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Patient-centered Outcomes with Concomitant Use of Proton Pump Inhibitors and Other Drugs

Clinical therapeutics, 2017-02, Vol.39 (2), p.404-427.e36 [Peer Reviewed Journal]

Elsevier HS Journals, Inc. ;2017 Elsevier HS Journals, Inc. ;Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved. ;Copyright Elsevier Limited Feb 2017 ;ISSN: 0149-2918 ;EISSN: 1879-114X ;DOI: 10.1016/j.clinthera.2017.01.011 ;PMID: 28189362

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Title:
Patient-centered Outcomes with Concomitant Use of Proton Pump Inhibitors and Other Drugs
Author: Shamliyan, Tatyana A., MD, MS ; Middleton, Maria, MPH ; Borst, Clarissa, PhD
Subjects: Acute coronary syndromes ; Anticoagulants ; antiplatelets ; Bias ; Biopsy ; Breast cancer ; Cancer therapies ; cardiovascular disease ; combination therapy ; Dementia ; Drug Interactions ; Drugs ; drug–drug interactions ; Gastrointestinal Hemorrhage - chemically induced ; Gastrointestinal Hemorrhage - prevention & control ; HIV ; Human immunodeficiency virus ; Humans ; hypertension ; Hypotheses ; Internal Medicine ; Literature reviews ; Medical Education ; Medical libraries ; Meta-analysis ; Morbidity ; Mortality ; Myocardial Infarction - epidemiology ; outcomes ; Patients ; PPIs ; proton pump inhibitors ; Proton Pump Inhibitors - administration & dosage ; Proton Pump Inhibitors - adverse effects ; Quality ; Randomized Controlled Trials as Topic ; Risk ; Software ; Stroke - epidemiology ; Studies ; Transplants & implants
Is Part Of: Clinical therapeutics, 2017-02, Vol.39 (2), p.404-427.e36
Description: Abstract Purpose We performed a systematic review of patient-centered outcomes after the concomitant use of proton pump inhibitors (PPIs) and other drugs. Methods We searched 4 databases in July 2016 to find studies that reported mortality and morbidity after the concomitant use of PPIs and other drugs. We conducted direct meta-analyses using a random-effects model and graded the quality of evidence according to the Grading of Recommendations Assessment, Development and Evaluation working group approach. Findings We included data from 17 systematic reviews and meta-analyses, 16 randomized controlled trials, and 16 observational studies that examined the concomitant use of PPIs with medications from 10 drug classes. Low-quality evidence suggests that the use of PPIs is associated with greater morbidity when administered with antiplatelet drugs, bisphosphonates, antibiotics, anticoagulants, metformin, mycophenolate mofetil, or nelfinavir. Concomitant PPIs reduce drug-induced gastrointestinal bleeding and are associated with greater docetaxel and cisplatin response rates in patients with metastatic breast cancer. For demonstrated statistically significant relative risks and benefits from concomitant PPIs, the magnitudes of the effects are small, with <100 attributable events per 1000 patients treated, and the effects are inconsistent among specific drugs. Among individual PPIs, the concomitant use of pantoprazole or esomeprazole, but not omeprazole or lansoprazole, is associated with an increased risk for all-cause mortality, nonfatal myocardial infarction, or stroke. Clopidogrel is associated with a greater risk for myocardial infarction compared with prasugrel. Conflicting results between randomized controlled trials and observational studies and high risk for bias in the body of evidence lessened our confidence in the results. Implications Available evidence suggests a greater risk for adverse patient outcomes after the concomitant use of PPIs and medications from 9 drug classes and warns against inappropriate drug combinations. ( Clin Ther . 2017;39:XXX–XXX) © 2017 Elsevier HS Journals, Inc.
Publisher: United States: Elsevier Inc
Language: English
Identifier: ISSN: 0149-2918
EISSN: 1879-114X
DOI: 10.1016/j.clinthera.2017.01.011
PMID: 28189362
Source: MEDLINE
ProQuest Central

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Patient-centered Outcomes with Concomitant Use of Proton Pump Inhibitors and Other Drugs

Elsevier HS Journals, Inc. ;2017 Elsevier HS Journals, Inc. ;Copyright © 2017 Elsevier HS Journals, Inc. All rights reserved. ;Copyright Elsevier Limited Feb 2017 ;ISSN: 0149-2918 ;EISSN: 1879-114X ;DOI: 10.1016/j.clinthera.2017.01.011 ;PMID: 28189362

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