureus.39193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Clostridium difficile (C. difficile) is a common cause of hospital-acquired diarrhea. It is associated with significantly higher mortality and morbidity in addition to the cost-effectiveness burden on the healthcare system. The primary risk factors for C. difficile infection (CDI) are past C. difficile exposure, proton pump inhibitors, and antibiotic usage. These risk factors are also associated with poor prognosis. OBJECTIVE This study was performed in Dr. Sulaiman Al Habib Tertiary Hospital in the Eastern Region of Saudi Arabia. The aim was to evaluate the risk and prognostic factors of CDI and their association with the outcomes of hospital stay, such as complications, length of stay (LOS), and treatment duration. PATIENTS AND METHODS This is a retrospective cohort study for all patients who tested for C. difficile in the medical department. The target population was all adult patients ≥16 years with positive stool toxins for C. difficile between April 2019 and July 2022. The main outcome measures are risk and poor prognostic factors for CDI. RESULTS C. difficle infection patients were included in the study; 12 (52.2%) were female, and 11 (47.8%) were male. The mean age of the patients was 58.3 (SD: 21.5) years; 13 (56.5%) patients were below 65 years, and 10 were above 65 years. Only four patients were without comorbidities, and 19 (82.6%) patients had various comorbidities. Importantly, hypertension was the most common comorbidity in 47.8% of the patients. Furthermore, advanced age significantly impacted the hospital LOS as the mean age among patients who stayed at the hospital less than four days and those who stayed ≥4 days was 49.08 (19.7) and 68.36 (19.5), respectively (P = .028). CONCLUSION Advanced age was the most frequent poor prognostic factor among our inpatient participants with positive CDI. It was significantly associated with longer hospital LOS, more complications, and longer treatment duration.
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Affiliation(s)
- Mohammed A Miqdad
- Internal Medicine, Dr. Sulaiman Al Habib Medical Group, Khobar, SAU
- Tele-Geriatric Research Fellowship, Michigan State University, Michigan, USA
| | | | - Abdullah Mohamad
- Internal Medicine, Dr. Sulaiman Al Habib Medical Group, Khobar, SAU
| | - Hasan Hulwi
- Internal Medicine, Dr. Sulaiman Al Habib Medical Group, Khobar, SAU
| | - Ubaid Rais
- Pharmacology, Dr. Sulaiman Al Habib Medical Group, Khobar, SAU
| | - Mohammad Taleb
- Internal Medicine, Dr. Sulaiman Al Habib Medical Group, Khobar, SAU
| | - Talal Aloreibi
- Infectious Diseases, Dr. Sulaiman Al Habib Medical Group, Khobar, SAU
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Colard-Thomas J, Thomas QD, Viala M. Comedications with Immune Checkpoint Inhibitors: Involvement of the Microbiota, Impact on Efficacy and Practical Implications. Cancers (Basel) 2023; 15:2276. [PMID: 37190203 PMCID: PMC10136801 DOI: 10.3390/cancers15082276] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) have been a major breakthrough in solid oncology over the past decade. The immune system and the gut microbiota are involved in their complex mechanisms of action. However, drug interactions have been suspected of disrupting the fine equilibrium necessary for optimal ICI efficacy. Thus, clinicians are facing a great deal of sometimes contradictory information on comedications with ICIs and must at times oppose conflicting objectives between oncological response and comorbidities or complications. We compiled in this review published data on the role of the microbiota in ICI efficacy and the impact of comedications. We found mostly concordant results on detrimental action of concurrent corticosteroids, antibiotics, and proton pump inhibitors. The timeframe seems to be an important variable each time to preserve an initial immune priming at ICIs initiation. Other molecules have been associated with improved or impaired ICIs outcomes in pre-clinical models with discordant conclusions in retrospective clinical studies. We gathered the results of the main studies concerning metformin, aspirin, and non-steroidal anti-inflammatory drugs, beta blockers, renin-angiotensin-aldosterone system inhibitors, opioids, and statins. In conclusion, one should always assess the necessity of concomitant treatment according to evidence-based recommendations and discuss the possibility of postponing ICI initiation or switching strategies to preserve the critical window.
