Association between proton pump inhibitor use and mortality in patients with hepatocellular carcinoma receiving tyrosine kinase inhibitor

Discontinuation was defined as a gap of more than 30 days in TKI use after the index date. Since TKI reimbursement was discontinued by Taiwan NHI in patients with disease progression, TKIs discontinuation was used as a surrogate outcome for tumour progression. IPTW adjustment resulted in less significant differences in most baseline patient characteristics, comorbidities and concomitant drugs use between the PPI and non-PPI cohorts (table 1).Table 1 Demographic characteristics of the study subjects after inverse probability of treatment weighting (IPTW) adjustment Characteristics PPI Non-PPI Difference Difference n=2196 n=8013 Unadjusted Adjusted Age, years 63.664 63.638 −1.10 0.026 Male 79.9% 79.0% 0.035 0.002 Comorbidities Chronic hepatitis B 87.6% 87.8% −0.010 −0.002 Chronic hepatitis C 35.6% 36.0% −0.017 −0.004 Alcoholic liver diseases 13.1% 12.6% 0.027 0.005 Liver decompensation 20.4% 20.1% 0.098 0.003 Peptic ulcer diseases 61.3% 61.1% 0.180 0.002 Diabetes mellitus 38.4% 37.8% 0.001 0.006 Hypertension 59.3% 58.7% −0.016 0.007 Hypercholesteraemia 17.0% 16.8% −0.007 0.002 Cerebrovascular events 14.4% 14.3% −0.001 0.001 Acute coronary syndrome 23.2% 23.3% −0.005 0.000 Chronic obstructive pulmonary disease 29.3% 29.1% −0.002 0.002 Chronic renal diseases 8.7% 8.3% −0.009 0.004 Osteoporosis 2.4% 2.4% −0.004 −0.001 Bone fracture 27.7% 27.1% 0.002 −0.001 Heart failure 6.2% 6.4% 0.002 −0.002 Liver failure 7.7% 7.6% 0.017 0.002 Renal failure 13.8% 13.5% 0.000 0.003 Vascular invasion 21.0% 20.5% 0.084 0.004 Concomitant drug use Nucleos(t)ide analogue use 23.% 23.1% 0.032 −0.001 Statins use 4.1% 4.1% −0.004 0.000 Metformin use 11.4% 11.1% −0.006 0l003 Oral antibiotics use 25.7% 25.8% 0.151 −0.001 PPI, proton pump inhibitor. [...]concomitant PPI and TKI use is prevalent and associated with an increased risk of overall mortality in patients with advanced stage HCC.