PPI use hurts survival outcomes in glioblastoma

In patients with newly diagnosed glioblastoma, the use proton pump inhibitors (PPI) may be detrimental to survival, according to a meta-analysis.

For the meta-analysis, researchers conducted a secondary analysis of individual prospectively captured patient data from five randomized clinical trials involving patients with a new diagnosis of glioblastoma. Drug use at baseline was assessed at the following landmarks: start of temozolomide maintenance cycles 1 (landmark 1) and 4 (landmark 2), and end of cycle 6 (landmark 3).

The primary endpoints were progression-free survival (PFS) and overall survival (OS) from baseline and from the start of each corresponding landmark time.

The analysis included 2,981 patients (median age 58 years, 62.3 percent male). Those treated with potent ALDH1A1-activating (PA) PPIs had worse PFS at landmarks 1 (hazard ratio [HR], 1.14, 95 percent confidence interval [CI], 1.01–1.28), 2 (HR, 1.26, 95 percent CI, 1.09–1.44), and 3 (HR, 1.31, 95 percent CI, 1.10–1.56). They also had poor OS at landmarks 1 (HR, 1.34, 95 percent CI, 1.08–1.66) and 2 (HR, 1.14, 95 percent CI, 1.01–1.29). These associations were observed independently of MGMT promoter methylation and steroid use.

The use of other antacid drugs had no effect on survival outcomes.

In light of the findings, the researchers emphasized that PA-PPI use be discouraged in patients with glioblastoma, since alternative agents are available and a detrimental effect cannot be excluded.