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Affiliation(s)
- Julien Colard-Thomas
- Department of Medical Oncology, Montpellier Cancer Institute (ICM), University of Montpellier (UM), 34090 Montpellier, France
| | - Quentin Dominique Thomas
- Department of Medical Oncology, Montpellier Cancer Institute (ICM), University of Montpellier (UM), 34090 Montpellier, France
- Oncogenic Pathways in Lung Cancer, Montpellier Cancer Research Institute (IRCM) INSERM U1194, University of Montpellier (UM), 34090 Montpellier, France
| | - Marie Viala
- Department of Medical Oncology, Montpellier Cancer Institute (ICM), University of Montpellier (UM), 34090 Montpellier, France
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Manabe Y, Ishibashi T, Asano R, Tonomura S, Maeda Y, Motooka D, Ueda J, Yanagawa M, Edamoto-Taira Y, Chikaishi-Kirino T, Masaki T, Inagaki T, Nakamura S, Katada Y, Okazawa M, Narazaki M, Ogo T, Kumanogoh A, Nakaoka Y. Gut dysbiosis is associated with aortic aneurysm formation and progression in Takayasu arteritis. Arthritis Res Ther 2023; 25:46. [PMID: 36964623 PMCID: PMC10037851 DOI: 10.1186/s13075-023-03031-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/16/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Takayasu arteritis (TAK) is an autoimmune large vessel vasculitis that affects the aorta and its major branches, eventually leading to the development of aortic aneurysm and vascular stenosis or occlusion. This retrospective and prospective study aimed to investigate whether the gut dysbiosis exists in patients with TAK and to identify specific gut microorganisms related to aortic aneurysm formation/progression in TAK. METHODS We analysed the faecal microbiome of 76 patients with TAK and 56 healthy controls (HCs) using 16S ribosomal RNA sequencing. We examined the relationship between the composition of the gut microbiota and clinical parameters. RESULTS The patients with TAK showed an altered gut microbiota with a higher abundance of oral-derived bacteria, such as Streptococcus and Campylobacter, regardless of the disease activity, than HCs. This increase was significantly associated with the administration of a proton pump inhibitor used for preventing gastric ulcers in patients treated with aspirin and glucocorticoids. Among patients taking a proton pump inhibitor, Campylobacter was more frequently detected in those who underwent vascular surgeries and endovascular therapy for aortic dilatation than in those who did not. Among the genus of Campylobacter, Campylobacter gracilis in the gut microbiome was significantly associated with clinical events related to aortic aneurysm formation/worsening in patients with TAK. In a prospective analysis, patients with a gut microbiome positive for Campylobacter were significantly more likely to require interventions for aortic dilatation than those who were negative for Campylobacter. Furthermore, patients with TAK who were positive for C. gracilis by polymerase chain reaction showed a tendency to have severe aortic aneurysms. CONCLUSIONS A specific increase in oral-derived Campylobacter in the gut may be a novel predictor of aortic aneurysm formation/progression in patients with TAK.
