[Proton pump inhibitors and clopidogrel: a hazardous association?]

[Evaluation of the implantation of a de-prescribing process for proton pump inhibitor (PPI) using an algorithm within an internal medicine department]

INTRODUCTION

The prescription of proton pump inhibitors (PPIs) seems excessive. Taken over the long term, PPIs can cause serious side effects. It therefore turns out to be justified to suspend treatments whose expected benefit seems too low compared to the risks involved : it is deprescription. The objective of this study is to assess a process for the deprescription of PPIs in a hospital internal medicine department.

METHOD

After collegial deliberation, an algorithm for assisting in the deprescription of PPIs was validated. If necessary, the PPI was phased out over 1 month. A telephone follow-up at 1, 2 and 3 months was carried out in order to assess the maintenance of deprescription and the occurrence of digestive symptoms. The evaluation criteria were the rate of deprescription and the rate of maintenance of deprescription at 3 months following reports from patients, their caregivers or a family member.

RESULTS

105 patients with a mean age of 72 years were included over a period of 21 weeks, and in 31 cases (29%), deprescription was performed. After 3 months of follow-up, there was 71% maintenance of deprescription. Three patients were lost to follow-up and 6 patients resumed PPI.

CONCLUSION

The approach undertaken resulted in the suspension of PPI intake in almost 3 out of 10 cases. This result was maintained at least three months for a large majority of patients. It will be interesting to continue this process and extend the monitoring over longer periods, in order to ensure that PPI de-prescription is maintained in the long term.