Proton Pump Inhibitor Therapy and Risk of Knee Replacement Surgery: A General Population-based Cohort Study
Abstract
Objective: Proton pump inhibitors (PPIs) are among the most commonly used medications for patients with osteoarthritis (OA). Various types of PPIs have different impacts on lowering serum magnesium level that may affect knee OA progression. We aimed to compare the risk of clinically relevant endpoint of knee replacement (KR) among initiators of five different PPIs with that among histamine-2 receptor antagonist (H2RA) initiators. Design: Among patients with knee OA (≥50 years) in The Health Improvement Network database in the UK we conducted five sequential propensity-score matched cohort studies to compare the risk of KR over five-year among patients who initiated omeprazole (n=2,672), pantoprazole (n=664), lansoprazole (n=3,747), rabeprazole (n=751), or esomeprazole (n=827) with those who initiated H2RA. Results: The prevalence of PPI prescriptions among participants with knee OA increased from 12.7% in 2000 to 44.0% in 2017. Two-hundred-and-seventy-four KRs (30.8/1000 person-years) occurred in omeprazole initiators and 230 KRs (25.4/1000 person-years) in H2RA initiators. Compared with H2RA initiators, the risk of KR was 21% higher in omeprazole initiators (hazard ratio [HR]=1.21,95% confidence interval [CI]:1.01–1.44). Similar results were observed when pantoprazole use was compared with H2RA use (HR=1.38,95%CI:1.00–1.90). No such an increased risk of KR was observed among lansoprazole (HR=1.06,95%CI:0.92–1.23), rabeprazole (HR=0.97,95%CI:0.73–1.30), or esomeprazole…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 3,747 participants or records.
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