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Affiliation(s)
- Yusuke Manabe
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomohiko Ishibashi
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Ryotaro Asano
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
- Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shuichi Tonomura
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Yuichi Maeda
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Japan
| | - Daisuke Motooka
- Department of Infection Metagenomics, Research Institute for Microbial Diseases, Osaka University, Suita, Japan
| | - Jin Ueda
- Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masahiro Yanagawa
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuko Edamoto-Taira
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Tomomi Chikaishi-Kirino
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Takeshi Masaki
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Tadakatsu Inagaki
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Shota Nakamura
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Japan
| | - Yoshinori Katada
- Department of Respiratory Medicine and Rheumatology, Suita Municipal Hospital, Suita, Japan
| | - Makoto Okazawa
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Masashi Narazaki
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Advanced Clinical and Translational Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Immunopathology, WPI, Immunology Frontier Research Center (iFReC), Osaka University, Suita, Japan
| | - Takeshi Ogo
- Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Suita, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Japan
- Department of Immunopathology, WPI, Immunology Frontier Research Center (iFReC), Osaka University, Suita, Japan
- Center for Infectious Disease for Education and Research (CiDER), Osaka University, Suita, Japan
- Japan Agency for Medical Research and Development - Core Research for Evolutional Science and Technology (AMED-CREST), Osaka University, Suita, Japan
- Center for Advanced Modalities and DDS (CAMaD), Osaka University, Suita, Japan
| | - Yoshikazu Nakaoka
- Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
- Department of Cardiovascular Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
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Ito T, Ramos-Alvarez I, Jensen RT. Successful Lifetime/Long-Term Medical Treatment of Acid Hypersecretion in Zollinger-Ellison Syndrome (ZES): Myth or Fact? Insights from an Analysis of Results of NIH Long-Term Prospective Studies of ZES. Cancers (Basel) 2023; 15:1377. [PMID: 36900170 PMCID: PMC10000208 DOI: 10.3390/cancers15051377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 02/24/2023] Open
Abstract
Analysis of the efficacy/pharmacology of long-term/lifetime medical treatment of acid hypersecretion in a large cohort of ZES patients in a prospective study. This study includes the results from all 303 patients with established ZES who were prospectively followed and received acid antisecretory treatment with either H2Rs or PPIs, with antisecretory doses individually titrated by the results of regular gastric acid testing. The study includes patients treated for short-term periods (<5 yrs), patients treated long-term (>5 yrs), and patients with lifetime treatment (30%) followed for up to 48 years (mean 14 yrs). Long-term/lifelong acid antisecretory treatment with H2Rs/PPIs can be successfully carried out in all patients with both uncomplicated and complicated ZES (i.e., with MEN1/ZES, previous Billroth 2, severe GERD). This is only possible if drug doses are individually set by assessing acid secretory control to establish proven criteria, with regular reassessments and readjustments. Frequent dose changes both upward and downward are needed, as well as regulation of the dosing frequency, and there is a primary reliance on the use of PPIs. Prognostic factors predicting patients with PPI dose changes are identified, which need to be studied prospectively to develop a useful predictive algorithm that could be clinically useful for tailored long-term/lifetime therapy in these patients.
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Affiliation(s)
- Tetsuhide Ito
- Neuroendocrine Tumor Centre, Fukuoka Sanno Hospital, International University of Health and Welfare, 3-6-45 Momochihama, Sawara-Ku, Fukuoka 814-0001, Japan
| | | | - Robert T. Jensen
- Digestive Diseases Branch, NIDDK, NIH, Bethesda, MD 20892-1804, USA
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Seah S, Tan YK, Teh K, Loh WJ, Tan PT, Goh LC, Malakar RD, Aw TC, Lau CS, Dhalliwal T, Kui SL, Kam JW, Khoo J, Tay TL, Tan E, Au V, Soh SB, Zhang M, King TF, Gani L, Puar TH. Proton-pump inhibitor use amongst patients with severe hypomagnesemia. Front Pharmacol 2023; 14:1092476. [PMID: 36794273 PMCID: PMC9922884 DOI: 10.3389/fphar.2023.1092476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 01/31/2023] Open
Abstract
Introduction: Long-term proton pump inhibitor (PPI) use has been associated with hypomagnesemia. It is unknown how frequently PPI use is implicated in patients with severe hypomagnesemia, and its clinical course or risk factors. Methods: All patients with severe hypomagnesemia from 2013 to 2016 in a tertiary center were assessed for likelihood of PPI-related hypomagnesemia using Naranjo algorithm, and we described the clinical course. The clinical characteristics of each case of PPI-related severe hypomagnesemia was compared with three controls on long-term PPI without hypomagnesemia, to assess for risk factors of developing severe hypomagnesemia. Results: Amongst 53,149 patients with serum magnesium measurements, 360 patients had severe hypomagnesemia (<0.4 mmol/L). 189 of 360 (52.5%) patients had at least possible PPI-related hypomagnesemia (128 possible, 59 probable, two definite). 49 of 189 (24.7%) patients had no other etiology for hypomagnesemia. PPI was stopped in 43 (22.8%) patients. Seventy (37.0%) patients had no indication for long-term PPI use. Hypomagnesemia resolved in most patients after supplementation, but recurrence was higher in patients who continued PPI, 69.7% versus 35.7%, p = 0.009. On multivariate analysis, risk factors for hypomagnesemia were female gender (OR 1.73; 95% CI: 1.17-2.57), diabetes mellitus (OR, 4.62; 95% CI: 3.05-7.00), low BMI (OR, 0.90; 95% CI: 0.86-0.94), high-dose PPI (OR, 1.96; 95% CI: 1.29-2.98), renal impairment (OR, 3.85; 95% CI: 2.58-5.75), and diuretic use (OR, 1.68; 95% CI: 1.09-2.61). Conclusion: In patients with severe hypomagnesemia, clinicians should consider the possibility of PPI-related hypomagnesemia and re-examine the indication for continued PPI use, or consider a lower dose.
