Association between use of proton pump inhibitors and tuberculosis risk: a systematic review

Hu, Song; Park, H; Hj, Seo

doi:10.5588/ijtld.18.0585

Cited by 3 publications

(3 citation statements)

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“…In the post hoc analysis of the OAK and POLAR trials, LC patients adminstered a combination of chemotherapy and atezolizumb had worse outcomes with PPI use [23]. Sustaining a low pH may weaken our defense to some microorganisms, and an increased risk of TB infection has been observed in clinical studies [24,25]. These findings are compatible with those of our study.…”

Section: Discussionsupporting

confidence: 89%

Influence of Rifamycin on Survival in Patients with Concomitant Lung Cancer and Pulmonary Tuberculosis

Lee,

Wei,

Shu

2023

Biomedicines

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Background: The coexistence of lung cancer and tuberculosis is not rare. Rifamycin plays a pivotal role in anti-tuberculosis therapy. However, its potential impact on the liver metabolism of oncology drugs raises concerns. We performed this study to explore whether Rifamycin affects the survival of patients with tuberculosis and lung cancer. Methods: Drawing from the Taiwan National Health Insurance Research Database, we identified patients diagnosed with concurrent lung cancer and tuberculosis between 2000 and 2014. Patients were categorized based on whether they underwent rifamycin-inclusive or rifamycin-exempt anti-tuberculosis therapy. Subsequently, we paired them at a 1:1 ratio and evaluated the mortality risk over a two-year span. Results: Out of the study participants, 1558 (81.4%) received rifamycin-based anti-tuberculosis therapy, while 356 (18.6%) underwent a rifamycin-free regimen. Analysis revealed no marked variance in the biennial mortality rate between the groups (adjusted hazard ratio: 1.33, 95% confidence interval 0.93–1.90, p = 0.1238). When focusing on the matched sets comprising 127 individuals in each group, the data did not indicate a significant link between rifamycin and a heightened two-year mortality risk (adjusted hazard ratio: 1.00, 95% confidence interval 0.86–1.18, p = 0.9538). Conclusions: For individuals with concomitant lung cancer and tuberculosis, rifamycin’s administration did not adversely influence two-year survival. Thus, rifamycin-containing anti-TB regimens should be prescribed for the indicated patients.

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Section: Discussionsupporting

confidence: 89%

Influence of Rifamycin on Survival in Patients with Concomitant Lung Cancer and Pulmonary Tuberculosis

Lee,

Wei,

Shu

2023

Biomedicines

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“…Similar to the most recent meta-analyses, we also found no evidence of associations between PPI use and risk of Alzheimer’s disease 25 , colon and rectum cancer 26 , prostate cancer 27 , and breast cancer 27 . Previous meta-analyses or original studies suggested that the risk of tuberculosis 28 , pancreatic cancer 29 , liver cancer 27 , visual and auditory impairments 30 were increased with PPI use. However, these associations were not confirmed by our study, potentially because our study employed a more comprehensive approach to control for potential confounders.…”

Section: Discussionmentioning

confidence: 99%

Individualized prevention of proton pump inhibitor related adverse events by risk stratification

Xia,

He,

Smith

et al. 2024

Nat Commun

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Proton pump inhibitors (PPIs) are commonly used for gastric acid-related disorders, but their safety profile and risk stratification for high-burden diseases need further investigation. Analyzing over 2 million participants from five prospective cohorts from the US, the UK, and China, we found that PPI use correlated with increased risk of 15 leading global diseases, such as ischemic heart disease, diabetes, respiratory infections, and chronic kidney disease. These associations showed dose-response relationships and consistency across different PPI types. PPI-related absolute risks increased with baseline risks, with approximately 82% of cases occurring in those at the upper 40% of the baseline predicted risk, and only 11.5% of cases occurring in individuals at the lower 50% of the baseline risk. While statistical association does not necessarily imply causation, its potential safety concerns suggest that personalized use of PPIs through risk stratification might guide appropriate decision-making for patients, clinicians, and the public.

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“…Firstly, significant heterogeneity exists among the included studies. Although subgroup analyses indicated that gender, diabetic status of the participants, study design, and definitions of stain use may not affect the results, other study characteristics may contribute to the heterogeneity, such as the dose and duration of statin use, concurrent using of some other medications which may affect the risk of tuberculosis infection [for example metformin (35), or proton pump inhibitor (36)] and the glycemic status of patients with diabetes (37). Moreover, since the individual patient data was not available, we could only perform subgroup analyses based on studylevel data.…”

Section: Discussionmentioning

confidence: 99%

Statin Use May Be Associated With Reduced Active Tuberculosis Infection: A Meta-Analysis of Observational Studies

Li¹,

Sheng²,

Lou³

2020

Front. Med.

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Background: Tuberculosis remains one of the leading causes of mortality among the infectious diseases, while statins were suggested to confer anti-infective efficacy in experimental studies. We aimed to evaluate the association between statin use and tuberculosis infection in a meta-analysis. Method: Relevant studies were obtained via systematically search of PubMed and Embase databases. A random or a fixed effect model was applied to pool the results according to the heterogeneity among the included studies. Subgroup analyses according to the gender and diabetic status of the participants were performed. We assessed the quality of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Nine observational studies were included. Significant heterogeneity was detected among the studies (p for Cochrane's Q test < 0.001, I 2 = 93%). The GRADE approach showed generally low quality of evidence. Pooled results showed that statin use was associated with reduced active tuberculosis infection (risk ratio [RR]: 0.60, 95% confidence interval [CI]: 0.45 to 0.75, p < 0.001). Subgroup analyses showed that the negative association between statin use and active tuberculosis infection was consistent in men (RR: 0.63, p = 0.01) and women (RR: 0.58, p < 0.001), in participants with (RR: 0.63, p = 0.02) and without diabetes (RR: 0.50, p < 0.001), in retrospective cohort studies (RR: 0.56, p = 0.02), prospective cohort studies (RR: 0.76, p = 0.03), nested case-controls studies (RR: 0.57, p < 0.001), and case-control studies (RR: 0.60, p < 0.001), and in studies with statin used defined as any use within 1 year (RR: 0.59, p < 0.001) or during follow-up (RR: 0.61, p < 0.001). Significant publication bias was detected (p for Egger's regression test = 0.046). Subsequent "trim and fill" analyses retrieved an unpublished study to generate symmetrical funnel plots, and meta-analysis incorporating this study did not significantly affect the results (RR: 0.72, 95% CI: 0.68 to 0.76, p < 0.001). Conclusions: Statin use may be associated with reduced active tuberculosis infection. Randomized controlled trials (RCTs) are needed to confirm the potential preventative role of statin use on tuberculosis infection.

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Association between use of proton pump inhibitors and tuberculosis risk: a systematic review

Cited by 3 publications

References 0 publications

Influence of Rifamycin on Survival in Patients with Concomitant Lung Cancer and Pulmonary Tuberculosis

Influence of Rifamycin on Survival in Patients with Concomitant Lung Cancer and Pulmonary Tuberculosis

Individualized prevention of proton pump inhibitor related adverse events by risk stratification

Statin Use May Be Associated With Reduced Active Tuberculosis Infection: A Meta-Analysis of Observational Studies

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