Proton Pump Inhibitors Decrease Efficacy of DAAs in HCV Infection

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The heterogeneity between studies of the overall analysis was insignificant, with an I<sup>2</sup> of 24%.
The heterogeneity between studies of the overall analysis was insignificant, with an I2 of 24%.

Among patients with hepatitis C infection receiving direct-acting antivirals (DAAs), the use of proton pump inhibitors was shown to be associated with a 26% increased risk for failure to achieve sustained virologic response compared with non-use of proton pump inhibitors, according to the results of research published in The Journal of Clinical and Translational Hepatology.

In this systematic review and meta-analysis, 9 cohort studies (n=32,684) that compared the safety and efficacy of DAAs in patients with hepatitis C infection with or without concomitant use of proton pump inhibitors were evaluated. The researchers combined adjusted point estimates from each study to determine the efficacy and safety of DAAs.

Proton pump inhibitor use concomitant with DAA use was associated with a reduced likelihood of achieving sustained virologic response compared with non-use of proton pump inhibitors (odds ratio [OR] 0.74; P <.001). Low heterogeneity among studies was reported (I2 24%).

In a subgroup analysis, the use of proton pump inhibitors was also associated with a decreased rate of sustained virologic response at 12 weeks compared with no proton pump inhibitor use (OR 0.68; P =.01) with low heterogeneity (I2 33%). When a subgroup analysis included only studies that adjusted for confounders, proton pump inhibitor use remained significantly associated with lower odds of achieving sustained virologic response (OR 0.66; P =.02) with low heterogeneity (I2 50%). 

The use of sofosbuvir or ribavirin in DAA regimens did not have a significant effect on the association between proton pump inhibitor use and lower odds of achieving sustained virologic response at 12 weeks.

In an interview with Infectious Diseases Advisor, Karn Wijarnpreecha, MD, of Bassett Medical Center in Cooperstown, New York, and lead author on the paper, concluded that, “physicians should consider whether proton pump inhibitor therapy is indicated for patients receiving DAAs, and withdraw proton pump inhibitor therapy in the absence of indications.”

Reference

Wijarnpreecha K, Chesdachai S, Thongprayoon C, Jaruvongvanich V, Ungprasert P, Cheungpasitporn W. Efficacy and safety of direct-acting antivirals in hepatitis C virus-infected patients taking proton pump inhibitors. J Clin Transl Hepatol. 2017;5:327-334.

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