An Emulated Clinical Trial of Deprescribing Proton Pump Inhibitors in Patients With Cirrhosis

INTRODUCTION:Proton pump inhibitors (PPI) are overused and carry harms in cirrhosis. Deprescribing is advocated but has not been trialed.METHODS AND FINDINGS:We emulated a clinical trial using Medicare data. All patients were receiving chronic PPI therapy before a compensated cirrhosis diagnosis. We compared the risk death/decompensation over 3 years between continuous users and deprescribers. We find that PPI deprescription is associated with less ascites and that cumulative PPI use is associated with more ascites and encephalopathy. Ultimately, 71% of deprescribers restart PPIs.DISCUSSION:PPI deprescribing has benefits but requires ongoing support and alternative therapies for gastrointestinal symptoms.