Deprescribing Chronic Use of Proton Pump Inhibitor Among Older Adults With Polypharmacy: A Systematic Review

• Main Authors: WU, MEI-HUI, 吳美慧
• Other Authors: YEH, MIN-LI
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/j83tnr

碩士 === 馬偕醫學院 === 長期照護研究所 === 107 === Polypharmacy are very common in the elderly. Long-term polypharmacy may increase incidents of falls, physical and cognitive impairment, hospitalization and even death, result in high cost burden on the health insurance system due to potentially inappropriate medications and adverse drug events. is the process of tapering, discontinuing, or withdrawing drugs, which may manage polypharmacy and improve outcomes. Chronic use of (PPIs) without reassessment may aggravate polypharmacy, increase the risk of potential adverse drug events and drug interactions (e.g., diarrhea associated with Clostridium difficile infections, pneumonia, hypomagnesemia, and fractures). The aim of this study is to evaluate the safety, effectiveness and feasibility of the intervention conducted by of long-term PPIs for the improvement of medication safety and health outcomes among . We searched online electronic databases (e.g., PubMed, EMBASE) from the earliest record to February 21, 2019. Each study was assessed for bias with the Cochrane risk of bias tool. The inclusion criteria is the studies that evaluated who took PPIs for more than 8 weeks. The exclusion criteria is the chronic use of PPI was to provide gastroprotection. The effects associated with PPI in were determined. There were 3 studies that met the inclusion criteria. To explore the safety of PPI deprescription, gastrointestinal symptom control and drug withdrawal were applied. To explore the effectiveness of PPI deprescription, drug burden and drug costs were applied. The participant satisfaction was applied to explore the feasibility of PPI deprescription. The 3 studies used different deprescription methods including discontinuation, tapering and on-demand. The results showed the discontinuation method easily led to the recurrence of gastrointestinal symptoms (RR=3.02; 95% CI=1.74 to 5.24), drug withdrawal (RR=3.41; 95% CI=1.91 to 6.09), with significant differences. The successful discontinuation rate of tapering method was higher, however with statistically nonsignificant. On-demand method appeared to be sufficient for maintenance treatment in gastroesophageal reflux disease patients, and the symptom alleviation with statistically nonsignificant, but the number of pills consumed daily were lower (MD= -0.50; 95% CI= -0.65 to -0.35), with significant differences. No significant differences was found for convenience of medication and subjective satisfaction. Since only 3 studies were enrolled, though the evidence of the individual literature was good, the studies were not enough for meta-analysis, subgroup analysis and sensitivity analysis. The result of this study in regarding the of long-term PPIs for medication safety and health outcome among is not conclusive. Further rigorous randomized controlled trials are required for the exploration of the relevant issues in the future.