Influence of PPI Therapy on Outcome of Infliximab Therapy in IBD

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A team of investigators sought to determine how concomitant proton pump inhibitor treatment influences response to infliximab therapy in patients with inflammatory bowel disease.

Patients undergoing treatment with infliximab for inflammatory bowel disease (IBD) and taking concomitant proton pump inhibitors (PPIs) were found to be less likely to achieve remission of IBD, according to study results published in Gut.

Infliximab is a biologic therapy that is commonly used as a first-line treatment for IBD. Although PPI use early in life appears to be associated with risk of developing IBD later in life, it is unclear whether PPI use influences outcomes of IBD therapy. Therefore, researchers sought to evaluate whether PPIs affect the response to infliximab therapy in patients with IBD.

Adult patients who were undergoing treatment with infliximab for moderate to severe IBD and who were part of the Yale Open Data Access Framework were evaluated. Multivariable analysis and propensity score-matched analysis were performed to assess week-30 remission rates, week-54 remission rates, and hospitalization rates in 147 and 889 patients on infliximab therapy with and without PPI exposure, respectively.

Among 5 randomized controlled studies, patients on PPIs were significantly less likely to achieve week-30 remission on multivariable analysis (odds ratio 0.45; P <.001). After propensity score matching adjusted for baseline differences in patient characteristics, week-30 remission rates were 30% and 49% in patients with and without PPI therapy, respectively (P <.001). By analyzing separately for disease, the findings remained statistically significant with Crohn disease but did not reach significance with ulcerative colitis. The investigators saw similar results with week-54 remission rates. Patients taking PPIs were also more likely to be hospitalized (15% vs 8%; P =.007), but rates of adverse events such as gastroenteritis were not different between the 2 groups.

The authors concluded, “In this patient-level meta-analysis of randomized controlled studies, we found that patients with IBD taking PPI were less likely to achieve remission while on infliximab therapy.”

They added, “The results of our study warrant further investigation into the effect of PPI on IBD outcomes and therapies.”


Lu TX, Dapas M, Lin E, Peters T, Sakuraba A. The influence of proton pump inhibitor therapy on the outcome of infliximab therapy in inflammatory bowel disease: a patient-level meta-analysis of randomized controlled studies.  Gut. Published online December 17, 2020. doi:10.1136/gutjnl-2020-321609