AChEI use ups lung cancer risk in older, comorbid patients

Medication with acetylcholinesterase inhibitors (AChEI) increases the risk of lung cancer among older patients and those with several comorbidities, reports a recent study.

Researchers conducted a retrospective analysis of 116,106 new AChEI users enrolled in the Taiwan Longitudinal Health Insurance Database. Users were matched 1:3 according to age, sex, and index year with 348,318 controls. The main outcome of interest was the risk of developing lung cancer.

Over 15 years of follow-up, 4,713 AChEI users developed lung cancer, as compared with 14,071 controls. The respective incidence rates were 371.04 vs 362.52 per 100,000 person-years. Kaplan-Meier analysis revealed no significant difference in lung cancer incidence between users and controls (p=0.245), an effect confirmed by Cox regression analysis (adjusted hazard ratio [HR], 1.198, 95 percent confidence interval [CI], 0.765–1.774; p=0.167).

In contrast, AChEI users aged ≥65 years were nearly 50 percent more likely to develop lung cancer than younger counterparts (adjusted HR, 1.498, 95 percent CI, 1.124–1.798; p<0.001). Similarly, lung cancer risk was elevated among those with comorbidities such as pneumonia, pulmonary alveolar pneumonopathy, and hypertension, among others.

Moreover, long-term use of the AChEIs rivastigmine (366–730 days: adjusted HR, 1.245, 95 percent CI, 1.041–1.884; p=0.003; ≥731 days: adjusted HR, 1.297, 95 percent CI, 1.043–1.889; p=0.001) and galantamine (≥731 days: adjusted HR, 1.211, 95 percent CI, 1.070–1.978; p<0.001) likewise correlated with a higher risk of lung cancer.

“To the best of our knowledge, this is the first study on the topic of the association between the usage of ACEI and the risk of lung cancer,” the researchers said.