Can angiotensin-converting enzyme inhibitors reduce the incidence, severity, and duration of radiation proctitis?

Abduelmenem Alashkham, Catherine Paterson, Petra Rauchhaus, Ghulam Nabi

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

PURPOSE: To determine whether participants taking angiotensin-converting enzyme inhibitors (ACEIs) and treated with radical radiation therapy with neoadjuvant/adjuvant hormone therapy have less incidence, severity, and duration of radiation proctitis.

METHODS AND MATERIALS: A propensity score analysis of 817 patients who underwent radical radiation therapy with neoadjuvant or adjuvant hormone therapy as primary line management in a cohort study during 2009 to 2013 was conducted. Patients were stratified as follows: group 1, hypertensive patients taking ACEIs (as a study group); group 2, nonhypertensive patients not taking ACEIs; and group 3, hypertensive patients not taking ACEIs (both as control groups). The incidence, severity, and duration of proctitis were the main outcome. χ(2) tests, Mann-Whitney U tests, analysis of variance, risk ratio (RR), confidence interval (CI), Kaplan-Meier plots, and log-rank tests were used.

RESULTS: The mean age of the participants was 68.91 years, with a follow-up time of 3.38 years. Based on disease and age-matched comparison, there was a statistically significant difference of proctitis grading between the 3 groups: χ(2) (8, n=308) = 72.52, P<.001. The Mann-Whitney U test indicated that grades of proctitis were significantly lower in hypertensive patients taking ACEIs than in nonhypertensive patients not taking ACEIs and hypertensive patients not taking ACEIs (P<.001). The risk ratio (RR) of proctitis in hypertensive patients taking ACEIs was significantly lower than in hypertensive patients not taking ACEIs (RR 0.40, 95% CI 0.30-0.53, P<.001) and in nonhypertensive patients not taking ACEIs (RR 0.58, 95% CI 0.44-0.77, P<.001). Time to event analysis revealed that hypertensive patients taking ACEIs were significantly different from the control groups (P<.0001). Furthermore, hypertensive patients taking ACEIs had significantly faster resolution of proctitis (P<.0001).

CONCLUSION: Patients who were taking ACEIs were significantly less likely to have high-grade proctitis after radical radiation therapy with neoadjuvant or adjuvant hormone therapy (P<.001). The intake of ACEIs was significantly associated with a reduced risk of radiation-induced proctitis and also with acceleration of its resolution.

Original languageEnglish
Pages (from-to)93-101
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume94
Issue number1
DOIs
Publication statusPublished - 1 Jan 2016
Externally publishedYes

Fingerprint

enzyme inhibitors
angiotensins
Proctitis
Angiotensin-Converting Enzyme Inhibitors
incidence
Radiation
Incidence
radiation
hormones
Odds Ratio
confidence
radiation therapy
therapy
Radiotherapy
Hormones
Confidence Intervals
Nonparametric Statistics
intervals
grade
rank tests

