Predictors for inappropriate proton pump inhibitor use: observational study in primary care

Abstract

Background: Proton pump inhibitor (PPI) indications are limited to gastrointestinal disorders and ulcer prophylaxis. Still, PPIs are among the most frequently prescribed drugs. Aim: To evaluate the appropriateness of PPI prescriptions and identify predictive factors for inappropriate PPI use. Design and Setting: Observational study using a Dutch primary care database with all new PPI prescriptions between 2016 and 2018. Methods: Individual patient data and details on PPI use were collected. Appropriateness of initiation and continuation of PPI prescriptions was evaluated using the applicable guidelines. Results: We evaluated 148,926 patients (≥ 18 years) from 27 general practices. A total of 23,601 (16%) patients started PPI therapy (mean age 57 ± 17 years, 59% female). Valid PPI indications at initiation were seen in 10,466 PPI users (44%). Predictors for inappropriately initiated PPI use were older age (OR 1.03, 95%CI 1.03-1.03), and use of non-selective NSAIDs (OR 5.15, 95%CI 4.70-5.65), ADP receptor inhibitors (OR 5.07, 95%CI 3.46-7.41), coxibs (OR 3.93, 95%CI 2.92-5.28) and low-dose aspirin (OR 3.83, 95%CI 3.07-4.77). Despite an initial valid indication, PPI use was inaccurately continued in 32% of patients on short-course therapy for dyspepsia and in 11% of patients on ulcer prophylaxis. Conclusion: More than half of PPI users in primary care seem to have an inappropriate indication with unnecessary ulcer prophylaxis related to drug use being one of the leading causes. Future initiatives to reduce PPI use for unnecessary ulcer prophylaxis and timely deprescription if PPI is no longer indicated, are needed.

Impact of proton pump inhibitors on the onset of gastrointestinal immune‐related adverse events during immunotherapy

“…More than half of PPIs prescribed among our patients were not clearly motivated. This evidence is in line with other papers 20,21 …”

“…This evidence is in line with other papers. 20,21 In our cohort, concomitant PPI use seems to have a detrimental impact on PFS and OS, even if statistical significance is not reached. Two recent meta-analyses suggested that PPIs are significantly associated with poorer OS and PFS for cancer patients treated with ICIs.…”

Long-Term Proton Pump Inhibitor Therapy Increases the Risk of Infection in Patients with Incident Hemodialysis

“…Long-term PPI use should be avoided due to the risk of adverse effects, as recommended by several countries [30][31][32]. Infectious diseases, particularly, abdominal infections and pneumonia, are among the adverse effects also reported in patients with CKD [22,33].…”

Impact of large scale, multicomponent intervention to reduce proton pump inhibitor overuse in integrated healthcare system: difference-in-difference study

“…Proton pump inhibitors (PPIs) are one of the most commonly prescribed classes of drugs, but an estimated 25-70% of PPI users may not have an appropriate indication, depending on the clinical setting 1234. For such patients, PPIs cause unnecessary healthcare spending and pill burden.…”

“…Proton pump inhibitors (PPIs) are one of the most commonly prescribed classes of drugs, but an estimated 25-70% of PPI users may not have an appropriate indication, depending on the clinical setting. 1 2 3 4 For such patients, PPIs cause unnecessary healthcare spending and pill burden. Observational studies have also shown associations between PPIs and many medical conditions, including chronic kidney disease, fractures, pneumonia, cardiovascular disease, and Clostridium difficile infection, although only indirect evidence supports a causal link between PPIs and these conditions, with uncertain clinical significance.…”