Potassium-competitive acid blockers linked to gastric cancer risk after H pylori eradication

Exposure to potassium-competitive acid blockers (PCABs) may heighten the risk of developing gastric cancer after successful treatment for Helicobacter pylori infection, according to a study.

Researchers used a population-based claims database in Japan and identified patients who were prescribed a clarithromycin-based first regimen for H pylori eradication. Exclusion criteria were lack of response to the regimen and diagnosis of gastric cancer before or within 1 year after H pylori eradication.

Propensity matching was used to compare gastric cancer incidence between PCAB users and histamine type-2 receptor antagonist (H2RA) users. PCAB included only vonoprazan in this study.

The analysis included 54,055 patients, among whom 568 (1.05 percent) received a diagnosis of gastric cancer over a mean follow-up of 3.65 years. The cumulative incidence rate of gastric cancer among PCAB users was higher than that among H2RA users at year 3 (1.64 percent vs 0.71 percent), at year 4 (2.02 percent vs 1.04 percent), and at year 5 (2.36 percent vs 1.22 percent).

PCAB use was associated with an increased risk of gastric cancer compared with H2RA use (matched hazard ratio, 1.92; 95 percent confidence interval, 1.13–3.25; p=0.016). The risk was greater with higher PCAB doses and longer duration of use.

Sensitivity analyses showed that the risk of gastric cancer incidence among PCAB users was comparable to that among PPI users.