PPIs Or Acid Reflux Drugs Affects Cognitive Abilities Of Breast Cancer Survivors
Researchers from New Ohio State University have shown an association between breast cancer
survivors' use of proton pump inhibitors
) and reports of problems with concentration and memory. On average, cognitive
problems reported by PPI
users were between 20 and 29 percent more severe than issues reported by non-PPI
are sold under such brand names as Nexium, Prevacid and Prilosec.
The research, the first to look at PPI
use in breast cancer
survivors, used data from three previous Ohio State clinical trials examining fatigue, a yoga intervention and vaccine response in breast cancer
patients and survivors. In each of those studies, participants had reported their use of prescribed and over-the-counter medications and rated any cognitive
symptoms they had as part of routine data collection.
It was observed that after controlling for a variety of factors that could affect cognition
such as depression or other illnesses, types of cancer t
reatment, age and education, the researchers found that PPI
use predicted more severe concentration and memory symptoms as well as lower quality of life related to impaired cognition
Dr Annelise Madison, lead author of the study and a graduate student in clinical psychology at Ohio State told Thailand Medical
News, "The severity of the cognitive
problems reported by PPI
users in this study was comparable to what patients undergoing chemotherapy had reported in a large observational study. PPI
non-users also reported problems, but were definitely getting better. Based on what we're seeing, we don't know if PPI
users might not be able to fully recover cognitively after chemotherapy. It's an area for further investigation."
The research findings were published in the Journal of Cancer Survivorship
Dr Madison pursued this study based on her knowledge of PPIs
' known potential to bypass the blood-brain barrier and previous research suggesting that off-label use of PPIs
patients may increase tumors' responsiveness to chemotherapy and protect the digestive system from the ravages of chemo drugs.
She added, "I thought there could be a cognitive
effect from taking PPIs,
particularly in this population, because breast cancer
survivors are already at risk for cognitive
are over the counter and generally considered safe so there haven't been many long-term trials, especially looking at cogniti
outcomes, because nobody was really thinking that would be a downstream effect."
As a component of her graduate program, Madison works in the lab of Janice Kiecolt-Glaser, professor of psychiatry and psychology and director of the Institute for Behavioral Medicine Research at Ohio State. For this work, Madison conducted secondary analyses of three of Kiecolt-Glaser's earlier studies examining inflammation's connection to breast cancer
treatment and survivorship.
Medical data from 551 women in those earlier studies, 88 of whom reported taking PPIs
, were used in Madison's analysis. The women in the previous studies had provided self-reports of PPI
use and cognitive
symptoms multiple times over varied periods of time depending on the design of each study.
Females in the studies looking at fatigue in newly diagnosed patients and investigating yoga's effect on inflammation and fatigue in survivors had completed a questionnaire rating the severity of their memory and concentration problems on a scale of 0 to 10 over the previous five days. Madison's analysis found that on average, PPI
users' concentration problems in the fatigue study were 20 percent more severe than those reported by non-PPI
users. In the yoga study, PPI
users' concentration problems were 29 percent more severe than those reported by non-PPI
users. There were no differences in reported memory problems.
The third study, which featured data from the placebo visit of a typhoid vaccine trial, reported memory problems were 28 percent more severe in PPI
users than in non-users, with no differences in reports of concentration issues. Breast cancer
survivors in this study completed an additional questionnaire measuring the functional implications of their cognitive
users' scores were lower than non-users' scores on this assessment, where PPI
users reported a poorer quality of life, greater cognitive impairment and poorer cognitive
abilities compared to non-users.
Dr Kiecolt-Glaser, senior author of the paper and an investigator in Ohio State's Comprehensive Cancer
Center added, "The fact that this study found similar effects across three different sets of patients who are at different stages of cancer
survivorship gives some weight to what we're seeing. Had it been in only a single study, it could have been a chance effect."
The FDA has approved PPIs
for short-term use to treat common gastric acid conditions and longer-term use for gastric ulcers and disorders involving excessive acid secretion. Madison noted that the off-label maintenance use of PPIs
patients can last a long time: Her analysis showed that at least two-thirds of the breast cancer
survivors using PPIs
had taken them for between six months and two years.
Dr Madison stressed that the study shows a correlation between PPI
use and cognitive
problems in breast cancer
survivors, and that a clinical trial controlling PPI
doses and obtaining objective cognitive
data would be required to identify any causal effect.
Reference: Annelise A. Madison et al, Cognitive problems of breast cancer survivors on proton pump inhibitors, Journal of Cancer Survivorship (2020). DOI: 10.1007/s11764-019-00815-4