Patient/GP-focused deprescribing intervention reduces inappropriate PPI use

Proton pump inhibitors (PPIs) are frequently prescribed for inappropriate durations or indications. Inappropriate use is associated with several adverse drug reactions and may significantly increase healthcare costs. Deprescribing should be considered when inappropriate use is identified. Although various interventions have been developed to encourage PPI deprescribing, uncertainty exists regarding the optimal way to promote deprescribing.To examine this issue, researchers in France conducted a population-based trial to assess the effectiveness of a patient- and general practitioner (GP)-centred PPI deprescribing intervention, targeting both patients and their GPs, compared with a GP-centred intervention only or usual care. Secondary objectives were to assess the impact of these deprescribing interventions on gastroesophageal reflux disease (GERD) symptom recurrence. The cluster-randomized, open-label, clinical trial was conducted over a one-year period in adults with at least one year of PPI use in GP practices in two regions of western France. The patients’ GPs were also included in the study. GP practices were randomized to three groups in a 1:1:1 ratio as follows:a patient- and GP-centred deprescribing intervention combining a patient education brochure on PPI deprescribing provided directly to patients, plus a letter and PPI deprescribing algorithm sent to their GPsa GP-centred deprescribing intervention in which only the GP received a letter and the algorithmusual care (no intervention).For the patient-centred deprescribing intervention, patients received an educational brochure about PPIs accompanied by a motivational cover letter. The brochure was designed to increase patient knowledge about PPIs and alternative approaches to manage GERD, as well as to encourage discussion with a healthcare professional regarding PPI dose reduction or discontinuation.GPs received a letter and details of a PPI decision-support deprescribing algorithm developed by the www.deprescribing.org team. This evidence-based algorithm was selected because the Appraisal of Guidelines for Research and Evaluation II score was highest among the set of algorithms reviewed.The primary outcome was PPI dose reduction, defined as a ≥ 50% reduction in annual PPI use, measured in defined daily doses (DDDs) using data from reimbursement claims. Secondary measures included Gastroesophageal Reflux Disease Impact Scale scores, assessed in a 10% sample.Key results:A total of 1,498 GPs and 34,409 patients were included from 683 primary care practices (mean patient age 68.6 years, 56.7% female, mean baseline annual PPI use 413.7 DDDs).PPI dose reduction was higher in the patient- and GP-centred deprescribing intervention group (1,710 of 11,442 patients [14.9%]) compared with the usual care group (825 of 11,732 [7.0%]); adjusted absolute difference, 6.9%; 95%CI, 5.7%–8.3%; p < 0.001) PPI dose reduction was also higher in the patient- and GP-centred deprescribing intervention group (1,710 of 11,442 patients [14.9%]) compared with the GP-centred intervention alone (862 of 11,235 [7.7%]); adjusted absolute difference, 6.7%; 95% CI, 5.4%–8.2%, p < 0.001).Gastroesophageal Reflux Disease Impact Scale scores did not significantly differ among groups.The authors conclude that in this randomized clinical trial, the combined patient- and GP-centred approach to deprescribing was more effective than the GP-centred intervention alone or usual care in reducing potentially inappropriate PPI use. Furthermore, the deprescribing interventions did not have any meaningful impact on long-term GERD activity. The authors maintain that the superiority of the patient- and GP-centred deprescribing intervention compared with the GP-centred intervention alone underscores the value of prioritizing patient-centred deprescribing strategies.Reference1. Fournier JP, Gaultier A, Riche VP, et al. Deprescribing intervention and reduction of proton pump inhibitor use in primary care. A cluster randomized clinical trial. JAMA Intern Med 2026. Published online April 13, 2026. (accessed April 14, 2026).

Patient/GP-focused deprescribing intervention reduces inappropriate PPI use

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