Abstract
ObjectiveThe association between antipsychotic use and gastric cancer risk remains unclear. Therefore, this study aimed to determine the association between antipsychotic exposure and the incidence of gastric cancer.MethodsUsing a nested case‐control design, a total of 34 470 gastric cancer patients and 163 430 nongastric cancer controls were identified from Taiwan's National Health Insurance Research Database between 1 January 1997 and 31 December 2013. We analyzed the data using a conditional logistic regression model to adjust for possible confounding variables.ResultsAntipsychotic use was independently inversely associated with gastric cancer risk after controlling for potential confounding factors including income, urbanization, medications, physical and medical illness, aspirin use, nonsteroidal anti‐inflammatory drug use and triple therapy. In addition, dose‐dependent trends against gastric cancer risk were also shown with individual antipsychotic compounds including thioridazine, haloperidol, sulpiride, clozapine, olanzapine, quetiapine, amisulpride, and risperidone. A sensitivity analysis showed that second‐generation antipsychotics had significant dose‐dependent effects in reducing the risk of gastric cancer risk in patients with and without peptic ulcer disease.ConclusionsAntipsychotic use was inversely associated with gastric cancer risk, and dose‐dependent effects against gastric cancer were also seen with several individual antipsychotic compounds.
Highlights
Gastric cancer results in 738 000 deaths worldwide every year, and it is the third and fifth leading cause of cancer death among men and women, respectively.[1]
This is the first study assessing the association between antipsychotics and gastric cancer risk using a population‐based design; we found that the incidence of gastric cancer was inversely associated with antipsychotic use after controlling for potential confounding factors
As in previous studies,[8,9] we found that thioridazine could reduce gastric cancer risk with cumulative DDD (cDDD) ≥168 in population‐based environments
Summary
Gastric cancer results in 738 000 deaths worldwide every year, and it is the third and fifth leading cause of cancer death among men and women, respectively.[1]. Among second‐generation antipsychotics (SGAs), risperidone and aripiprazole were reported to have gastro‐protective effects on gastric ulcers in vitro,[14,15] but the influence of SGA exposure in gastric cancer patients remains unclear. A Danish population‐based cohort study revealed that use of antipsychotics was associated with a decreased risk of rectum, colon, and prostate cancer, but the risk of gastric cancer was not assessed.[16] FGAs are gradually being replaced by SGAs due to fewer side effects, there is little evidence of a relationship between use of SGA and gastric cancer. We sought to determine the association between antipsychotic exposure (both FGAs and SGAs) and gastric cancer in a large cross‐national cohort from the Taiwan National Health Insurance Research Database (NHIRD).
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