Cite this

@article{16bc4f4e48ab4189b13f7778208312a4,
title = "Can angiotensin-converting enzyme inhibitors reduce the incidence, severity, and duration of radiation proctitis?",
abstract = "PURPOSE: To determine whether participants taking angiotensin-converting enzyme inhibitors (ACEIs) and treated with radical radiation therapy with neoadjuvant/adjuvant hormone therapy have less incidence, severity, and duration of radiation proctitis.METHODS AND MATERIALS: A propensity score analysis of 817 patients who underwent radical radiation therapy with neoadjuvant or adjuvant hormone therapy as primary line management in a cohort study during 2009 to 2013 was conducted. Patients were stratified as follows: group 1, hypertensive patients taking ACEIs (as a study group); group 2, nonhypertensive patients not taking ACEIs; and group 3, hypertensive patients not taking ACEIs (both as control groups). The incidence, severity, and duration of proctitis were the main outcome. χ(2) tests, Mann-Whitney U tests, analysis of variance, risk ratio (RR), confidence interval (CI), Kaplan-Meier plots, and log-rank tests were used.RESULTS: The mean age of the participants was 68.91 years, with a follow-up time of 3.38 years. Based on disease and age-matched comparison, there was a statistically significant difference of proctitis grading between the 3 groups: χ(2) (8, n=308) = 72.52, P<.001. The Mann-Whitney U test indicated that grades of proctitis were significantly lower in hypertensive patients taking ACEIs than in nonhypertensive patients not taking ACEIs and hypertensive patients not taking ACEIs (P<.001). The risk ratio (RR) of proctitis in hypertensive patients taking ACEIs was significantly lower than in hypertensive patients not taking ACEIs (RR 0.40, 95{\%} CI 0.30-0.53, P<.001) and in nonhypertensive patients not taking ACEIs (RR 0.58, 95{\%} CI 0.44-0.77, P<.001). Time to event analysis revealed that hypertensive patients taking ACEIs were significantly different from the control groups (P<.0001). Furthermore, hypertensive patients taking ACEIs had significantly faster resolution of proctitis (P<.0001).CONCLUSION: Patients who were taking ACEIs were significantly less likely to have high-grade proctitis after radical radiation therapy with neoadjuvant or adjuvant hormone therapy (P<.001). The intake of ACEIs was significantly associated with a reduced risk of radiation-induced proctitis and also with acceleration of its resolution.",
keywords = "Aged, Aged, 80 and over, Analysis of Variance, Angiotensin-Converting Enzyme Inhibitors/therapeutic use, Chi-Square Distribution, Humans, Hypertension/drug therapy, Incidence, Male, Middle Aged, Neoadjuvant Therapy/methods, Neoplasm Grading, Proctitis/etiology, Propensity Score, Prostatic Neoplasms/pathology, Statistics, Nonparametric, Time Factors",
author = "Abduelmenem Alashkham and Catherine Paterson and Petra Rauchhaus and Ghulam Nabi",
note = "Copyright {\circledC} 2016 Elsevier Inc. All rights reserved.",
year = "2016",
month = "1",
day = "1",
doi = "10.1016/j.ijrobp.2015.09.013",
language = "English",
volume = "94",
pages = "93--101",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "1",

}

Can angiotensin-converting enzyme inhibitors reduce the incidence, severity, and duration of radiation proctitis? / Alashkham, Abduelmenem; Paterson, Catherine; Rauchhaus, Petra; Nabi, Ghulam.

In: International Journal of Radiation Oncology Biology Physics, Vol. 94, No. 1, 01.01.2016, p. 93-101.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Can angiotensin-converting enzyme inhibitors reduce the incidence, severity, and duration of radiation proctitis?

AU - Alashkham, Abduelmenem

AU - Paterson, Catherine

AU - Rauchhaus, Petra

AU - Nabi, Ghulam

N1 - Copyright © 2016 Elsevier Inc. All rights reserved.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - PURPOSE: To determine whether participants taking angiotensin-converting enzyme inhibitors (ACEIs) and treated with radical radiation therapy with neoadjuvant/adjuvant hormone therapy have less incidence, severity, and duration of radiation proctitis.METHODS AND MATERIALS: A propensity score analysis of 817 patients who underwent radical radiation therapy with neoadjuvant or adjuvant hormone therapy as primary line management in a cohort study during 2009 to 2013 was conducted. Patients were stratified as follows: group 1, hypertensive patients taking ACEIs (as a study group); group 2, nonhypertensive patients not taking ACEIs; and group 3, hypertensive patients not taking ACEIs (both as control groups). The incidence, severity, and duration of proctitis were the main outcome. χ(2) tests, Mann-Whitney U tests, analysis of variance, risk ratio (RR), confidence interval (CI), Kaplan-Meier plots, and log-rank tests were used.RESULTS: The mean age of the participants was 68.91 years, with a follow-up time of 3.38 years. Based on disease and age-matched comparison, there was a statistically significant difference of proctitis grading between the 3 groups: χ(2) (8, n=308) = 72.52, P<.001. The Mann-Whitney U test indicated that grades of proctitis were significantly lower in hypertensive patients taking ACEIs than in nonhypertensive patients not taking ACEIs and hypertensive patients not taking ACEIs (P<.001). The risk ratio (RR) of proctitis in hypertensive patients taking ACEIs was significantly lower than in hypertensive patients not taking ACEIs (RR 0.40, 95% CI 0.30-0.53, P<.001) and in nonhypertensive patients not taking ACEIs (RR 0.58, 95% CI 0.44-0.77, P<.001). Time to event analysis revealed that hypertensive patients taking ACEIs were significantly different from the control groups (P<.0001). Furthermore, hypertensive patients taking ACEIs had significantly faster resolution of proctitis (P<.0001).CONCLUSION: Patients who were taking ACEIs were significantly less likely to have high-grade proctitis after radical radiation therapy with neoadjuvant or adjuvant hormone therapy (P<.001). The intake of ACEIs was significantly associated with a reduced risk of radiation-induced proctitis and also with acceleration of its resolution.

