Strategies for discontinuation of proton pump inhibitors: a systematic review

Abstract

Discontinuation of PPIs is feasible in a clinical setting, and a substantial number of the patients treated without a clear indication can safely reduce or discontinue treatment. Tapering seems to be the most effective way of doing this.

Proton pump inhibitor prescribing patterns in the UK: a primary care database study

“…Previous studies [36][37][38][39] reported discontinuation rates that differed from those 236 identified in our study; however, these can be explained by variations in the study population 237 and the discontinuation strategies employed 38 . Reports regarding the outcomes of step-238 down therapy have been conflicting 40,41 .…”

“…35 As a consequence of this dramatic increase in PPI use and the associated potential risks, 36 clinical guidelines in the UK have recommended rationing the use of the PPI in the primary 37 care setting, either by stepping down the dose or stopping treatment all together 13 . 38 However, very few research studies have examined the extent to which the clinical guidelines 39 are being followed in the UK [14][15][16][17][18][19] . The aim of this study was to determine the prevalence of 40 PPI use and assess the practices employed to reduce PPI use in the general UK population.…”

Effect of a Proton Pump Inhibitor Deprescribing Guideline on Drug Usage and Costs in Long-Term Care

“…Our results (22% increase in deprescribing rate) are consistent with other interventions to reduce PPI use, which demonstrate rates of deprescribing of approximately 20% to 50%. 17,18 The preguideline deprescribing rate of 25% is consistent with a retrospective cohort study (n ¼ 10,731) that found PPIs were discontinued in approximately 25% of LTC residents within 180 days of being admitted, without any specific deprescribing intervention in place. 19 Time-series analysis demonstrated that implementation of the deprescribing guideline significantly reduced the average cost of PPIs per resident over time.…”

Outcome after Discontinuation of Proton Pump Inhibitors at a Residential Care Site: Quality Improvement Project

“…Tapering of PPI therapy seems to be more successful than abrupt discontinuation. 1 A systematic review published in 2013 showed that in 3 of the 5 included studies (which were conducted in asymptomatic volunteers), rebound hypersecretion of gastric acid occurred after discontinuation of PPI therapy. 32 Therefore, use of tapering as a PPI discontinuation strategy may prevent rebound hypersecretion and may increase patient comfort with deprescribing.…”

“…1 Certain conditions, such as Barrett esophagus, severe esophagitis, and long-term therapy with nonsteroidal antiinflammatory drugs (NSAIDs), qualify patients for indefinite use of PPIs; however, for other indications, such as gastroesophageal reflux disease (GERD), reflux esophagitis, Helicobacter pylori infection, and peptic ulcer, PPI therapy is recommended for only 2 to 12 weeks. 1 Previous literature has indicated overutilization of PPIs for patients in both hospital and community settings [2][3][4][5][6] and a lack of routine symptom re-evaluation in ambulatory care settings. 7 For example, Heidelbaugh and others 7 found that 36.1% of 946 patients taking PPIs in an ambulatory care setting had no documented appropriate indication for PPI therapy.…”