Successful deprescribing of proton pump inhibitors with a patient-centered process: the DESPIBP Project

Abstract

Background: Proton-pump inhibitors (PPIs) are among the most frequently prescribed drugs, but they are being overprescribed.

Objective: To evaluate the applicability of a deprescription algorithm in hospitalized patients with chronic PPI use.

Methods: A prospective study including consecutive gastroenterology department hospitalized patients with chronic PPI use. The prescription was reassessed and a deprescribing algorithm was applied. Follow-up was carried out at 4, 12, and 24 weeks.

Results: A total of 513 (44.22%) of 1160 had chronic PPI use; 371 met inclusion criteria and were evaluated: 285 (76.82%) with appropriate prescription and 86 (23.18%) with inappropriate, mainly (52.30%) due to polypharmacy. Seventy-five patients accepted the deprescribing process. Sixty-one (81.33%) maintained deprescription at week 4, 56 (74.66%) at week 12, and 54 (72.00%) at week 24. Eleven of 21 restarted the PPI because of symptoms. No differences were found between the successful deprescription group and the unsuccessful one, regarding sex (p = 0.877), age (p = 0.635), PPI indication (p = 0.663), or deprescription regimen (p = 0.805). No patient had any adverse event attributable to deprescription.

Conclusion: There is a high inappropriate indication for PPIs in patients admitted to the gastroenterology department. The application of a patient-centered deprescribing algorithm is a safe and effective strategy to reduce their inappropriate consumption in the medium term.

Keywords: Deprescribing; Discontinuation. Proton pump inhibitors; Hospitalization; Inappropriate prescriptions.