Patient-Inclusive Deprescribing Improves PPI Reduction but Not GERD Outcomes: JAMA
France: A study showed that an intervention involving both patient education and general practitioner (GP) guidance with a deprescribing algorithm effectively improved proton pump inhibitor (PPI) deprescribing. However, it did not significantly impact long-term GERD activity. The combined patient- and GP-focused approach was more effective than GP-only strategies, highlighting the importance of involving patients. Larger studies are needed, but tailored deprescribing interventions appear to be a safe and effective approach.
Proton pump inhibitors are among the most commonly prescribed medications worldwide, often used for prolonged periods even when no longer clinically indicated. Long-term and inappropriate use has been linked to adverse effects and increased healthcare costs, making deprescribing an important strategy in primary care. In this context, Jean-Pascal Fournier and colleagues conducted a large cluster randomized clinical trial, published in JAMA Internal Medicine, to assess whether a structured intervention could reduce unnecessary PPI use.
The trial was carried out across primary care practices in western France and included more than 34,000 adult patients who had been on PPI therapy for at least one year, along with nearly 1,500 general practitioners. Practices were randomly assigned to one of three groups: a combined patient- and GP-directed intervention, a GP-only intervention, or usual care. The combined intervention included sending educational brochures directly to patients explaining the rationale for reducing PPI use, alongside a structured deprescribing algorithm provided to GPs. In contrast, the GP-only group received just the clinical guidance.
The trial revealed the following findings:
- At 1 year, the combined patient- and GP-focused intervention showed superior outcomes in reducing PPI use.
- Approximately 15% of patients in the combined intervention group achieved ≥50% reduction in annual PPI use.
- This was significantly higher compared to 7.0% in the usual care group.
- The combined approach also outperformed the GP-only strategy, where 7.7% of patients reduced PPI use.
- Findings highlight the importance of direct patient engagement in successful deprescribing.
- No significant difference in GERD symptom control was observed across groups.
- Gastroesophageal Reflux Disease Impact Scale (GIS) scores were comparable between all groups.
- Reduction in PPI use did not lead to worsening of long-term symptom burden for most patients.
The study highlights the value of shared decision-making in clinical practice, particularly for medication optimization. By providing patients with accessible information and involving them in the deprescribing process, clinicians may achieve better outcomes than relying solely on physician-directed interventions.
Overall, the findings support the implementation of scalable, patient-inclusive deprescribing strategies in primary care to address the widespread issue of inappropriate PPI use. While further research is warranted to confirm long-term safety and effectiveness, this approach offers a practical pathway to reduce medication overuse without compromising patient well-being.
Reference:
Fournier J, Gaultier A, Riche V, Tessier P, Rat C, Nguyen-Soenen J. Deprescribing Intervention and Reduction of Proton Pump Inhibitor Use in Primary Care: A Cluster Randomized Clinical Trial. JAMA Intern Med. Published online April 13, 2026. doi:10.1001/jamainternmed.2026.0584
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