Autoimmune and immune-mediated inflammatory diseases after exposure to acid-suppressive medication: A systematic review and meta-analysis.

Pub Date : 2023-01-01 DOI:10.3233/JRS-220012

Anna Nevalainen, Olli Nevalainen

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引用次数: 1

Abstract

Background: Pharmacovigilance risk signals have proposed a relationship between the use of acid-suppressive medications and the development of certain autoimmune and immune-mediated inflammatory diseases.

Objective: A systematic review and a meta-analysis was performed.

Methods: We reviewed MEDLINE (Ovid) and Scopus for comparative observational studies between these diseases and previous exposure to proton-pump inhibitors (PPI), H2-receptor antagonists (H2RA), and antacids. The protocol was registered on the PROSPERO database (CRD42020192715).

Results: From 3,191 citations, 25 articles were eligible and covered 16 diseases. Microscopic colitis (MC) was studied the most (7 studies). In a random-effects meta-analysis, there was low certainty evidence (GRADE approach) of a non-significant relationship between exposure to any PPIs and MC (meta-OR 3.28, 95% CI 0.98-11.0, I2 98.2%, six studies, 4,436 PPI-exposed MC patients). Moderate certainty evidence pointed towards large odds of collagenous colitis after exposure to lansoprazole (meta-OR 14.5, 95% CI 9.37-22.3, I2 10.2%, three studies, 1,725 lansoprazole-exposed patients). After PPI exposure, the risk of rheumatoid arthritis was slightly increased based on low certainty evidence from two cohort studies totaling 475 diagnoses (meta-RR 1.62, 95% CI 1.12-2.34, I2 34.5%).

Conclusions: In patients with MC, it would be reasonable to carefully review the indication of PPI, especially in CC patients using lansoprazole.

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暴露于抑酸药物后的自身免疫和免疫介导的炎症性疾病：一项系统综述和荟萃分析。

背景：药物警戒风险信号提出了抑酸药物的使用与某些自身免疫和免疫介导的炎症疾病的发展之间的关系。目的：进行系统综述和荟萃分析。方法：我们回顾了MEDLINE（Ovid）和Scopus对这些疾病与先前暴露于质子泵抑制剂（PPI）、H2受体拮抗剂（H2RA）和抗酸剂之间的比较观察性研究。该方案已在PROSPERO数据库（CRD42020192715）上注册。结果：从3191次引用中，25篇文章符合条件，涵盖16种疾病。显微镜下结肠炎（MC）研究最多（7项研究）。在一项随机效应荟萃分析中，有低确定性证据（GRADE方法）表明暴露于任何PPI与MC之间存在不显著关系（meta-OR 3.28，95%CI 0.98-11.0，I2 98.2%，6项研究，4436名PPI暴露的MC患者）。中度确定性证据表明，兰索拉唑暴露后发生胶原性结肠炎的几率较大（meta-OR 14.5，95%CI 9.37-22.3，I2 10.2%，三项研究，1725名兰索拉唑接触患者）。PPI暴露后，根据两项共475例诊断的队列研究的低确定性证据，类风湿性关节炎的风险略有增加（meta RR 1.62，95%CI 1.12-2.34，I2 34.5%）。结论：在MC患者中，仔细审查PPI的指征是合理的，尤其是在使用兰索拉唑的CC患者中。

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