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Proton Pump Inhibitors May Increase the Risk of HCV Treatment Failure

Results from a new study published last month in the Journal of Clinical and Translational Hepatology have suggested that the use of a common medication while also taking direct-acting antiviral (DAA) medications may increase the risk of treatment failure. Researchers looked at the use of proton pump inhibitor medications taken at the same time as DAAs for hepatitis C. Proton pump inhibitors (PPIs) are medications that help to decrease acid production in the stomach. They are used to treat very common conditions such as indigestion, acid reflux, ulcers, gastroesophageal reflux disease (GERD), and more.

What Did the Research Show?

After reviewing the results from 9 different cohort studies that included nearly 33,000 individuals, the researchers found a common trend amongst those taking DAAs and PPIs at the same time. Specifically, when people were taking both a PPI and using a DAA medication, they had a lower chance of achieving sustained virologic response (SVR) at 12-weeks, as compared to those not taking a PPI. This trend was the same across all of the studies that the researchers investigated. Additionally, the trend was still found even when researchers controlled for other factors that could have led to treatment failure. It was also still found when breaking up the results and participants into different subgroups. The use of ribavirin and sofosbuvir with DAA treatment did not appear to significantly impact these results.

Overall, the study pointed toward a significantly increased risk of HCV treatment failure for people taking DAAs and PPIs at the same time. Other researchers have previously considered that there may be an association between the two medications and possible impact on treatment outcomes when used at the same time, however, this study strengthened this link. One possible idea as to why PPIs may affect DAA efficacy is that changes in stomach aay affect how much of other medications (like DAAs) our bodies can absorb. Stomach acid plays a key role in helping the human body break down and take in nutrients and other compounds.

What Does This Mean for Those on Treatment?

More research is needed to better understand the possible interactions between the two medications. The researchers encourage physicians treating individuals with HCV to consider the use of PPIs in patients who are to be treated or are being treated for hepatitis C with DAAs. Patients are always encouraged to speak with their healthcare team before making any changes to their medications or treatment plan.1

  1. Wijarnpreecha K, Chesdachai S, Thongprayoon C, et al. Efficacy and safety of direct-acting antivirals in hepatitis C virus-infected patients taking proton pump inhibitors. Journal of Clinical and Translational Hepatology. 28 Dec 2017; 5(4), 327-34. Available from: Accessed January 17, 2018.