Individual patient data meta-analysis of the association between proton pump inhibitor use and survival of patients with newly diagnosed glioblastoma

Proton pump inhibitors (PPIs) are often presecribed to prevent steroid-induced gastritis and peptic ulcer disease in patients with glioblastoma. Yet, these drugs may enhance the activity of aldehyde dehydrogenase 1 A1 (ALDH1A1), which has been linked to protection from oxidative stress, radiotherapy, and chemotherapy. An individual patient data meta-analysis of 5 prospective randomized clinical trials including a total of 2981 patients explored the associations of the use of potent ALDH1A1-activating PPIs (PA-PPIs) with outcomes in patients with newly diagnosed glioblastoma. Use of PA-PPIs was associated with inferior progression-free survival and overall survival outcomes, regardless of MGMT promoter methylation status and steroid use. No such association was observed with other antacid medications. The authors conclude that these findings suggest that PA-PPI use should be discouraged in patients with glioblastoma.