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Affiliation(s)
- Sherry Seah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yen Kheng Tan
- Doctor of Medicine Programme, Duke-NUS (National University School) Medical School, Singapore, Singapore
| | - Kevin Teh
- Department of Gastroenterology, Changi General Hospital, Singapore, Singapore
| | - Wann Jia Loh
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Pei Ting Tan
- Department of Clinical Trial Research Unit, Changi General Hospital, Singapore, Singapore
| | - Leng Chuan Goh
- Department of Pharmacy, Changi General Hospital, Singapore, Singapore
| | | | - Tar Choon Aw
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
| | - Chin Shern Lau
- Department of Laboratory Medicine, Changi General Hospital, Singapore, Singapore
| | - Trishpal Dhalliwal
- Department of Internal Medicine, Changi General Hospital, Singapore, Singapore
| | - Swee Leng Kui
- Department of Cardiology, Changi General Hospital, Singapore, Singapore
| | - Jia Wen Kam
- Department of Clinical Trial Research Unit, Changi General Hospital, Singapore, Singapore
| | - Joan Khoo
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Tunn Lin Tay
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Eberta Tan
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Vanessa Au
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Shui Boon Soh
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Meifen Zhang
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Thomas F. King
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Linsey Gani
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Troy H. Puar
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore,*Correspondence: Troy H. Puar,
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Jaruvongvanich VK, Matar R, Reisenauer J, Janu P, Mavrelis P, Ihde G, Murray M, Singh S, Kolb J, Nguyen NT, Thosani N, Wilson EB, Zarnegar R, Chang K, Canto MI, Abu Dayyeh BK. Hiatal hernia repair with transoral incisionless fundoplication versus Nissen fundoplication for gastroesophageal reflux disease: A retrospective study. Endosc Int Open 2023; 11:E11-E18. [PMID: 36618876 PMCID: PMC9812651 DOI: 10.1055/a-1972-9190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 10/19/2022] [Indexed: 01/06/2023] Open
Abstract
Background and study aims Concomitant hiatal hernia (HH) repair with transoral incisionless fundoplication (TIF) is a therapeutic option for patients with HH > 2 cm and gastroesophageal reflux disease (GERD). Data comparing this approach with laparoscopic Nissen fundoplication (LNF) are lacking. We performed an exploratory analysis to compare these two approaches' adverse events (AEs) and clinical outcomes. Patients and methods This was a multicenter retrospective cohort study of HH repair followed by LNF versus HH repair followed by TIF in patients with GERD and moderate HH (2-5 cm). AEs were assessed using the Clavien-Dindo classification. Symptoms (heartburn/regurgitation, bloating, and dysphagia) were compared at 6 and 12 months. Results A total of 125 patients with HH repair with TIF and 70 with HH repair with LNF were compared. There was no difference in rates of discontinuing or decreasing proton pump inhibitor use, dysphagia, esophagitis, disrupted wrap, and HH recurrence between the two groups ( P > 0.05). The length of hospital stay (1 day vs. 2 days), 30-day readmission rate (0 vs. 4.3 %), early AE rate (0 vs. 18.6 %), and early serious AE rate (0 vs. 4.3 %) favored TIF (all P < 0.05). The rate of new or worse than baseline bloating was lower in the TIF group at 6 months (13.8 % vs. 30.0 %, P = 0.009). Conclusions Concomitant HH repair with TIF is feasible and associated with lower early and serious AEs compared to LNF. Further comparative efficacy studies are warranted.
