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Decrease in Switches to ‘Unsafe’ Proton Pump Inhibitors After Communications About Interactions with Clopidogrel

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Abstract

Background

In 2009 and 2010 medicines regulatory agencies published official safety statements regarding the concomitant use of proton pump inhibitors and clopidogrel. We wanted to investigate a change in prescription behaviour in prevalent gastroprotective drug users (2008–2011).

Methods

Data on drug use were retrieved from the Out-patient Pharmacy Database of the PHARMO Database Network. We used interrupted time series analyses (ITS) to estimate the impact of each safety statement on the number of gastroprotective drug switches around the start of clopidogrel and during clopidogrel use.

Results

After the first statement (June 2009), significantly fewer patients switched from another proton pump inhibitor to (es)omeprazole (−14.9%; 95% CI −22.6 to −7.3) at the moment they started clopidogrel compared to the period prior to this statement. After the adjusted statement in February 2010, the switch percentage to (es)omeprazole decreased further (−4.5%; 95% CI −8.1 to −0.9). We observed a temporary increase in switches from proton pump inhibitors to histamine 2-receptor antagonists after the first statement; the decrease in the reverse switch was statistically significant (−23.0%; 95% CI −43.1 to −2.9).

Conclusions

With ITS, we were able to demonstrate a decrease in switches from other proton pump inhibitors to (es)omeprazole and an increase of the reverse switch to almost 100%. We observed a partial and temporary switch to histamine 2-receptor antagonists. This effect of safety statements was shown for gastroprotective drug switches around the start of clopidogrel treatment.

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Authors and Affiliations

  1. Department of Clinical Pharmacy, Saxenburgh Group, P.O. Box 1, 7770 AA, Hardenberg, The Netherlands

    Willemien J. Kruik-Kollöffel

  2. Department of Clinical Pharmacy, Hospital Group Twente, Almelo, Hengelo, The Netherlands

    Willemien J. Kruik-Kollöffel

  3. Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands

    Job van der Palen

  4. Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands

    Job van der Palen

  5. Pharmo Institute, Utrecht, The Netherlands

    Myrthe P. P. van Herk-Sukel

  6. Department of Cardiology, Hospital Group Twente, Almelo, Hengelo, The Netherlands

    H. Joost Kruik

  7. Department of Clinical Pharmacy, Medisch Spectrum Twente, Enschede, The Netherlands

    Kris L. L. Movig

Authors
  1. Willemien J. Kruik-Kollöffel
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Corresponding author

Correspondence to Willemien J. Kruik-Kollöffel.

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Funding

No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Willemien J. Kruik-Kollöffel, Job van der Palen, H. Joost Kruik and Kris L. L. Movig declare no support from any organization for the submitted work. Myrthe P. P. van Herk-Sukel is an employee of the PHARMO Institute for Drug Outcomes Research. This independent research institute performs financially supported studies for government and related healthcare authorities and several pharmaceutical companies. This study, however, was not supported by a pharmaceutical company. None of the other authors have any conflicts of interest to disclose and there are no other relationships or activities that could appear to have influenced the submitted work.

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Kruik-Kollöffel, W.J., van der Palen, J., van Herk-Sukel, M.P.P. et al. Decrease in Switches to ‘Unsafe’ Proton Pump Inhibitors After Communications About Interactions with Clopidogrel. Clin Drug Investig 37, 787–794 (2017). https://doi.org/10.1007/s40261-017-0536-x

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  • DOI: https://doi.org/10.1007/s40261-017-0536-x

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