Step-down from multiple- to single-dose proton pump inhibitors (PPIs): a prospective study of patients with heartburn or acid regurgitation completely relieved with PPIs.

Abstract

OBJECTIVES:

Management costs for gastroesophageal reflux disease are high because of the expensive medications used for maintenance therapy. Previous studies have illustrated the success of step-down from proton pump inhibitors (PPIs) to less-expensive therapy once symptoms have abated. This study was conducted to determine whether patients requiring greater than single-dose PPI for initial symptom resolution could be stepped-down to single-dose PPI and whether this intervention decreased costs or adversely affected quality of life.

METHODS:

Consecutive patients in whom greater than single-dose PPI had completely alleviated reflux-type symptoms (heartburn or acid regurgitation) were recruited through the use of pharmacy records of PPI prescriptions. Eligible subjects completed baseline demographic information and quality-of-life surveys and were stepped-down to single-dose PPI (lansoprazole 30 mg or omeprazole 20 mg daily). Follow-up continued for 6 months or until subjects reported recurrence of reflux-type symptoms, at which point PPIs were reinstituted at the dose that had originally alleviated the subjects' symptoms. The primary outcome was the proportion of subjects in whom step-down was successful, defined as no recurrence of reflux-type symptoms on single-dose PPI.

RESULTS:

A total of 117 subjects enrolled in the study; all were followed to the primary endpoint. 79.5% did not report recurrent symptoms of heartburn or acid regurgitation during the 6 months after step-down to single-dose PPI. Logistic regression revealed that longer duration of PPI use before study enrollment was associated with greater likelihood of symptom recurrence with step-down. Although quality of life was not significantly altered, dyspepsia (excluding reflux-type symptoms) increased. Overall costs of management were reduced.

CONCLUSIONS:

The majority of patients rendered asymptomatic on greater than single-dose PPI might be subsequently stepped-down to single-dose therapy without recurrence of reflux-type symptoms. This intervention can decrease management costs without adversely affecting quality of life.

• Authors: John M Inadomi, Lisa McIntyre, Latoya Bernard, A Mark Fendrick
• Journal: The American journal of gastroenterology (Am J Gastroenterol) Vol. 98 Issue 9 Pg. 1940-4 (Sep 2003) ISSN: 0002-9270 [Print] United States
• PMID: 14499769 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• 2-Pyridinylmethylsulfinylbenzimidazoles
• Proton Pump Inhibitors
• Proton Pumps
• Lansoprazole
• Omeprazole

Topics

• 2-Pyridinylmethylsulfinylbenzimidazoles
• Adult
• Aged
• Aged, 80 and over
• Cohort Studies
• Dose-Response Relationship, Drug
• Drug Administration Schedule
• Female
• Follow-Up Studies
• Gastroesophageal Reflux (diagnosis, drug therapy)
• Heartburn (diagnosis, drug therapy)
• Humans
• Lansoprazole
• Logistic Models
• Male
• Middle Aged
• Multivariate Analysis
• Omeprazole (administration & dosage, analogs & derivatives)
• Patient Satisfaction
• Probability
• Prospective Studies
• Proton Pump Inhibitors
• Proton Pumps (therapeutic use)
• Quality of Life
• Risk Assessment
• Severity of Illness Index
• Treatment Outcome