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Affiliation(s)
| | - Reem Matar
- Mayo Clinic – Gastroenterology and Hepatology, Rochester, Minnesota, United States
| | | | - Peter Janu
- Fox Valley Technical College, ThedaCare Regional Medical System, Appleton, Wisconsin, United States
| | - Peter Mavrelis
- Methodist Hospitals Inc. – Surgery, Gary, Indiana, United States
| | - Glenn Ihde
- Matagorda Regional Medical Center – Matagorda Medical Group, Bay City, Texas, United States
| | - Michael Murray
- UNRMed – University of Nevada, Reno, Nevada, United States
| | - Sneha Singh
- Mayo Clinic – Gastroenterology and Hepatology, Rochester, Minnesota, United States
| | - Jennifer Kolb
- UCIrvine – Gastroenterology, Irvine, California, United States
| | | | - Nirav Thosani
- University of Texas McGovern Medical School – Gastroenterology, Hepatology and Nutrition, Houston, Texas, United States
| | - Erik B. Wilson
- University of Texas McGovern Medical School – Surgery, Houston, Texas, United States
| | - Rasa Zarnegar
- Weill Cornell Medical College – Surgery, New York, New York, United States
| | - Kenneth Chang
- UCIrvine – Gastroenterology, Irvine, California, United States
| | - Marcia I. Canto
- Johns Hopkins Hospital and Health System – Gastroenterology, Baltimore, Maryland, United States
| | - Barham K. Abu Dayyeh
- Mayo Clinic – Gastroenterology and Hepatology, Rochester, Minnesota, United States
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Yang Y, Du H, Zou G, Song Z, Zhou Y, Li H, Tan C, Chen H, Fischetti VA, Li J. Encapsulation and delivery of phage as a novel method for gut flora manipulation in situ: A review. J Control Release 2023; 353:634-649. [PMID: 36464065 DOI: 10.1016/j.jconrel.2022.11.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/27/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022]
Abstract
Intestinal flora regulation is an effective method to intervene and treat diseases associated with microbiome imbalance. In addition to conventional probiotic supplement, phage delivery has recently exhibited great prospect in modifying gut flora composition and regulating certain gene expression of gut bacteria. However, the protein structure of phage is vulnerable to external factors during storage and delivery, which leads to the loss of infection ability and flora regulation function. Encapsulation strategy provides an effective solution for improving phage stability and precisely controlling delivery dosage. Different functional materials including enzyme-responsive and pH-responsive polymers have been used to construct encapsulation carriers to protect phages from harsh conditions and release them in the colon. Meanwhile, diverse carriers showed different characteristics in structure and function, which influenced their protective effect and delivery efficiency. This review systematically summarizes recent research progress on the phage encapsulation and delivery, with an emphasis on function properties of carrier systems in the protection effect and colon-targeted delivery. The present review may provide a theoretical reference for the encapsulation and delivery of phage as microbiota modulator, so as to expedite the development of functional material and delivery carrier, as well as the advances in practical application of intestinal flora regulation.
