Proton pump inhibitors (PPI) are associated with poor outcomes in cirrhosis. Comparing impact of PPI versus potassium-channel acid blockers (PCABs) is important. Cirrhosis patients on PCABs vs PPIs were followed for outcomes (liver-related hospitalizations/complications, mortality, and infections). Groups were compared using adjusted/unadjusted Cox-proportional hazards at 6/12 months post-initiation. 35,056 patients (31,688 PPI, 3,368 PCAB) were included. Adjusted analysis showed lower 6/12-month outcomes with vonoprazan versus PPI for mortality (aHR-0.36/0.39), infections (aHR-0.60/0.67), liver-complications (aHR-0.16/0.18), and liver-related hospitalizations (aHR-0.12/0.13), which remained largely consistent on sensitivity analyses. Cirrhosis patients on PCABs demonstrate lower risk for poor outcomes at 6 and 12-months versus PPIs.
Patel et al. (Tue,) studied this question.