PPI Therapy May Render Infliximab Less Effective in IBD Patients

By Megan Brooks

December 29, 2020

NEW YORK (Reuters Health) - Proton-pump inhibitors (PPI) may affect the response to infliximab in patients with inflammatory bowel disease (IBD), according to a meta-analysis.

"The results of our study raise caution in prescribing a PPI to patients with IBD," the study team writes in Gut.

Use of PPIs in early life has been linked to increased risk of developing IBD later on, but whether PPI use influences outcome in IBD remains unclear, Dr. Thomas Lu and colleagues from the University of Chicago note.

To investigate, they analyzed patient-level data from five randomized controlled studies of adults with moderate-to-severe IBD treated with infliximab; 889 patients were also taking a PPI and 147 were not.

They found that PPI users were significantly less likely to achieve remission at 30 weeks while on infliximab therapy (odds rati,o 0.45; P<0.001).

Following propensity-score matching and adjustment for differences in patient characteristics at baseline, week-30 remission rates were 30% in PPI users versus 49% in non-users. Week-54 remission rates were also lower with PPI use than non-use (40% vs. 62%; P<0.001).

"This association was significant for all patients combined and especially for patients with Crohn's disease," Dr. Lu and colleagues report.

Patients on PPI were also more likely to be hospitalized (15% vs. 8%, P=0.007).

Gastric acid provides a natural antimicrobial barrier and inhibiting it with a PPI has been linked with an increased risk of infectious gastroenteritis. However, in this analysis gastroenteritis rates were not significantly different in PPI users and non-users, the researchers note.

PPI therapy may also alter immune-cell function and promote gut dysbiosis, which are potential mechanisms for the lower remission rates and should be investigated further, they suggest.

It also remains unclear what impact PPI therapy may have in IBD patients taking a different class of biologic therapy such as anti-integrin therapy. This is another area for further investigation.

The study had no commercial funding and the authors have declared no competing interests.

SOURCE: http://bit.ly/37GK4wC Gut, online December 18, 2020.

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