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Affiliation(s)
- Yufan Yang
- State Key Laboratory of Agricultural Microbiology, Key Laboratory of Environment Correlative Dietology, College of Food Science and Technology, Shenzhen Institute of Nutrition and Health, Huazhong Agricultural University, Wuhan 430070, China; College of Biomedicine and Health, Huazhong Agricultural University, Wuhan 430070, China
| | - Hu Du
- College of Life Science and Technology, Huazhong Agricultural University, Wuhan 430070, China
| | - Geng Zou
- State Key Laboratory of Agricultural Microbiology, Key Laboratory of Environment Correlative Dietology, College of Food Science and Technology, Shenzhen Institute of Nutrition and Health, Huazhong Agricultural University, Wuhan 430070, China; College of Biomedicine and Health, Huazhong Agricultural University, Wuhan 430070, China
| | - Zhiyong Song
- College of Science, Huazhong Agricultural University, Wuhan 430070, China
| | - Yang Zhou
- State Key Laboratory of Agricultural Microbiology, Key Laboratory of Environment Correlative Dietology, College of Food Science and Technology, Shenzhen Institute of Nutrition and Health, Huazhong Agricultural University, Wuhan 430070, China
| | - Hao Li
- Faculty of Bioscience Engineering, Ghent University, Gent 9000, Belgium
| | - Chen Tan
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China
| | - Huanchun Chen
- College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China
| | - Vincent A Fischetti
- Laboratory of Bacterial Pathogenesis and Immunology, The Rockefeller University, New York 10065, USA
| | - Jinquan Li
- State Key Laboratory of Agricultural Microbiology, Key Laboratory of Environment Correlative Dietology, College of Food Science and Technology, Shenzhen Institute of Nutrition and Health, Huazhong Agricultural University, Wuhan 430070, China; College of Biomedicine and Health, Huazhong Agricultural University, Wuhan 430070, China; Laboratory of Bacterial Pathogenesis and Immunology, The Rockefeller University, New York 10065, USA; Shenzhen Branch, Guangdong Laboratory for Lingnan Modern Agriculture, Genome Analysis Laboratory of the Ministry of Agriculture and Rural Affairs, Agricultural Genomics Institute at Shenzhen, Chinese Academy of Agricultural Sciences, Shenzhen 518000, China.
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Aubert CE, Blum MR, Gastens V, Dalleur O, Vaillant F, Jennings E, Aujesky D, Thompson W, Kool T, Kramers C, Knol W, O'Mahony D, Rodondi N. Prescribing, deprescribing and potential adverse effects of proton pump inhibitors in older patients with multimorbidity: an observational study. CMAJ Open 2023; 11:E170-E178. [PMID: 36854455 PMCID: PMC9981164 DOI: 10.9778/cmajo.20210240] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Proton pump inhibitors (PPIs) contribute to polypharmacy and are associated with adverse effects. As prospective data on longitudinal patterns of PPI prescribing in older patients with multimorbidity are lacking, we sought to assess patterns of PPI prescribing and deprescribing, as well as the association of PPI use with hospital admissions over 1 year in this population. METHODS We conducted a prospective, longitudinal cohort study using data from the Optimizing Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older Adults (OPERAM) trial, a randomized controlled trial testing an intervention to reduce inappropriate prescribing (2016-2018). This trial included adults aged 70 years and older with at least 3 chronic conditions and prescribed at least 5 chronic medications. We assessed prevalence of PPI use at time of hospital admission, and new prescriptions and deprescribing at discharge, and at 2 months and 1 year after discharge, by intervention group. We used a regression with competing risk for death to assess the association of PPI use with readmissions related to their potential adverse effects, and all-cause readmission. RESULTS Overall, 1080 (57.4%) of 1879 patients (mean age 79 yr) had PPI prescriptions at admission, including 496 (45.9%) patients with a potentially inappropriate indication. At discharge, 133 (24.9%) of 534 patients in the intervention group and 92 (16.8%) of 546 patients in the control group who were using PPIs at admission had deprescribing. Among 680 patients who were not using PPIs at discharge, 47 (14.6%) of 321 patients in the intervention group and 40 (11.1%) of 359 patients in the control group had a PPI started within 2 months. Use of PPIs was associated with all-cause readmission (n = 770, subdistribution hazard ratio 1.31, 95% confidence interval 1.12-1.53). INTERPRETATION Potentially inappropriate use of PPI, new PPI prescriptions and PPI deprescribing were frequent among older adults with multimorbidity and polypharmacy. These data suggest that persistent PPI use may be associated with clinically important adverse effects in this population.
