The Study: Baker JF, Reed G, Poudel DR, Harrold LR, Kremer JM. Obesity and response to advanced therapies in rheumatoid arthritis. Arthritis Care Res (Hoboken). 2022 Feb 10. doi: 10.1002/acr.24867. Epub ahead of print. PMID: 35143117.
2) Risk Factors for CPPD
Proton pump inhibitors & the risk of calcium pyrophosphate deposition in a population-based study
Why was this study done? Calcium pyrophosphate deposition disease (CPPD) is common among older adults, but no therapies specifically target CPPD. Hypomagnesemia is associated with the risk of CPPD, and proton pump inhibitor (PPI) use is associated with hypomagnesemia. This study investigated whether PPI use is a risk factor for incident CPPD.
What were the study methods? We used data from the U.K.-based IQVIA Medical Research Database. First, we conducted a propensity score-matched cohort study to compare the risk of incident CPPD among PPI users vs. histamine receptor 2 (H2) blocker users. We used multivariable Cox proportional hazard models, censoring subjects at the time of drug switch. In our second study design, we evaluated incident use of PPI and H2 blockers prior to incident CPPD, using a nested, case-control study, matched 1:4 by age and sex.
What were the key findings? We did not find evidence that incident PPI use was associated with a higher risk of CPPD when compared with H2 blocker use. In the casecontrol study, when compared with non-users, both PPI and H2 blocker users had a higher risk of incident CPPD. Incident PPI use was not significantly associated with incident CPPD, compared with H2 blocker use.
What are the main conclusions? Incident use of PPIs was not significantly associated with an increased risk of CPPD compared with incident H2 blocker use in either study design. However, due to few CPPD cases, we had limited precision in detecting small treatment effects, so this does not rule out a causal association. The results from the case-control study are interesting: It is possible that H2 blocker use may have a similar effect to that of PPI use because users of both medications had a higher risk of CPPD than people who did not use either medication. Confounding by indication cannot be ruled out in this observational study.
What are the implications for patients? Patients diagnosed with CPPD should be ready to review their medication lists with their providers. Patients who are on PPIs in the long term should discuss the need for continuing this therapy.
