Proton pump inhibitor therapy and risk of knee replacement surgery: a general population-based cohort study,Osteoarthritis and Cartilage

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Proton pump inhibitor therapy and risk of knee replacement surgery: a general population-based cohort study
Osteoarthritis and Cartilage ( IF 7.2 ) Pub Date : 2022-01-11 , DOI: 10.1016/j.joca.2021.12.010
C Zeng ₁ , T Neogi ₂ , A T Chan ₃ , J Wei ₄ , D Misra ₅ , N Lu ₆ , H K Choi ₇ , G Lei ₈ , Y Zhang ₇

Affiliation

Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA.
Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Harvard Medical School, Boston, MA, USA.
Health Management Center, Xiangya Hospital, Central South University, Changsha, China.
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Arthritis Research Canada, Richmond, British Columbia, Canada.
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center of Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.

Objective

Proton pump inhibitors (PPIs) are among the most commonly used medications for patients with osteoarthritis (OA). Various types of PPIs have different impacts on lowering serum magnesium level that may affect knee OA progression. We aimed to compare the risk of clinically relevant endpoint of knee replacement (KR) among initiators of five different PPIs with that among histamine-2 receptor antagonist (H2RA) initiators.

Design

Among patients with knee OA (≥50 years) in The Health Improvement Network database in the UK we conducted five sequential propensity-score matched cohort studies to compare the risk of KR over 5-year among patients who initiated omeprazole (n = 2,672), pantoprazole (n = 664), lansoprazole (n = 3,747), rabeprazole (n = 751), or esomeprazole (n = 827) with those who initiated H2RA.

Results

The prevalence of PPI prescriptions among participants with knee OA increased from 12.7% in 2000–44.0% in 2017. Two-hundred-and-seventy-four KRs (30.8/1,000 person-years) occurred in omeprazole initiators and 230 KRs (25.4/1,000 person-years) in H2RA initiators. Compared with H2RA initiators, the risk of KR was 21% higher in omeprazole initiators (hazard ratio [HR] = 1.21,95% confidence interval [CI]:1.01–1.44). Similar results were observed when pantoprazole use was compared with H2RA use (HR = 1.38,95%CI:1.00–1.90). No such an increased risk of KR was observed among lansoprazole (HR = 1.06,95%CI:0.92–1.23), rabeprazole (HR = 0.97,95%CI:0.73–1.30), or esomeprazole (HR = 0.83,95%CI:0.60–1.15) initiators compared with that among H2RA initiators.

Conclusions

In this population-based cohort study, initiation of omeprazole or pantoprazole use was associated with a higher risk of KR than initiation of H2RA use. This study raises concern regarding an unexpected risk of omeprazole and pantoprazole on accelerating OA progression.

中文翻译：

质子泵抑制剂治疗和膝关节置换手术的风险：基于一般人群的队列研究

客观的

质子泵抑制剂（PPI）是骨关节炎（OA）患者最常用的药物之一。不同类型的 PPI 对降低血清镁水平有不同的影响，从而可能影响膝关节 OA 的进展。我们的目的是比较五种不同 PPI 起始剂与组胺 2 受体拮抗剂 (H2RA) 起始剂之间膝关节置换 (KR) 临床相关终点的风险。

设计

在英国健康改善网络数据库中的膝关节 OA 患者（≥50 岁）中，我们进行了五项序贯倾向评分匹配队列研究，以比较开始使用奥美拉唑的患者 ( n = 2,672) 5 年内发生 KR 的风险，开始 H2RA 的患者使用泮托拉唑 ( n = 664)、兰索拉唑 ( n = 3,747)、雷贝拉唑 ( n = 751) 或埃索美拉唑 ( n = 827)。

结果

膝关节 OA 患者中 PPI 处方的患病率从 2000 年的 12.7% 上升至 2017 年的 44.0%。奥美拉唑引发剂发生了 274 个 KR（30.8/1,000 人年），230 个 KR（25.4/1,000 人年）发生了 230 个 KR（25.4/1,000 人年）。 H2RA 发起者为 1,000 人年）。与H2RA引发剂相比，奥美拉唑引发剂发生KR的风险高21%（风险比[HR] = 1.21，95%置信区间[CI]：1.01–1.44）。当泮托拉唑的使用与 H2RA 的使用进行比较时，观察到类似的结果（HR = 1.38，95% CI：1.00–1.90）。在兰索拉唑 (HR = 1.06,95%CI:0.92–1.23)、雷贝拉唑 (HR = 0.97,95%CI:0.73–1.30) 或埃索美拉唑 (HR = 0.83,95%CI:0.73–1.30) 中未观察到 KR 风险增加:0.60–1.15) 引发剂与 H2RA 引发剂之间的比较。