Proton-pump inhibitors among adults: a nationwide drug-utilization study

Abstract

Background:The use of proton-pump inhibitors (PPIs) has grown worldwide, and there are concerns about increased unsubstantiated long-term use. The aim of the study was to describe the real-world use of PPIs over the past decade in an entire national population.Methods:This was a nationwide population-based drug-utilization study. Patterns of outpatient PPI use among adults in Iceland between 2003 and 2015 were investigated, including annual incidence and prevalence, duration of use, and dose of tablet used (lower versus higher), as well as the proportion of PPI use attributable to gastroprotection.Results:We observed 1,372,790 prescription fills over the entire study period, of which 95% were for higher-dose PPIs. Annual incidence remained stable across time (3.3–4.1 per 100 persons per year), while the annual prevalence increased from 8.5 per 100 persons to 15.5 per 100 persons. Prevalence increased with patient age and was higher among women than men. Duration of treatment increased with patients’ age (36% of users over 80 years remained on treatment after 1 year compared with 13% of users aged 19–39 years), and was longer among those initiating on a higher dose compared with a lower dose. The proportion of PPI users concurrently using nonsteroidal anti-inflammatory drugs decreased over the study period, while the proportion concurrently using acetylsalicylic acid, oral anticoagulants, or platelet inhibitors increased.Conclusions:In this nationwide study, a considerable increase in overall outpatient use of PPIs over a 13-year period was observed, particularly among older adults. Patients were increasingly treated for longer durations than recommended by clinical guidelines and mainly with higher doses.

A Study on the Status of Proton Pump Inhibitor Prescriptions Using Diagnosis Procedure Combination Data in Japan

“…PPIs have become one of the best-selling drug classes in many countries [15][16][17][18]. PPI use is also increasing in Japan, with an annual expenditure in 2017 that was estimated at 268 billion yen [19].…”

Proton pump inhibitors reduce breast cancer risk in gastric ulcer patients: A population‐based cohort study

“…[11][12][13] A UK and a Iceland case-control study found the cancer risk was not associated with using PPIs. 8,9 The novelty in our study is that both study cohorts were peptic ulcer patients who were homogenous in comorbidities.…”

“…Because PPIs could potentially enhance anti‐tumor chemotherapy, it has also been suspected that these medicines may play a role in preventing tumor development . We hypothesized that PPIs usage in women with peptic ulcer might have a lower risk of breast cancer.…”

“…[4][5][6][7] Because PPIs could potentially enhance anti-tumor chemotherapy, it has also been suspected that these medicines may play a role in preventing tumor development. 8,9 We hypothesized that PPIs usage in women with peptic ulcer might have a lower risk of breast cancer.The aim of the present study was used population-based insurance claims data of Taiwan to evaluate the risk of breast cancer development associated with using PPIs in women with gastric ulcer.…”

Proton pump inhibitor use and risk of breast cancer, prostate cancer, and malignant melanoma: An Icelandic population‐based case‐control study

“…Third, in 2009 low‐dose PPIs became available over‐the‐counter (OTC) in Iceland, and OTC use is not recorded in the Medicine Registry. This may have led to some misclassification of PPI use in our study but is unlikely to have impacted the results much as the amount of OTC use was relatively low during the study period, ranging from 1% to 10% of total PPI volume sold annually in 2009 to 2014 . Another misclassification of PPI exposure might has modestly biased the study results since we did not have information on PPI use prior to 2003, causing some potential PPI users before 2003 to be considered as never users.…”