Impact of proton pump inhibitors on the onset of gastrointestinal immune‐related adverse events during immunotherapy

Abstract

Abstract Introduction The gut microbiota (GM) can influence the pathogenesis of immune‐mediated adverse events (irAEs). Proton pump inhibitors (PPIs) can affect the integrity of GM, but their role in promoting irAEs is still poorly understood. Methods In this retrospective single‐center cohort study, the primary endpoint was the evaluation of the incidence of gastrointestinal (GI) irAEs in cancer patients on PPIs (exposed) versus cancer patients who were not on PPIs (unexposed). Results Three hundred and sixty three patients' records (248 M/115F, median age 69) were reviewed. Twenty‐three exposed patients (92%) developed GI irAEs while only two unexposed patients (8%) developed GI irAEs (hazard ratio [HR] 13.22, 95% confidence interval [CI] 3.11–56.10, p < 0.000). This HR was confirmed after weighting for the propensity score (HR15.13 95% CI 3.22–71.03, p < 0.000). Conclusion Chronic PPI use is associated with an increased risk of GI irAES.

Keywords

• colitis
• hepatitis
• immune checkpoint inhibitors
• microbiome
• proton pomp inhibitors
• toxicity