Vonoprazan Is Associated With Better Liver-Related Outcomes Compared With Proton Pump Inhibitors in Cirrhosis

Proton pump inhibitors (PPIs) are associated with poor outcomes in cirrhosis. Comparing impact of PPI vs potassium-channel acid blockers (PCABs) is important. Patients with cirrhosis 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 postinitiation. Overall, 35,056 patients (31,688 PPI, 3,368 PCAB) were included. Adjusted analysis showed lower 6/12-month outcomes with vonoprazan vs PPI for mortality (adjusted hazard ratio [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. Patients with cirrhosis on PCABs demonstrate lower risk of poor outcomes at 6 and 12-months vs PPIs.