Studie: Läkemedel mot sura uppstötningar – ökad risk för död

En nyligen genomförd kohortstudie som publicerades i British Medical Journal har väckt alarmerande insikter gällande biverkningarna av läkemedel mot sura uppstötningar, så kallade PPI, läkemedel som klassas som protonpumpshämmare.

Denna långsiktiga observationsstudie genomfördes under en tioårsperiod med amerikanska veteraner. Den fördjupade studien använde omfattande data från databaserna. Forskarna använde också National Death Index-data för att analysera dödlighet och dödsorsak.

Resultaten visar tydligt att långsiktig användning av syradämpande läkemedel (PPI) har negativa hälsoeffekter. Biverkningar inkluderar ökad risk för dödlighet, kardiovaskulär sjukdom, kronisk njursjukdom och viss sorts cancer.

Bara i USA använder 15 miljoner människor läkemedel klassade som Proton Pump Inhibitors (PPI).

“Abstract
Objective To estimate all cause mortality and cause specific mortality among patients taking proton pump inhibitors (PPIs).

Design Longitudinal observational cohort study.

Setting US Department of Veterans Affairs.

Participants New users of PPIs (n=157 625) or H2 blockers (n=56 842).

Main outcome measures All cause mortality and cause specific mortality associated with taking PPIs (values reported as number of attributable deaths per 1000 patients taking PPIs).

Results There were 45.20 excess deaths (95% confidence interval 28.20 to 61.40) per 1000 patients taking PPIs. Circulatory system diseases (number of attributable deaths per 1000 patients taking PPIs 17.47, 95% confidence interval 5.47 to 28.80), neoplasms (12.94, 1.24 to 24.28), infectious and parasitic diseases (4.20, 1.57 to 7.02), and genitourinary system diseases (6.25, 3.22 to 9.24) were associated with taking PPIs. There was a graded relation between cumulative duration of PPI exposure and the risk of all cause mortality and death due to circulatory system diseases, neoplasms, and genitourinary system diseases. Analyses of subcauses of death suggested that taking PPIs was associated with an excess mortality due to cardiovascular disease (15.48, 5.02 to 25.19) and chronic kidney disease (4.19, 1.56 to 6.58). Among patients without documented indication for acid suppression drugs (n=116 377), taking PPIs was associated with an excess mortality due to cardiovascular disease (22.91, 11.89 to 33.57), chronic kidney disease (4.74, 1.53 to 8.05), and upper gastrointestinal cancer (3.12, 0.91 to 5.44). Formal interaction analyses suggested that the risk of death due to these subcauses was not modified by a history of cardiovascular disease, chronic kidney disease, or upper gastrointestinal cancer. Taking PPIs was not associated with an excess burden of transportation related mortality and death due to peptic ulcer disease (as negative outcome controls).

Conclusions Taking PPIs is associated with a small excess of cause specific mortality including death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer. The burden was also observed in patients without an indication for PPI use. Heightened vigilance in the use of PPI may be warranted.“