Risk of Clostridioides difficile infection with potassium-competitive acid blockers: A systematic review with restricted quantitative synthesis
Abstract
Background The risk of Clostridioides difficile infection (CDI) related to potassium-competitive acid blocker (P-CAB) use remains uncertain. Objective This study aimed to systematically synthesize available evidence on CDI risk among P-CAB users. Design Systematic review with restricted quantitative synthesis. Data sources and methods Studies evaluating P-CAB use and CDI-related outcomes were identified through searches of PubMed/MEDLINE, Embase, and the Cochrane Library. Owing to heterogeneity in P-CAB agents, comparators, study designs, and effect measures, the primary quantitative synthesis was restricted to incidence-based odds ratio (OR)-scale estimates from studies directly comparing vonoprazan with proton pump inhibitors (PPIs). Studies involving other P-CABs, alternative comparators, hazard ratios, risk ratios, or pharmacovigilance-derived ORs were summarized narratively because they were not directly comparable with the primary clinical contrast. Results Five studies were included, of which two directly comparing vonoprazan with PPIs were eligible for quantitative synthesis. The pooled estimate indicated no significant difference in CDI risk between vonoprazan and PPIs (OR, 1.07; 95% confidence interval [CI], 0.91–1.25). Contextual cohort studies investigating tegoprazan or mixed P-CAB exposure did not show a significant increase in CDI risk compared with conventional acid suppressants; however, they differed in terms of the agents, comparators, and effect measures…
How strong is the evidence?
Evidence Hub reads this as a systematic review. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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