Trends, utilisation and appropriateness of proton pump inhibitor prescriptions among recent initiators: a decade-long analysis of patients with a 1-year washout period (2013-2021).

OBJECTIVE

To describe temporal trends in initiation, dose intensity, utilisation and potentially inappropriate prescribing of proton pump inhibitors (PPIs) among recent initiators in an urban Chinese outpatient setting.

DESIGN

Retrospective, annual identification of recent PPI initiators using a 1-year washout definition (repeated cross-sectional approach).

SETTING

Outpatient prescriptions recorded in the hospital information system of Jinshan Hospital Affiliated to Fudan University, Shanghai, China, 2013-2021.

PARTICIPANTS

Adults aged ≥18 years who initiated PPI and had no PPI prescription in the preceding year.

OUTCOME MEASURES: Primary and secondary outcome measures annual initiation rates (overall and stratified by sex, age group, dose intensity and indication), utilisation metrics (defined daily dose/1000 inhabitants/day, defined daily cost, drug utilisation index) and components of potentially inappropriate prescribing (indication-related, prophylaxis-related and incomplete diagnosis).

RESULTS

Among 114 241 recent initiators (mean age 48.47 years; 51.43% female), initiation rates increased from 1.79% (95% CI 1.76% to 1.83%) in 2013 to 2.79% (2.74% to 2.83%) in 2021 (p<0.001), with the steepest rise in adults aged 18-34 years. High-dose initiation peaked in 2019 and then declined, while standard-dose initiation increased after 2019. Across 2013-2021, potentially inappropriate indication-related prescribing decreased (30.94% in 2013 to 10.36% in 2021), whereas prophylaxis-related prescribing remained common.

CONCLUSIONS

PPI initiation increased substantially over the past decade, particularly among younger adults. These patterns raise concerns about potential overuse and suboptimal prescribing. The results underscore the need for targeted prescription review and deprescribing-oriented stewardship, with particular attention to young adults, prophylactic indications and dose optimisation.