AB - PURPOSE: To determine whether participants taking angiotensin-converting enzyme inhibitors (ACEIs) and treated with radical radiation therapy with neoadjuvant/adjuvant hormone therapy have less incidence, severity, and duration of radiation proctitis.METHODS AND MATERIALS: A propensity score analysis of 817 patients who underwent radical radiation therapy with neoadjuvant or adjuvant hormone therapy as primary line management in a cohort study during 2009 to 2013 was conducted. Patients were stratified as follows: group 1, hypertensive patients taking ACEIs (as a study group); group 2, nonhypertensive patients not taking ACEIs; and group 3, hypertensive patients not taking ACEIs (both as control groups). The incidence, severity, and duration of proctitis were the main outcome. χ(2) tests, Mann-Whitney U tests, analysis of variance, risk ratio (RR), confidence interval (CI), Kaplan-Meier plots, and log-rank tests were used.RESULTS: The mean age of the participants was 68.91 years, with a follow-up time of 3.38 years. Based on disease and age-matched comparison, there was a statistically significant difference of proctitis grading between the 3 groups: χ(2) (8, n=308) = 72.52, P<.001. The Mann-Whitney U test indicated that grades of proctitis were significantly lower in hypertensive patients taking ACEIs than in nonhypertensive patients not taking ACEIs and hypertensive patients not taking ACEIs (P<.001). The risk ratio (RR) of proctitis in hypertensive patients taking ACEIs was significantly lower than in hypertensive patients not taking ACEIs (RR 0.40, 95% CI 0.30-0.53, P<.001) and in nonhypertensive patients not taking ACEIs (RR 0.58, 95% CI 0.44-0.77, P<.001). Time to event analysis revealed that hypertensive patients taking ACEIs were significantly different from the control groups (P<.0001). Furthermore, hypertensive patients taking ACEIs had significantly faster resolution of proctitis (P<.0001).CONCLUSION: Patients who were taking ACEIs were significantly less likely to have high-grade proctitis after radical radiation therapy with neoadjuvant or adjuvant hormone therapy (P<.001). The intake of ACEIs was significantly associated with a reduced risk of radiation-induced proctitis and also with acceleration of its resolution.

KW - Aged

KW - Aged, 80 and over

KW - Analysis of Variance

KW - Angiotensin-Converting Enzyme Inhibitors/therapeutic use

KW - Chi-Square Distribution

KW - Humans

KW - Hypertension/drug therapy

KW - Incidence

KW - Male

KW - Middle Aged

KW - Neoadjuvant Therapy/methods

KW - Neoplasm Grading

KW - Proctitis/etiology

KW - Propensity Score

KW - Prostatic Neoplasms/pathology

KW - Statistics, Nonparametric

KW - Time Factors

UR - http://www.scopus.com/inward/record.url?scp=84952638545&partnerID=8YFLogxK

UR - http://www.mendeley.com/research/angiotensinconverting-enzyme-inhibitors-reduce-incidence-severity-duration-radiation-proctitis-1

U2 - 10.1016/j.ijrobp.2015.09.013

DO - 10.1016/j.ijrobp.2015.09.013

M3 - Article

VL - 94

SP - 93

EP - 101

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 1

ER -