The association between acid-suppressive agent use and the risk of cancer: a systematic review and meta-analysis
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PHARMACOEPIDEMIOLOGY AND PRESCRIPTION
The association between acid-suppressive agent use and the risk of cancer: a systematic review and meta-analysis Hyun Jin Song 1,2
&
Nakyung Jeon 3 & Patrick Squires 2
Received: 22 February 2020 / Accepted: 1 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Acid-suppressive agents (ASAs) may be associated with cancer; previous studies reported that the risk of cancer with acid suppressants has differed depending on the site of cancer. Here, we conducted a systematic review and meta-analysis of the association between ASA use and the type of cancer risk. Methods MEDLINE, EMBASE, and Cochrane library databases were searched for publications up to the end of September 2019 for MeSH terms and text words related to cancer and ASAs. Studies on the association between ASAs and cancer risk, which included a control group and reported the relative risk of cancer, were included. The inverse-variance random effect model was used to estimate the pooled relative risk (RR) and 95% confidence interval (CI), and subgroup analysis for type of acid suppressants, drug uptake duration, and cumulative doses was performed. Heterogeneity was assessed using the I2 test and Q statistic. Results Thirty-nine cohort and case–control studies were included. ASA use was found to be significantly associated with a 46% higher risk of gastric cancer (RR, 1.46; 95% CI, 1.18–1.80) and a 53% higher risk of liver cancer (RR, 1.53; 95% CI, 1.31–1.78) compared with nonuse; however, there was no significant association for esophageal, colorectal, pancreatic, lung, breast, prostate, and kidney cancer; melanoma; and lymphoma. Conclusions ASAs were significantly associated with an increased risk of gastric and liver cancer; therefore, special attention of ASA use considering the potential risk of gastric and liver cancer is needed. Keywords Acid-suppressive agent . Cancer . Proton pump inhibitor . Histamine 2-receptor antagonist . Systematic review . Meta-analysis
Introduction Hyun Jin Song and Nakyung Jeon contributed equally to this work as first authors. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00228-020-02927-8) contains supplementary material, which is available to authorized users. * Hyun Jin Song [email protected] 1
Department of Pharmaceutical Policy and Outcomes Research, School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
2
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, HPNP Building Room 2320, 1225 Center Drive, Gainesville, FL 32610, USA
3
College of Pharmacy, Chonnam National University, Gwangju, South Korea
Histamine 2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs), common acid-suppressive agents (ASAs), are the mainstay treatments for gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD). Both classes of drugs can effectively alleviate patient symptoms and decrease the frequency and duration of gastroeso
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