PMID- 36578549
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230103
IS  - 1663-9812 (Print)
IS  - 1663-9812 (Electronic)
IS  - 1663-9812 (Linking)
VI  - 13
DP  - 2022
TI  - Do proton pump inhibitors affect the effectiveness of chemotherapy in colorectal 
      cancer patients? A systematic review with meta-analysis.
PG  - 1048980
LID - 10.3389/fphar.2022.1048980 [doi]
LID - 1048980
AB  - Proton pump inhibitors (PPI), one of the most commonly prescribed medications, 
      carry a myriad of adverse events. For colorectal cancer (CRC) patients, it still 
      remains unclear whether the concurrent use of proton pump inhibitors (PPI) would 
      negatively affect chemotherapy. PubMed, Medline, Embase, and Cochrane Library 
      were searched from inception to 10 June 2022, to identify relevant studies 
      involving CRC patients receiving chemotherapy and reporting comparative survival 
      outcomes between PPI users and non-users. Meta-analyses were performed using 
      random-effects models. We identified 16 studies involving 8,188 patients (PPI = 
      1,789; non-PPI = 6,329) receiving either capecitabine-based or fluorouracil-based 
      regimens. The overall survival (HR, 1.02; 95% CI, 0.91 to 1.15; I(2) = 0%) and 
      progression-free survival (HR, 1.15; 95% CI, 0.98 to 1.35; I(2) = 29%) were 
      similar between PPI users and non-users in patients taking capecitabine-based 
      regimens, with low statis-tical heterogeneity. Although the subgroup analysis 
      indicated that early-stage cancer patients taking capecitabine monotherapy with 
      concurrent PPI had a significantly higher disease progression rate (HR, 1.96; 95% 
      CI, 1.21 to 3.16; I(2) = 0%) than those who did not use PPIs, both groups had 
      comparable all-cause mortality (HR, 1.31; 95% CI, 0.75 to 2.29; I(2) = 0%). On 
      the other hand, there was little difference in both OS and PFS in both early- and 
      end-stage patients taking capecitabine combination therapy between PPI users and 
      non-users. Conversely, the use of concomitant PPI in patients taking 
      fluorouracil-based regimens contributed to a marginally significant higher 
      all-cause mortality (HR, 1.18; 95% CI, 1.00 to 1.40; I(2) = 74%), but with high 
      statistical heterogeneity. In conclusion, PPI has little survival influence on 
      CRC patients treated with capecitabine-based regimens, especially in patients 
      taking capecitabine combination therapy. Thus, it should be safe for clinicians 
      to prescribe PPI in these patients. Although patients treated with 
      fluorouracil-based regimens with concomitant PPI trended toward higher all-cause 
      mortality, results were subject to considerable heterogeneity. Systematic Review 
      Registration: identifier 
      https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022338161.
CI  - Copyright (c) 2022 Lin, Wang, Kang, Porpiglia, Chang, Huang, Bhimani, Abdul-Lattif, 
      Azmat, Wang, Lin, Chang and Chi.
FAU - Lin, Wan-Ying
AU  - Lin WY
AD  - Department of Family Medicine, Taipei Medical University Hospital, Taipei, 
      Taiwan.
FAU - Wang, Shih-Syuan
AU  - Wang SS
AD  - Department of Education, Center for Evidence-Based Medicine, Taipei Medical 
      University Hospital, Taipei, Taiwan.
FAU - Kang, Yi-No
AU  - Kang YN
AD  - Department of Education, Center for Evidence-Based Medicine, Taipei Medical 
      University Hospital, Taipei, Taiwan.
FAU - Porpiglia, Andrea S
AU  - Porpiglia AS
AD  - Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA, 
      United States.
FAU - Chang, Yu
AU  - Chang Y
AD  - Section of Neurosurgery, Department of Surgery, National Cheng Kung University 
      Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
FAU - Huang, Chin-Hsuan
AU  - Huang CH
AD  - Department of Education, Center for Evidence-Based Medicine, Taipei Medical 
      University Hospital, Taipei, Taiwan.
FAU - Bhimani, Ronak
AU  - Bhimani R
AD  - Department of Internal Medicine, Lower Bucks Hospital, Bristol, PA, United 
      States.
FAU - Abdul-Lattif, Eahab
AU  - Abdul-Lattif E
AD  - Department of Internal Medicine, Lower Bucks Hospital, Bristol, PA, United 
      States.
FAU - Azmat, Muneeba
AU  - Azmat M
AD  - Department of Internal Medicine, Lower Bucks Hospital, Bristol, PA, United 
      States.
FAU - Wang, Tsu-Hsien
AU  - Wang TH
AD  - Department of Education, Center for Evidence-Based Medicine, Taipei Medical 
      University Hospital, Taipei, Taiwan.
FAU - Lin, Yu-Shiuan
AU  - Lin YS
AD  - Department of Education, Center for Evidence-Based Medicine, Taipei Medical 
      University Hospital, Taipei, Taiwan.
FAU - Chang, Yu-Cheng
AU  - Chang YC
AD  - Department of Education, Center for Evidence-Based Medicine, Taipei Medical 
      University Hospital, Taipei, Taiwan.
FAU - Chi, Kuan-Yu
AU  - Chi KY
AD  - Department of Education, Center for Evidence-Based Medicine, Taipei Medical 
      University Hospital, Taipei, Taiwan.
AD  - Department of Internal Medicine, Taipei Medical University Hospital, Taipei, 
      Taiwan.
LA  - eng
PT  - Systematic Review
DEP - 20221212
PL  - Switzerland
TA  - Front Pharmacol
JT  - Frontiers in pharmacology
JID - 101548923
PMC - PMC9792119
OTO - NOTNLM
OT  - chemotherapy
OT  - colorectal cancer
OT  - meta-analysis
OT  - proton pump inhibitor (PPI)
OT  - systematic review
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/12/30 06:00
MHDA- 2022/12/30 06:01
PMCR- 2022/12/12
CRDT- 2022/12/29 02:27
PHST- 2022/09/20 00:00 [received]
PHST- 2022/11/25 00:00 [accepted]
PHST- 2022/12/29 02:27 [entrez]
PHST- 2022/12/30 06:00 [pubmed]
PHST- 2022/12/30 06:01 [medline]
PHST- 2022/12/12 00:00 [pmc-release]
AID - 1048980 [pii]
AID - 10.3389/fphar.2022.1048980 [doi]
PST - epublish
SO  - Front Pharmacol. 2022 Dec 12;13:1048980. doi: 10.3389/fphar.2022.1048980. 
      eCollection 2022.