Kim Yerim, Seo Seung In, Lee Kyung Joo, Kim Jinseob, Yoo Jong Jin, Seo Won-Woo, Lee Hyung Seok, Shin Woon Geon
Department of Neurology, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea.
Division of Gastroenterology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea.
Ther Adv Neurol Disord. 2022 Nov 8;15:17562864221135700. doi: 10.1177/17562864221135700. eCollection 2022.
Dementia has a crucial impact on the quality of life of elderly patients and their caregivers. Proton-pump inhibitors (PPIs) are the most frequently prescribed treatment, but they have been shown to be associated with dementia. The data are inconsistent, however.
To investigate the association between PPIs use and Alzheimer's disease (AD) or all-cause dementia in six observational Korean databases using a Common Data Model (CDM) and to perform a distributed network analysis.
Subjects aged over 18 years between 1 January 2004 and 31 December 2020. Among 7,293,565 subjects from 6 cohorts, 41,670 patients met the eligibility criteria. A total of 2206 patients who were included in both cohorts or with a history of dementia were excluded. After propensity matching, 5699 propensity-matched pairs between the PPIs and histamine-2 receptor antagonist (HRA) users were included in this study. The primary outcome was the incidence of AD at least 365 days after drug exposure. The secondary outcome was the incidence of all-cause dementia at least 365 days after drug exposure.
In the 1:1 propensity score matching, the risk of AD or all-cause dementia was not significantly different between the PPIs and HRA groups in all six databases. In the distributed network analysis, the long-term PPI users (⩾365 days) were unassociated with AD [hazard ratio (HR) = 0.92, 95% confidence interval (CI) = 0.68-1.23; = 0%] and all-cause dementia (HR =1.04, 95% CI = 0.82-1.31; = 0%) compared with HRA users.
In the distributed network analysis of six Korean hospital databases using Observational Medical Outcomes Partnership (OMOP)-CDM data, the long-term use of PPI was not associated with a statistically significantly increased risk of AD or all-cause dementia. Therefore, we suggest that physicians should not avoid these medications because of concern about dementia risk.
痴呆对老年患者及其照料者的生活质量有至关重要的影响。质子泵抑制剂（PPIs）是最常开具的治疗药物，但已显示它们与痴呆有关。然而，数据并不一致。
使用通用数据模型（CDM）在六个韩国观察性数据库中研究PPIs使用与阿尔茨海默病（AD）或全因性痴呆之间的关联，并进行分布式网络分析。
研究对象为2004年1月1日至2020年12月31日期间年龄超过18岁的人群。在来自6个队列的7293565名受试者中，41670名患者符合纳入标准。共有2206名同时纳入两个队列或有痴呆病史的患者被排除。倾向得分匹配后，本研究纳入了PPIs使用者与组胺-2受体拮抗剂（HRA）使用者之间的5699对倾向得分匹配对。主要结局是药物暴露后至少365天AD的发生率。次要结局是药物暴露后至少365天全因性痴呆的发生率。
在1:1倾向得分匹配中，在所有六个数据库中，PPIs组和HRA组之间AD或全因性痴呆的风险无显著差异。在分布式网络分析中，与HRA使用者相比，长期使用PPIs（≥365天）与AD[风险比（HR）=0.92，95%置信区间（CI）=0.68-1.23；P=0%]和全因性痴呆（HR=1.04，95%CI=0.82-1.31；P=0%）无关。
在使用观察性医疗结局合作组织（OMOP）-CDM数据对六个韩国医院数据库进行的分布式网络分析中，长期使用PPI与AD或全因性痴呆风险的统计学显著增加无关。因此，我们建议医生不应因担心痴呆风险而避免使用这些药物。
