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Concomitant Use of Proton Pump Inhibitors and Palbociclib Among Patients With Breast Cancer

IMPORTANCE: Proton pump inhibitors (PPIs) are commonly used drugs to relieve gastrointestinal tract symptoms, but their acid-inhibitory action negatively affects the bioavailability and clinical outcomes of orally administered concomitant drugs. OBJECTIVE: To identify the clinical outcomes of patien...

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Autores principales: Lee, Ju-Eun, Kwon, Sun-Hong, Kwon, Swan, Jung, Hye-In, Nam, Jin Hyun, Lee, Eui-Kyung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10362477/
https://www.ncbi.nlm.nih.gov/pubmed/37477917
http://dx.doi.org/10.1001/jamanetworkopen.2023.24852
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author Lee, Ju-Eun
Kwon, Sun-Hong
Kwon, Swan
Jung, Hye-In
Nam, Jin Hyun
Lee, Eui-Kyung
author_facet Lee, Ju-Eun
Kwon, Sun-Hong
Kwon, Swan
Jung, Hye-In
Nam, Jin Hyun
Lee, Eui-Kyung
author_sort Lee, Ju-Eun
collection PubMed
description IMPORTANCE: Proton pump inhibitors (PPIs) are commonly used drugs to relieve gastrointestinal tract symptoms, but their acid-inhibitory action negatively affects the bioavailability and clinical outcomes of orally administered concomitant drugs. OBJECTIVE: To identify the clinical outcomes of patients with advanced breast cancer who concomitantly use PPIs and palbociclib. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used nationwide claims data between November 1, 2016, and July 31, 2021, in South Korea. Patients with breast cancer receiving palbociclib between November 1, 2017, and July 31, 2020, were identified. Patients whose prescriptions for palbociclib and PPI overlapped by at least 33% were classified into a concomitant PPI group. Patients who never received PPI during the palbociclib treatment period were classified into a nonconcomitant PPI group. Patients were selected through 1:3 propensity score matching for analyses. EXPOSURES: Concomitant use of PPIs with palbociclib. MAIN OUTCOMES AND MEASURES: Time to progression and death. These outcomes were presented as progression-free survival (PFS) and overall survival (OS) and were analyzed using the Kaplan-Meier method and log-rank test. Cox proportional hazards regression was used to estimate the hazard ratio (HR) of concomitant PPI use associated with clinical PFS and/or OS. RESULTS: A total of 344 women were included in the concomitant PPI group and 966 in the nonconcomitant PPI group. Among 1310 patients identified after matching, 1108 (84.6%) were older than 50 years; 1111 (84.8%) were treated with letrozole and anastrozole (endocrine sensitive); and 199 (15.2%) were treated with fulvestrant (endocrine resistant). The median clinical PFS in the concomitant PPI group was shorter than that of the nonconcomitant PPI group (25.3 [95% CI, 19.6-33.0] vs 39.8 [95% CI, 34.9 to not applicable] months; P < .001), and the HR was 1.76 (95% CI, 1.46-2.13). Concomitant use of PPI was also associated with shorter OS (HR, 2.71 [95% CI, 2.07-3.53]). Both clinical PFS and OS in the concomitant PPI group were consistently poor in patients receiving endocrine-sensitive and endocrine-resistant treatment. CONCLUSIONS AND RELEVANCE: These findings suggest that concomitant use of PPIs with palbociclib may hinder the complete therapeutic benefits of palbociclib in patients with breast cancer.
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spelling pubmed-103624772023-07-23 Concomitant Use of Proton Pump Inhibitors and Palbociclib Among Patients With Breast Cancer Lee, Ju-Eun Kwon, Sun-Hong Kwon, Swan Jung, Hye-In Nam, Jin Hyun Lee, Eui-Kyung JAMA Netw Open Original Investigation IMPORTANCE: Proton pump inhibitors (PPIs) are commonly used drugs to relieve gastrointestinal tract symptoms, but their acid-inhibitory action negatively affects the bioavailability and clinical outcomes of orally administered concomitant drugs. OBJECTIVE: To identify the clinical outcomes of patients with advanced breast cancer who concomitantly use PPIs and palbociclib. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used nationwide claims data between November 1, 2016, and July 31, 2021, in South Korea. Patients with breast cancer receiving palbociclib between November 1, 2017, and July 31, 2020, were identified. Patients whose prescriptions for palbociclib and PPI overlapped by at least 33% were classified into a concomitant PPI group. Patients who never received PPI during the palbociclib treatment period were classified into a nonconcomitant PPI group. Patients were selected through 1:3 propensity score matching for analyses. EXPOSURES: Concomitant use of PPIs with palbociclib. MAIN OUTCOMES AND MEASURES: Time to progression and death. These outcomes were presented as progression-free survival (PFS) and overall survival (OS) and were analyzed using the Kaplan-Meier method and log-rank test. Cox proportional hazards regression was used to estimate the hazard ratio (HR) of concomitant PPI use associated with clinical PFS and/or OS. RESULTS: A total of 344 women were included in the concomitant PPI group and 966 in the nonconcomitant PPI group. Among 1310 patients identified after matching, 1108 (84.6%) were older than 50 years; 1111 (84.8%) were treated with letrozole and anastrozole (endocrine sensitive); and 199 (15.2%) were treated with fulvestrant (endocrine resistant). The median clinical PFS in the concomitant PPI group was shorter than that of the nonconcomitant PPI group (25.3 [95% CI, 19.6-33.0] vs 39.8 [95% CI, 34.9 to not applicable] months; P < .001), and the HR was 1.76 (95% CI, 1.46-2.13). Concomitant use of PPI was also associated with shorter OS (HR, 2.71 [95% CI, 2.07-3.53]). Both clinical PFS and OS in the concomitant PPI group were consistently poor in patients receiving endocrine-sensitive and endocrine-resistant treatment. CONCLUSIONS AND RELEVANCE: These findings suggest that concomitant use of PPIs with palbociclib may hinder the complete therapeutic benefits of palbociclib in patients with breast cancer. American Medical Association 2023-07-21 /pmc/articles/PMC10362477/ /pubmed/37477917 http://dx.doi.org/10.1001/jamanetworkopen.2023.24852 Text en Copyright 2023 Lee JE et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Lee, Ju-Eun
Kwon, Sun-Hong
Kwon, Swan
Jung, Hye-In
Nam, Jin Hyun
Lee, Eui-Kyung
Concomitant Use of Proton Pump Inhibitors and Palbociclib Among Patients With Breast Cancer
title Concomitant Use of Proton Pump Inhibitors and Palbociclib Among Patients With Breast Cancer
title_full Concomitant Use of Proton Pump Inhibitors and Palbociclib Among Patients With Breast Cancer
title_fullStr Concomitant Use of Proton Pump Inhibitors and Palbociclib Among Patients With Breast Cancer
title_full_unstemmed Concomitant Use of Proton Pump Inhibitors and Palbociclib Among Patients With Breast Cancer
title_short Concomitant Use of Proton Pump Inhibitors and Palbociclib Among Patients With Breast Cancer
title_sort concomitant use of proton pump inhibitors and palbociclib among patients with breast cancer
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10362477/
https://www.ncbi.nlm.nih.gov/pubmed/37477917
http://dx.doi.org/10.1001/jamanetworkopen.2023.24852
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