Loading ...

TOPLINE:

Individuals who used potassium-competitive acid blockers (P-CABs) did not face a higher risk for Clostridioides difficile infection than those who used proton pump inhibitors (PPI) or histamine-2 receptor antagonists (H2RAs).

METHODOLOGY:

• Previous observational studies have linked PPI to a higher risk for C difficile infection; P-CABs are a relatively newer class of acid-suppressive agents, but real-world evidence on the risk for C difficile infection with P-CABs remains limited.
• Researchers conducted a retrospective cohort study to determine whether initiating P-CABs increases the risk for C difficile infection compared with initiating PPI or H2RAs in adults who were newly prescribed these acid-suppressive drugs between 2019 and 2024.
• P-CABs included tegoprazan and fexuprazan; PPIs included omeprazole, pantoprazole, rabeprazole, esomeprazole, lansoprazole, ilaprazole, and dexlansoprazole; and H2RAs included cimetidine, ranitidine, roxatidine, famotidine, lafutidine, and nizatidine.
• Three matched cohorts, each representing one pairwise drug class comparison, were analyzed: P-CABs vs PPI (61,596 P-CAB users matched to 132,683 PPI users), P-CABs vs H2RAs (42,794 P-CAB users matched to 89,415 H2RA users), and PPI vs H2RAs (85,686 PPI users matched to 159,178 H2RA users).
• The primary outcome was the occurrence of C difficile infection within 90 days following the initiation of acid-suppressive drugs, with C difficile infection defined as the presence of at least one of the following: a prescription for oral vancomycin, a diagnostic code for C difficile infection, or a positive C difficile toxin A test result.

TAKEAWAY:

• The incidence rate of C difficile infection events was 0.18% vs 0.27% among P-CAB users vs PPI users. No statistically significant between-group difference in the risk for C difficile infection was observed (hazard ratio [HR], 0.87; 95% CI, 0.69-1.10).
• C difficile infection events occurred in 0.20% vs 0.25% of P-CAB users vs H2RA users, and no additional risk for C difficile infection was associated with P-CABs vs H2RAs (HR, 0.85; 95% CI, 0.64-1.12).
• Among PPI vs H2RA users, the events of C difficile infection were 0.49% vs 0.38% (HR, 1.04; 95% CI, 0.84-1.30).
• In sensitivity analyses, P-CABs were associated with a lower risk for C difficile infection than PPI or H2RAs among those with an exposure duration of more than 7 days.

IN PRACTICE:

“[The study] findings indicate that P-CABs do not appear to increase the risk of CDI [C difficile infection] compared with PPIs or H2RAs and may, under specific conditions, be associated with a reduced risk,” the authors of the study concluded.

SOURCE:

The study was led by Gyeongmin Lim, Sungkyunkwan University, Suwon, Republic of Korea. It was published online in the American Journal of Gastroenterology.

LIMITATIONS:

Differences in approved indications across drug classes may have introduced selection bias because H2RAs are generally prescribed for mild conditions such as functional dyspepsia, PPI are often prescribed for more severe conditions such as peptic ulcer disease, and P-CABs have more limited approved indications. Because the study drew data mainly from secondary and tertiary hospitals, the findings may not generalize to primary care. Despite using validated definitions and routinely collected data, the researchers could not eliminate the risk for exposure and outcome misclassification.

DISCLOSURES:

The study was supported by a grant funded by the Ministry of Health and Welfare, Republic of Korea. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.