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Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Manuel R Blum
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Viktoria Gastens
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Olivia Dalleur
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Fanny Vaillant
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Emma Jennings
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Drahomir Aujesky
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Wade Thompson
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Tijn Kool
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Cornelius Kramers
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Wilma Knol
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Denis O'Mahony
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Nicolas Rodondi
- Department of General Internal Medicine (Aubert, Blum, Aujesky, Rodondi), Inselspital, Bern University Hospital, University of Bern; Institute of Primary Health Care (Aubert, Blum, Gastens, Rodondi), University of Bern, Bern, Switzerland; Clinical Pharmacy Research Group (Dalleur), Université Catholique de Louvain, Louvain Drug Research Institute; Pharmacy Department (Dalleur, Vaillant), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium; Department of Medicine (Geriatrics) (Jennings, O'Mahony), Cork University Hospital, University College Cork, Cork, Ireland; Women's College Hospital Research Institute (Thompson), Toronto, Ont.; Department of Anesthesiology, Pharmacology, and Therapeutics (Thompson), Faculty of Medicine, University of British Columbia, Vancouver, BC; Departments of Internal Medicine and Pharmacology-Toxicology (Kool, Kramers), Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, the Netherlands; Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons (Knol), University Medical Centre Utrecht, University of Utrecht, the Netherlands
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Sousa AJC, de Sousa Neto BP, da Costa DS, de Sousa MC, de Carvalho CES, Quintans-Junior LJ, Quintans JSS, Neves JA, da Silva FV, Viana AFSC, Nunes PHM, de Cássia Meneses Oliveira R. Antiulcerogenic and healing activity of hecogenin acetate in rodents. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2022; 396:759-769. [PMID: 36474020 DOI: 10.1007/s00210-022-02341-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
Peptic ulcers are lesions in the gastric and duodenal mucosa generated by an imbalance between protective factors (gastroduodenal mucus secretion, bicarbonate production, adequate blood flow) and harmful factors (excess pepsin or hydrochloric acid). Some drugs used in peptic ulcer therapy are associated with adverse effects. The aim of this study was to evaluate the antiulcerogenic and healing activity of hecogenin acetate (HA) in acute and chronic models of gastric lesions in rodents. The antiulcerogenic activity of HA was evaluated in models of gastric lesions induced by absolute ethanol and in acidified ethanol with HA (5, 10, and 20 mg/kg). For the model of gastric lesions induced by ischemia and reperfusion, rats were pre-treated with HA (5, 10, 20 mg/kg). After that, they were submitted to 30 min of ischemia, followed by 1 h of reperfusion. To evaluate the healing activity was induced gastric ulcer using acetic acid (80%) in rats. After 24 h, they were treated for 7 consecutive days with HA (10 and 20 mg/kg). They were evaluated the possible signs of toxicity, measurement of the lesions, collagen deposition, and histological analysis. HA significantly reduced the area of the lesion in models of gastric lesions induced by absolute and acidified ethanol, ischemia-induced gastric lesions and reperfusion, and regarding healing. In the collagen deposition, the presence and increase of collagen demonstrate the healing effect. The AH has antiulcerogenic and healing potential demonstrated by the decrease in gastric injury and presence of collagen fibers, respectively.
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48
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Simadibrata DM, Syam AF, Lee YY. A comparison of efficacy and safety of potassium-competitive acid blocker and proton pump inhibitor in gastric acid-related diseases: A systematic review and meta-analysis. J Gastroenterol Hepatol 2022; 37:2217-2228. [PMID: 36181401 PMCID: PMC10092067 DOI: 10.1111/jgh.16017] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/09/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Potassium-competitive acid blocker (PCAB) is a recent alternative to proton pump inhibitor (PPI) for potent acid suppression. The current systematic review and meta-analysis aimed to compare the efficacy and safety of PCAB versus PPI in treating gastric acid-related diseases. METHODS We searched up to June 5, 2022, for randomized controlled trials of gastric acid-related diseases that included erosive esophagitis, symptomatic gastroesophageal reflux disease (GERD), peptic ulcers, and Helicobacter pylori infection. The pooled risk ratio (RR) was evaluated for the efficacy outcome and treatment-emergent adverse events (TEAEs) as the safety outcome. Sensitivity analyses were performed to test the robustness of the study findings. RESULTS Of the 710 screened studies, 19 studies including 7023 participants were analyzed. The RRs for the healing of erosive esophagitis with Vonoprazan versus PPI were 1.09 (95% confidence interval [CI] 1.03-1.14), 1.03 (95% CI 1.00-1.07), and 1.02 (95% CI 1.00-1.05) in Weeks 2, 4, and 8, respectively. There were no differences in the improvement of GERD symptoms and healing of gastric and duodenal ulcers between PCAB and PPI. The pooled eradication rates of H. pylori were significantly higher in Vonoprazan versus PPI first-line treatment (RR 1.13; 95% CI 1.04-1.22). The overall RR of TEAEs with Vonoprazan versus PPI was 1.08 (95% CI 0.89-1.31). Overall, the risk of bias was low to some concerns. Furthermore, sensitivity analyses confirmed the robustness of the study's conclusion. CONCLUSION Vonoprazan is superior to PPI in first-line H. pylori eradication and erosive esophagitis but non-inferior in other gastric acid-related diseases. Likewise, short-term safety is comparable in both treatment groups.
