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Trends in acid suppressant drug prescriptions in primary care in the UK: a population-based cross-sectional study
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  • Published on:
    Re: Re: Trends in acid suppressant drug prescriptions in primary care in the UK
    • Devin Abrahami, Graduate student McGill University
    • Other Contributors:
      • Laurent Azoulay, Assoicate professor

    We thank the author for their interest in our paper on the prescribing trends of acid suppressant drugs in the UK.1 Our paper found that new users of proton pump inhibitors (PPIs) were slightly older than new users of histamine-2 receptor antagonists (H2RAs), though the prevalence of both drug classes increases with age. As highlighted by the meta-analysis by Wang et al. the observational evidence regarding the risk of dementia associated with acid suppressant use has been inconclusive, with some studies finding an increased risk and others a decreased risk.2 Based on the pooled estimates of 17 studies, the authors did not conclude that the use of acid suppressant drugs is associated with an increased risk of dementia. An important aspect of these studies is that acid suppressant users were compared to non-users, which makes it challenging to separate the effects of the drug from the underlying indication, limiting conclusions that may be drawn regarding the dementia risk. However, as described in our paper,1 there are other serious adverse effects associated with the use of PPIs that have not been associated with H2RAs, including gastrointestinal malignancies, H. pylori infection and hypomagnesemia. We agree with the author that certain indications favour the prescribing of PPIs over H2RAs, though a careful assessment of the risk-benefit profile is warranted.

    1. Abrahami D, McDonald EG, Schnitzer M, et al. Trends in acid suppressant drug prescripti...

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    Conflict of Interest:
    None declared.
  • Published on:
    Re: Trends in acid suppressant drug prescriptions in primary care in the UK

    Abrahami et al. examined proton pump inhibitor (PPI) and histamine-2 receptor antagonist (H2RA) prescribing patterns over a long period in primary care in the UK (1). From 1990 to 2018, PPI prevalence increased from 0.2% to 14.2%, while H2RA prevalence were under 3.4%. The authors described that PPIs were associated with a number of adverse effects not attributed to H2RAs, and recommended H2RAs as a valuable treatment as acid suppressants. I have a comment about the study with special reference to dementia risk.

    Prescribing acid suppressants is more prevalent in the elderly. Wang et al. conducted a meta-analysis to investigate the risk of acid suppressants on dementia (2). The pooled adjusted hazard ratios (95% confidence intervals) of PPI users and H2RA users for the development of dementia were 0.98 (0.85-1.13) and 1.20 (0.98-1.47), respectively. Although there is no significant association regarding the effect of acid suppressants on the development of dementia, H2RA presented a trend of increased risk for dementia. There are medical reasons of prescribing PPIs instead of H2RAs, and evidence should be presented for concluding the higher adverse effects of PPIs than H2RAs.

    1. Abrahami D, McDonald EG, Schnitzer M, et al. Trends in acid suppressant drug prescriptions in primary care in the UK: a population-based cross-sectional study. BMJ Open 2020;10(12):e041529.
    2. Wang H, Tian L, Yan X. No association between acid suppressant use and...

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    Conflict of Interest:
    None declared.