Population-based deprescribing strategy for proton pump inhibitors: health outcomes from a case-control study

In 2017, 2018, and 2022, a population-based strategy was implemented to deprescribe proton pump inhibitors (PPIs) in patients who did not meet clinical indications for treatment. This study evaluates health outcomes related to the safety of deprescribing and the adverse effects associated with PPI consumption in these patients.

A nested case-control study within a cohort was conducted, with follow-up through December 31, 2024. The primary endpoint was a composite of mortality or urgent hospital admission. Secondary endpoints included upper gastrointestinal bleeding, other gastrointestinal events (ulcers, gastritis, or esophagitis), hypomagnesemia, cyanocobalamin deficiency, hypocalcemia, iron deficiency, pneumonia, Clostridioides difficile infection, and bone fractures. Adjustments were made for sex, age, Charlson Comorbidity Index, prior urgent hospital admissions, number of primary care visits in the preceding year, and number of prescribed medications. Additionally, a process mining analysis was performed to describe patient trajectories.

A total of 28,161 patients were included. PPI deprescribing proved to be safe regarding mortality and hospitalization (OR=0.78; 95% CI: 0.70-0.88). A higher incidence of gastric adverse events was observed, but not of gastrointestinal bleeding. Furthermore, a lower incidence of micronutrient deficiencies, fractures, and pneumonia was found among patients who underwent PPI deprescribing. In the sex-stratified analysis, deprescribing was associated with fewer admissions or hospitalizations in both groups.

The PPI deprescribing strategy in patients without risk factors for gastrointestinal bleeding seems to be safe in terms of mortality and hospital admissions.