2023-08-10 16:14:19
Very widely used to treat gastric disorders, proton pump inhibitors (PPIs) increase the risk of dementia when taken for long periods. This is what suggests a study published on Wednesday August 9 in Neurology, the journal of the american academy of neurology.
It covers a group of 5,712 people – 26% of whom had taken PPIs – with an average age of 75 years. The subjects, followed for five years and five months, were divided into four groups: those who do not use PPIs, those who use them for at most two years and eight months, those who take them for two years and eight months at four years and four months, and those over four years and four months. This work showed that people treated with PPIs for more than four and a half years have a relative risk of dementia increased by 33% – a slightly higher risk – compared to those who do not take these drugs. This result is obtained after adjusting for various factors, such as age, gender, taking other medications, and integrating elements such as high blood pressure or diabetes.
“This study does not prove that these drugs cause dementia but only shows an association”warns epidemiologist Kamakshi Lakshminarayan, of the University of Minnesota (Minneapolis), who coordinated the work. “Although we did not find an association with short-term use, we did find a higher risk of dementia associated with their long-term use”says the researcher.
Five molecules available in France
“This is not the first publication to question the prolonged use of PPIs and the risk of dementia”, emphasizes Dominique Deplanque, president of the French Society of Pharmacology and Therapeutics and head of the medical pharmacology department of the Lille University Hospital. Other work, however, had not shown a link. “Previous studies have never really settled, but this one is of very good quality. Biases have been kept to a minimum”explains Philippe Amouyel, director of the Alzheimer Foundation, for whom other work would however be necessary. “This study has limitations, although there are signals that remain to be confirmed”explains Marc Bardou, gastroenterologist and pharmacologist at the Dijon University Hospital. “PPIs are often used indiscriminately”he continues.
It is indeed one of the most prescribed therapeutic classes in community medicine and in hospitals. No less than 16 million people consume it in France, i.e. around a quarter of the population, according to 2019 figures from the High Authority for Health (HAS). This represents a cost of 260 million euros for Medicare. Five of these molecules are currently available in France: omeprazole, pantoprazole, lansoprazole, rabeprazole and esomeprazole. Reducing the secretion of gastric acid, they are mainly used to treat gastroesophageal reflux, to prevent gastroduodenal lesions which may be induced by non-steroidal anti-inflammatory drugs (NSAIDs) in patients at risk, and to treat gastroduodenal ulcers.
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