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Deprescribing versus continuation of chronic proton pump inhibitor use in adults

Overview of attention for article published in Cochrane database of systematic reviews, March 2017
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (95th percentile)
  • High Attention Score compared to outputs of the same age and source (88th percentile)

Mentioned by

news
1 news outlet
twitter
95 tweeters

Citations

dimensions_citation
64 Dimensions

Readers on

mendeley
277 Mendeley
citeulike
1 CiteULike
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Title
Deprescribing versus continuation of chronic proton pump inhibitor use in adults
Published in
Cochrane database of systematic reviews, March 2017
DOI 10.1002/14651858.cd011969.pub2
Pubmed ID
Authors

Taline A Boghossian, Farah Joy Rashid, Wade Thompson, Vivian Welch, Paul Moayyedi, Carlos Rojas-Fernandez, Kevin Pottie, Barbara Farrell

Abstract

Proton pump inhibitors (PPIs) are a class of medications that reduce acid secretion and are used for treating many conditions such as gastroesophageal reflux disease (GERD), dyspepsia, reflux esophagitis, peptic ulcer disease, and hypersecretory conditions (e.g. Zollinger-Ellison syndrome), and as part of the eradication therapy for Helicobacter pylori bacteria. However, approximately 25% to 70% of people are prescribed a PPI inappropriately. Chronic PPI use without reassessment contributes to polypharmacy and puts people at risk of experiencing drug interactions and adverse events (e.g. Clostridium difficile infection, pneumonia, hypomagnesaemia, and fractures). To determine the effects (benefits and harms) associated with deprescribing long-term PPI therapy in adults, compared to chronic daily use (28 days or greater). We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 10), MEDLINE, Embase, clinicaltrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). The last date of search was November 2016. We handsearched the reference lists of relevant studies. We screened 2357 articles (2317 identified through search strategy, 40 through other resources). Of these articles, we assessed 89 for eligibility. We included randomized controlled trials (RCTs) and quasi-randomized trials comparing at least one deprescribing modality (e.g. stopping PPI or reducing PPI) with a control consisting of no change in continuous daily PPI use in adult chronic users. Outcomes of interest were: change in gastrointestinal (GI) symptoms, drug burden/PPI use, cost/resource use, negative and positive drug withdrawal events, and participant satisfaction. Two review authors independently reviewed and extracted data and completed the risk of bias assessment. A third review author independently confirmed risk of bias assessment. We used Review Manager 5 software for data analysis. We contacted study authors if there was missing information. The review included six trials (n = 1758). Trial participants were aged 48 to 57 years, except for one trial that had a mean age of 73 years. All participants were from the outpatient setting and had either nonerosive reflux disease or milder grades of esophagitis (LA grade A or B). Five trials investigated on-demand deprescribing and one trial examined abrupt discontinuation. There was low quality evidence that on-demand use of PPI may increase risk of 'lack of symptom control' compared with continuous PPI use (risk ratio (RR) 1.71, 95% confidence interval (CI) 1.31 to 2.21), thereby favoring continuous PPI use (five trials, n = 1653). There was a clinically significant reduction in 'drug burden', measured as PPI pill use per week with on-demand therapy (mean difference (MD) -3.79, 95% CI -4.73 to -2.84), favoring deprescribing based on moderate quality evidence (four trials, n = 1152). There was also low quality evidence that on-demand PPI use may be associated with reduced participant satisfaction compared with continuous PPI use. None of the included studies reported cost/resource use or positive drug withdrawal effects. In people with mild GERD, on-demand deprescribing may lead to an increase in GI symptoms (e.g. dyspepsia, regurgitation) and probably a reduction in pill burden. There was a decline in participant satisfaction, although heterogeneity was high. There were insufficient data to make a conclusion regarding long-term benefits and harms of PPI discontinuation, although two trials (one on-demand trial and one abrupt discontinuation trial) reported endoscopic findings in their intervention groups at study end.

Twitter Demographics

The data shown below were collected from the profiles of 95 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 277 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Spain 1 <1%
Austria 1 <1%
Unknown 275 99%

Demographic breakdown

Readers by professional status Count As %
Researcher 46 17%
Student > Master 39 14%
Student > Bachelor 31 11%
Student > Ph. D. Student 25 9%
Other 21 8%
Other 61 22%
Unknown 54 19%
Readers by discipline Count As %
Medicine and Dentistry 97 35%
Nursing and Health Professions 36 13%
Pharmacology, Toxicology and Pharmaceutical Science 23 8%
Social Sciences 8 3%
Psychology 7 3%
Other 39 14%
Unknown 67 24%

Attention Score in Context

This research output has an Altmetric Attention Score of 69. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 09 August 2019.
All research outputs
#327,408
of 15,913,605 outputs
Outputs from Cochrane database of systematic reviews
#757
of 11,324 outputs
Outputs of similar age
#10,810
of 262,983 outputs
Outputs of similar age from Cochrane database of systematic reviews
#29
of 263 outputs
Altmetric has tracked 15,913,605 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 97th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 11,324 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 23.6. This one has done particularly well, scoring higher than 93% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 262,983 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 95% of its contemporaries.
We're also able to compare this research output to 263 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 88% of its contemporaries.