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The influence of proton pump inhibitor therapy on the outcome of infliximab therapy in inflammatory bowel disease: a patient-level meta-analysis of randomised controlled studies
  1. Thomas X Lu1,2,3,
  2. Matthew Dapas3,4,
  3. Erika Lin3,
  4. Trevor Peters3,
  5. Atsushi Sakuraba1
  1. 1Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL, USA
  2. 2Indiana University Health Southern Indiana Physicians, Bloomington, IN, USA
  3. 3The Graham School of Continuing Liberal and Professional Studies, University of Chicago, Chicago, IL, USA
  4. 4Department of Human Genetics, University of Chicago, Chicago, IL, USA
  1. Correspondence to Dr Atsushi Sakuraba, Inflammatory Bowel Disease Center, University of Chicago Medicine, Chicago, IL 60637, USA; asakurab{at}


Objective In treating patients with inflammatory bowel disease (IBD), how concomitant medications influence the response to infliximab is largely unexplored. We aim to evaluate whether proton pump inhibitors (PPIs) affect the response to infliximab therapy in patients with IBD.

Design Patient-level data of adult patients with moderate-to-severe IBD treated with infliximab were obtained from the Yale Open Data Access Framework. Multivariable analysis and propensity score-matched analysis were performed to assess week 30 remission rates, week 54 remission rates and hospitalisation rates in patients on infliximab therapy with and without PPI exposure.

Results Among the five randomised controlled studies, there were 147 and 889 patients on infliximab with and without PPI therapy, respectively. Patients on PPI were older, more likely to be Caucasian and were less likely to be on immunomodulator therapy. Patients on PPI were significantly less likely to achieve week 30 remission on multivariable analysis (OR 0.45, p<0.001). Following propensity score matching adjusting for baseline difference in patient characteristics, the week 30 remission rates were 30% and 49% in patients with and without PPI therapy, respectively (p<0.001). Analysing separately for disease, the findings remained statistically significant in Crohn’s disease but did not reach significance in UC. Similar results were seen with week 54 remission rates. Patients on PPI were also more likely to be hospitalised (15% vs 8%, p=0.007). Rates of adverse events such as gastroenteritis were not different between the two groups.

Conclusion In this patient-level meta-analysis of randomised controlled studies, we found that patients with IBD taking PPI were less likely to achieve remission while on infliximab therapy. The results of our study warrant further investigation into the effect of PPI on IBD outcomes and therapies.

  • crohn's disease
  • ulcerative colitis
  • inflammatory bowel disease
  • TNF-alpha
  • proton pump inhibition

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  • Correction notice This article has been corrected since it published Online First. The second affiliation and abstract have been updated.

  • Contributors TXL, MD, EL, TV: Data extraction and analysis. TXL and AS: Concept of study and manuscript preparation.

  • Funding TXL is supported by TL1 training grant in translational science and medical informatics (NIH TL1TR002388).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. The patient-level data were obtained from the Yale Open Data Access Framework and may be requested from the Yale Open Data Access Framework.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.