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TOPLINE
In a randomized clinical trial of primary care patients without an indication for long-term proton pump inhibitor (PPI) therapy, more than 40% successfully reduced their medication intake a year after starting deprescribing. Outcomes were similar across the three deprescribing strategies: on-demand PPI use, alginate substitution, and intermittent PPI use.
METHODOLOGY
- Up to 82% of long‑term PPI use lacks a valid medical indication. However, stopping the drugs abruptly can trigger rebound acid hypersecretion and worse symptoms, which is why physicians need structured ways to taper.
- Researchers conducted a clinical trial in Belgium to determine which deprescribing approach worked best to discontinue chronic PPI therapy in primary care patients without a long-term indication for PPI use.
- They included 629 patients (mean age, 60 years; 60% women) who had been taking PPIs for a median duration of 9 years. Each was randomly assigned to one of the three deprescribing approaches: on-demand PPI use, substitution of the PPI with alginate, or intermittent PPI use on a fixed schedule. Patients on high-dose PPIs (n = 122) had to taper to a maintenance dose over 1 month before being randomly assigned.
- After 1 month on their assigned approach, all patients were asked to stop the PPI or alginate and were followed for 1 year; antacids were permitted as rescue treatment.
- The primary outcome was a successful therapeutic outcome (STO), evaluated across all three deprescribing methods. A patient counted as a success if they took fewer than 4 doses per month and were willing to carry on with their current treatment regimen.
TAKEAWAY
- Among high-dose PPI users, 92% successfully tapered to a maintenance dose during the first month before being randomly assigned.
- At 1 year, 43.2% of patients achieved prolonged STO. Success rates were comparable across the three deprescribing strategies.
- Greater baseline heartburn (relative risk [RR], 0.82), postprandial distress (RR, 0.84), and epigastric pain (RR, 0.89), along with lower symptom-related quality of life (RR, 0.77), were each associated with a lower likelihood of achieving STO (P < .05 for all).
IN PRACTICE
"Deprescription via on-demand PPI use, an intermittent scheme, and replacement with an alginate all had similar success rates in stopping unnecessary PPI use. Lower baseline symptom burden and better symptom-related quality of life are key predictors of success, underscoring the importance of careful symptom assessment and patient-centered support during PPI deprescribing," the authors wrote.
SOURCE
The study was led by Janne Scheepers, KU Leuven, Leuven, Belgium. It was presented at the United European Gastroenterology (UEG) Week 2026 in Barcelona, Spain.
LIMITATIONS
The study did not report any specific limitations.
DISCLOSURES
The authors declared no disclosures.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
