Potassium-competitive acid blockers (PCABs) have been increasingly used to treat upper gastrointestinal disorders, replacing proton pump inhibitors (PPIs). Whereas PPIs are associated with an increased risk of gastric cancer (GC) after eradication, it is uncertain whether PCABs carry the same risk. Using a population-based claims database in Japan, we identified patients who were prescribed a clarithromycin-based first regimen of eradication between 2015 and 2018. Patients who failed this regimen and those diagnosed with GC before or within 1 year after eradication were excluded. We compared GC incidence between PCAB users and histamine type-2 receptor antagonist (H2RA) users, matching them on the basis of propensity scores calculated with considerations for age, sex, smoking, alcohol consumption, comorbidities, and co-administered medications. PCABs included only vonoprazan in this study. Among 54,055 patients, 568 (1.05%) developed GC during the follow-up period (mean, 3.65 years). The cumulative incidence of GC was 1.64% at 3 years, 2.02% at 4 years, and 2.36% at 5 years in PCAB users and 0.71% at 3 years, 1.04% at 4 years, and 1.22% at 5 years in H2RA users. The use of PCABs was associated with a higher GC risk (matched hazard ratio, 1.92; 95% confidence interval, 1.13–3.25; = .016). Longer PCAB use and high-dose PCAB use were significantly associated with higher incidence of GC. Sensitivity analyses showed the risk of GC incidence among PCAB users was comparable with that of PPI users. The use of PCABs was associated with an increased risk of GC among -eradicated patients, with duration/dose response effects.

中文翻译：

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根除幽门螺杆菌后沃诺拉赞与胃癌风险的关系

钾竞争性酸阻滞剂（PCAB）越来越多地用于治疗上消化道疾病，取代质子泵抑制剂（PPI）。虽然 PPI 与根除后胃癌 (GC) 风险增加相关，但 PCAB 是否具有相同的风险尚不确定。使用日本基于人群的索赔数据库，我们确定了 2015 年至 2018 年间接受基于克拉霉素的首次根除方案的患者。该方案失败的患者以及根除前或根除后 1 年内诊断为 GC 的患者被排除。我们比较了 PCAB 使用者和组胺 2 型受体拮抗剂 (H2RA) 使用者之间的 GC 发生率，并根据年龄、性别、吸烟、饮酒、合并症和联合用药计算得出的倾向评分进行匹配。本研究中 PCAB 仅包含沃诺拉赞。在 54,055 名患者中，568 名（1.05%）在随访期间（平均 3.65 年）发生了 GC。PCAB使用者的GC累积发生率为3年1.64%，4年2.02%，5年2.36%，H2RA使用者3年0.71%，4年1.04%，5年1.22%。PCAB 的使用与较高的 GC 风险相关（匹配风险比，1.92；95% 置信区间，1.13–3.25；= .016）。较长时间使用 PCAB 和使用高剂量 PCAB 与较高的 GC 发生率显着相关。敏感性分析显示 PCAB 使用者发生 GC 的风险与 PPI 使用者相当。PCAB 的使用与根除患者中 GC 风险增加相关，并具有持续时间/剂量反应效应。