PPI may weaken response to infliximab in inflammatory bowel disease

Inflammatory bowel disease (IBD) patients using a proton pump inhibitor (PPI) appear to have lower odds of achieving remission on infliximab therapy, a study reports.

The study was a patient-level meta-analysis of five randomized controlled studies obtained from the Yale Open Data Access Framework. Multivariable and propensity score-matched analyses were conducted to evaluate the following endpoints: week 30 remission rates, week 54 remission rates, and hospitalization rates.

In total, there were 1,036 adult patients with moderate-to-severe IBD treated with infliximab, of whom 147 used PPI concomitantly. PPI users were more likely to be older and be Caucasian and were less likely to be on immunomodulator therapy relative to those without PPI exposure.

On multivariable analysis, PPI use was associated with 55-percent lower odds of achieving week-30 remission (odds ratio [OR], 0.45; p<0.001). This was consistent in a propensity score matching adjusting for baseline difference in patient characteristics, with the week 30 remission rates being less favourable among PPI users vs nonusers (30 percent vs 49 percent; p<0.001).

Subgroup analysis showed that the association remained statistically significant in Crohn’s disease but not in ulcerative colitis.

Results for week-54 remission rates were similar.

Furthermore, PPI users were more likely to be hospitalized compared with nonusers (15 percent vs 8 percent; p=0.007). Adverse events such as gastroenteritis did not significantly differ between the two groups.

The findings suggest that PPI use may negatively affect the response to infliximab therapy in patients with IBD. Further investigation into the effect of PPI on IBD outcomes and therapies is warranted.