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Efficacy and Safety of Direct-acting Antivirals in Hepatitis C Virus-infected Patients Taking Proton Pump Inhibitors.

Authors
  • Wijarnpreecha, Karn1
  • Chesdachai, Supavit2
  • Thongprayoon, Charat1
  • Jaruvongvanich, Veeravich3
  • Ungprasert, Patompong4
  • Cheungpasitporn, Wisit4
  • 1 Department of Internal Medicine, Bassett Medical Center, Cooperstown, NY, USA.
  • 2 Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. , (Thailand)
  • 3 Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA.
  • 4 Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
Type
Published Article
Journal
Journal of clinical and translational hepatology
Publication Date
Dec 28, 2017
Volume
5
Issue
4
Pages
327–334
Identifiers
DOI: 10.14218/JCTH.2017.00017
PMID: 29226099
Source
Medline
Keywords
License
Unknown

Abstract

Background and Aims: Direct-acting antiviral (DAA) therapy is the cornerstone of the treatment of chronic hepatitis C virus (HCV) infection. Eradication of HCV, predicted by the attainment of a sustained virologic response (SVR) 12 weeks following DAA therapy, is the goal of this treatment. Interestingly, recent studies have reported the possible association between HCV-infected patients with DAA therapy concomitant use of proton pump inhibitors (PPIs) and lower odds of achieving SVR. This meta-analysis was conducted to summarize all available data and to estimate this potential association. Methods: Comprehensive literature review was conducted by first searching the Medline and Embase databases through March 2017 to identify all studies that investigated the safety and efficacy of DAAs in patients with HCV infection taking PPIs versus those without PPIs. Adjusted point estimates from each study were combined by the generic inverse variance method of DerSimonian and Laird. Results: Nine cohort studies with 32,684 participants met the eligibility criteria and were included in the meta-analysis. The use of PPIs concomitant with DAAs among HCV-infected patients was associated with lower odds of achieving SVR compared with non-PPI users (pooled odds ratio (OR): 0.74, 95% confidence interval (CI): 0.63-0.88, I2 = 24%). Subgroup analysis addressed the association between PPIs use and SVR12 demonstrated the association of PPI users showing lower odds of achieving SVR12 compared with those with no use of PPIs (pooled OR: 0.68, 95% CI: 0.51-0.9, I2 = 33%). Conclusions: This study demonstrated a significantly increased risk of failure to achieve SVR in HCV-infected patients taking DAA with PPIs compared to non-PPI users. Providers should consider whether PPI therapy is indicated for patients and withdraw of PPI therapy in the absence of indications, especially while on DAA therapy.

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