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GPs should ‘limit use and duration’ of PPIs, study suggests

Prescribers should be more vigilant about only prescribing PPIs when necessary as they are associated with increased risk of death, according to a new study.

The observational study found that there was a heightened risk of death in patients taking PPIs compared to patients taking other drugs that reduce the amount of stomach acid produced, such as H2 blockers, leading researchers to suggest that doctors should be more selective about who they prescribe the drugs to.

The researchers, led by a team from the Washington University School of Medicine, looked at data for just under 350,000 patients who received a prescription for either H2 blockers or PPIs for the first time between 2006 and 2008. When patients were followed up for an average of almost six years, researchers found that those taking PPIs were at a 25% increased risk of death from any cause.

They also found that risk of death with PPI was still 24% higher than with an H2 blocker in patients who did not have a documented gastrointestinal medical indication, such as dyspepsia or Barrett’s oesophagus, for their prescription. The risk also increased the longer patients were exposed to PPIs, rising to a 31% increased risk of death if patients were taking the drugs for between six and 12 months.

The authors said: ‘PPI are widely used by millions of people for indications and durations that were never tested or approved.

‘The findings in our study highlight a potential excess risk of death among users of PPI, and in particular among cohort participants without gastrointestinal comorbidities, and that risk is increased with prolonged duration of PPI exposure.

’Although our results should not deter prescription and use of PPI where medically indicated, they may be used to encourage and promote pharmacovigilance and emphasise the need to exercise judicious use of PPI and limit use and duration of therapy to instances where there is a clear medical indication and where benefit outweighs potential risk.’

The findings come as research published in June suggested that GPs should be co-prescribing PPIs in patients taking daily aspirin to reduce the risk of gastrointestinal bleeds in the elderly.

BMJ 2017; available online 3rd June


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