4CPS-057 Discontinuation of proton pump inhibitors during hospitalisation: a randomised controlled trial

Background and importanceMany patients take proton pump inhibitors (PPIs) even though the drugs are no longer needed.1 2 We know that there are side effects to long-term PPI treatment.3 No previous studies have examined whether it is possible to reduce or discontinue treatment during hospitalisation and continue it successfully after discharge.Aim and objectivesThe aim of the study was to investigate if PPIs can be discontinued or reduced through counselling by pharmacy staff during hospitalisation.Material and methodsA prospective randomised controlled study was performed in the Emergency and Medical Department. Patients were included if they had received PPIs for at least 2 months and were aged 18 years or older.Patients were excluded(1) if they were diagnosed with gastric ulcer within 6 months, eosinophilic oesophagitis, gastroesophageal reflux disease (GERD), Barrett’s oesophagus, gastrinoma and (2) if they were aged over 50 years and on treatment with non-steroidal anti-inflammatory drug (NSAIDs) except low-dose acetylsalicylic acid, steroids and/or platelet inhibitors, anticoagulants.The intervention was performed by pharmacy staff and included counselling on discontinuation or reduction of the use of PPIs, and also included a strategy to cope with rebound symptoms.The primary outcome was the proportion of patients who successfully discontinued or reduced their use of PPIs at follow-up telephone call 30 days after discharge. The data were tested with Fisher’s exact test (small samples).Results31 adults were included; 4 withdrew at their own request or because they could not be reached on follow-up telephone calls. 69.2% (95% CI 38.6% to 90.9%) (9/13 patients) in the intervention group successfully discontinued or reduced their PPI compared to 7.1% (95% CI 0.2 to 33.9) (1/14 patients) in the control group. The difference between groups was statistically significant (p=0.001).Conclusion and relevanceStatistically significantly more patients discontinued or reduced their use of PPI after counselling by the pharmacy staff. The pharmacy staff is capable of identifying patients for whom PPI dose reduction or discontinuation is relevant and performing a successful counselling on discontinuation or reduction of the use of PPIs.References and/or acknowledgements1. Schepisi R, et al. J Nutr Health Aging 2016;20(6):665–670.2. Akram F, et al. Australas Med J 2014;7(11):465–470.3. Mössner, J. Dtsch Arztebl Int 2016;113:477–483.Conflict of interestNo conflict of i