Concomitant PPI and Advanced Therapy Linked to Worse Outcomes in IBD

Coadministration of proton pump inhibitors (PPIs) and advanced therapy was found to be associated with worse clinical outcomes in patients with inflammatory bowel disease (IBD), according to study results presented at Digestive Disease Week (DDW), held from May 21 to 24, 2022, in San Diego, California, and virtually.

Researchers evaluated the real-world effects of concomitant PPI treatment and advanced therapy on health care resource use (HCRU) and treatment patterns in patients with ulcerative colitis (UC) and Crohn disease (CD). They used data from the IBM MarketScan Databases from January 1, 2015, to September 30, 2020.

Eligible participants were aged 18 years and older, had at least 1 inpatient or 2 or more outpatient claims for UC or CD, and were continuously enrolled 6 months before and 12 months after initiating a new advanced therapy. Researchers considered patients to be concomitant PPI and advanced therapy users if they had received PPI therapy within 30 days or less of starting a new advanced therapy.

Propensity score matching was used to match participants who received PPI and advanced therapy with those who received advanced therapy only, and the results were stratified by UC and CD. Study outcomes were HCRU (all-cause and IBD-related hospitalizations and emergency department [ED] visits or IBD-related surgeries) and treatment patterns (advanced therapy persistence or corticosteroid initiation).

A total of 2224 patients with UC (mean age, 48 years) and 3518 patients with CD (mean age, 46 years) were included in the study. Of the cohort, 9% of patients with UC and 15% with CD had previously used advanced therapy.

The coadministration of PPI and advanced therapy compared with advanced therapy alone led to more patients with UC having all-cause (24.3% vs 15.4%, P <.05) and IBD-related hospitalizations (20.7% vs 12.9%, P <.05). The CD group had no differences in hospitalization rates, although ED visits were increased in patients who received PPI and advanced therapy (all-cause: 34.6% vs 29.2%, P <.05; IBD-related: 19.3% vs 16.6%, P <.05).

The percentage of patients who had an all-cause ED visit or IBD-related surgery was increased among those with UC who were treated with PPI and advanced therapy (all cause ED: 32.6% vs 28.1%, P <.05; IBD surgery: 10.8% vs 6.4%, P <.05). Coadministration of PPI and advanced therapy compared with advanced therapy alone was associated with a higher percentage of patients with UC who discontinued treatment with the new advanced therapy (50.2% vs 43.3%, P <.05).

Steroid initiation occurred more frequently among patients with CD (60.7% vs 53.4%) and UC (64.6% vs 59.0%) who received concomitant treatment vs those who received only advanced therapy. The percentage of patients who had Clostridium difficile was comparable in those receiving PPI and advanced therapy vs those who received only advanced therapy.

“Real-world analysis indicates that coadministration of PPIs and [advanced therapy] is associated with worse outcomes in IBD patients, including increased HCRU such as hospitalization or ED visits, and can result in medication changes and more frequent steroid initiation in patients with UC or CD,” the investigators concluded.

Disclosure: This research was supported by AbbVie. Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Cross RK, Schwartz DA, Rossmann L, Tran J, Griffith J, Afzali A. Impact of concomitant proton pump inhibitor and advanced therapy use on health outcomes of patients with inflammatory bowel disease. Presented at: DDW 2022; May 21-24, 2022; San Diego, CA. Abstract Su1505.