title: Programme of stepping down from twice daily proton pump inhibitor therapy for symptomatic gastro-oesophageal reflux disease associated with a formulary change at a VA medical center.
abstract: BACKGROUND
  In July 2001, our Veterans' Affairs hospital changed its formulary proton pump inhibitor (PPI) from lansoprazole to rabeprazole. All patients previously receiving lansoprazole 30 mg twice daily were switched to rabeprazole 20 mg once daily.
  
  
  OBJECTIVE
  To determine if patients with gastro-oesophageal reflux disease (GERD), who were previously managed on lansoprazole 30 mg twice daily, could be maintained on rabeprazole 20 mg once daily.
  
  
  METHODS
  Four hundred and thirty-five patients had received lansoprazole 30 mg twice daily for at least 12 months before the formulary change. Medical records were reviewed for 12 months before and after the formulary change.
  
  
  RESULTS
  There were 432 men and three women with a mean age of 66.7 years (range: 38-91). Two hundred and twelve patients were excluded. Of the remaining 223, 111 (50%) were maintained successfully on rabeprazole 20 mg once daily. Twenty-three (10%) stayed off all acid suppression during follow-up. The number of endoscopies and clinic visits did not significantly change during the follow-up. Fifty-six percent who had erosive oesophagitis failed a dose taper compared with 31% of those with endoscopy-negative GERD (P<0.025).
  
  
  CONCLUSIONS
  Most patients receiving twice daily PPI therapy for GERD could be maintained on once daily PPI or no acid suppression for 12 months of follow-up. Dose reduction was more successful in those without erosive oesophagitis.
authors.affiliation: Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Coté
authors.forename: M R
authors.initials: MR
authors.lastname: Ferreira
authors.forename: K
authors.initials: K
authors.lastname: Rozenberg-Ben-Dror
authors.forename: C W
authors.initials: CW
authors.lastname: Howden
mesh_terms: D053799:2-Pyridinylmethylsulfinylbenzimidazoles / Q000008:administration & dosage* / Q000191:economics; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000008:administration & dosage* / Q000191:economics; D017046:Cost Savings; D004942:Esophagitis, Peptic / Q000150:complications; D005260:Female; D005572:Formularies, Hospital as Topic; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors; D064750:Rabeprazole; D017211:Treatment Failure
chemical_list: D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D064750:Rabeprazole