S2712 Vonoprazan Is Associated With a Lower Risk of Infections, Hospitalizations, and Death Compared to PPIs in Patients With Cirrhosis

Introduction: Acid suppression with proton pump inhibitors (PPI) is linked with infections and poor outcomes in cirrhosis. Potassium competitive acid blockers (PCAB) have been introduced as alternatives. We aimed to compare PCABs vs PPIs in predicting outcomes in cirrhosis. Methods: Using TriNetX, we created a cohort of cirrhosis patients using validated ICD-9/10 codes between Jan 2018 to Dec 2024 who were started on PPI or PCAB (vonoprazan) after cirrhosis diagnosis. Demographics, comorbidities, cirrhosis severity labs closest to the index PPI/vonoprazan prescription dates were chosen. To address the differences in baseline characteristics between the 2 groups, we extracted demographic variables such as age, sex, race, and ethnicity, comorbidities and concurrent medication use within 2 years before the index date. The laboratory tests analyzed in this study included MELD-Na labs and blood counts; closest labs from the index date were selected. Primary outcome was 6-month post-index date mortality, while infections and all-cause hospitalizations were secondary outcomes. One-year outcomes were also evaluated. Univariate analysis performed and crude estimate of odds ratio of outcomes were reported. Adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs) and P values were calculated using Cox proportional hazards regression models for all outcomes. Kaplan-Meier curves for outcomes were created. Results: Overall, 19,273 cirrhosis patients (63.9 ± 13.8 yrs, 66% men) were included. Most (89%, n = 17.285) were on PPI while the rest (11% n = 1988) were on vonoprazan. The median follow up was 180 (IQR 117 days). PPI users were older, and more male. PCAB users had higher cardiovascular disorders and GERD. Cirrhosis variables showed lower alcohol, higher HE with lactulose and rifaximin, and SBP with higher propranolol in PPI gp. Lower platelets, worse MELD score variables were seen in PPI but albumin was higher than PCABs. Cox proportional hazards shows lower rate of all outcomes at 6 and 12 months with vonoprazan versus PPIs which remained significant on adjusted comparisons. Kaplan Meier curves showed significant separation between vonoprazan and PPIs for all outcomes. Conclusion: In patients with cirrhosis there was a lower risk of infections, all-cause hospitalizations, and trend towards lower death at 6- and 12-months post-medication initiation date with vonoprazan compared to PPIs despite controlling for demographics, cirrhosis severity, and comorbid conditions. PCAB use in cirrhosis could be considered instead of PPIs.