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Affiliation(s)
| | - Ari Fahrial Syam
- Division of Gastroenterology, Department of Internal MedicineFaculty of Medicine Universitas Indonesia – Ciptomangunkusumo General HospitalJakartaIndonesia
| | - Yeong Yeh Lee
- School of Medical SciencesUniversiti Sains MalaysiaKota BharuMalaysia
- GI Function and Motility Unit, Hospital USMKota BharuMalaysia
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49
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Thompson W. Many People Take Proton Pump Inhibitor Unnecessarily: Reflecting On Why to Consider Deprescribing. Sr Care Pharm 2022; 37:600-602. [DOI: 10.4140/tcp.n.2022.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Affiliation(s)
- Wade Thompson
- Faculty of Medicine Department of Anesthesiology Pharmacology and Therapeutics University of British Columbia Vancouver, Canada Research Unit of General Practice University of Southern Denmark Odense, Denmark
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50
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Deng Z, Guo A, Wu C, Wang C. Proton pump inhibitors-related subacute cutaneous lupus erythematosus: Clinical characteristics, management, and outcome. J Cosmet Dermatol 2022; 21:7202-7208. [PMID: 36214602 DOI: 10.1111/jocd.15450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/23/2022] [Accepted: 10/06/2022] [Indexed: 01/06/2023]
Abstract
PURPOSE Previous knowledge about the association between proton pump inhibitors (PPIs) exposure and subacute cutaneous lupus erythematosus (SCLE) was mainly based on limited case reports or few review studies. We aim to evaluate the clinical characteristics, management, and outcome in patients with PPIs-induced SCLE. METHODS Case reports and case series from 2000 to December 31, 2021, on SCLE induced by PPIs were collected and retrospectively analyzed. RESULTS A total of 29 patients (6 male and 23 female) were included from 19 studies, the median age was 61 years (range 19-85), and 65.5% of patients were ≥60 years old. 37.9% of patients had the history of autoimmune diseases. The incubation period of PPIs intro to SCLE was 6 weeks for PPI-naive patients and 2 weeks for those re-administration of PPIs. The most common symptoms were annular and polycyclic erythematous (74.1%), rash or maculopapular (48.1%), and scaly plaques (40.7%). Trunk (69.2%), extremities (69.2%), face (26.9%), chest (26.9%), and back (26.9%) were common involved locations. Antinuclear antibodies, anti-Ro/SSA antibodies, and anti-La/SSB antibodies were positive in 24 patients (82.8%), 24 patients (82.8%), and 6 patients (20.7%), respectively. Direct immunofluorescence was positive in 50% of cases. Complete clinical remission (92.6%) was observed (median time: 4 weeks) with discontinuation of PPIs and treatment of oral corticosteroids (61.1%), hydroxychloroquine (44.4%), or topical steroids (16.7%). CONCLUSION PPIs-related SCLE is a rare adverse reaction based on clinical manifestations associated with immunological abnormalities and suggestive histological findings. PPIs should be suspected when considering possible culprits for drug-related SCLE.
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Affiliation(s)
- Zhenzhen Deng
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Aiyuan Guo
- Department of Dermatology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Cuifang Wu
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Chunjiang Wang
- Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China
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