Characteristics of children and adolescents first prescribed proton pump inhibitors or histamine-2-receptor antagonists: an observational cohort study

Abstract

Objective: To describe the characteristics of pediatric patients prescribed proton pump inhibitors (PPIs) vs those of pediatric patients prescribed histamine-2-receptor antagonists (H₂RAs).

Methods: Observational studies were conducted using The Health Improvement Network (THIN) and the PHARMO Database Network. Patients aged 0–18 years who were first prescribed a PPI or H₂RA between October 1, 2009 and September 30, 2012 (THIN) or between September 1, 2008 and August 31, 2011 (PHARMO) were included. Patient characteristics were identified and compared between the PPI and H₂RA cohorts using odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age and sex.

Results: The mean age (years) was higher in the PPI than in the H₂RA cohorts (THIN 12.3 [n = 8204] vs 5.4 [n = 7937], PHARMO 11.0 [n = 15 362] vs 7.1 [n = 6168]). Previous respiratory disease was more common in the PPI than in the H₂RA cohort in THIN (OR = 1.19, 95% CI = 1.08–1.30), as were asthma and respiratory medication use in PHARMO (OR = 1.27, 95% CI = 1.12–1.45 and OR = 1.23, 95% CI = 1.10–1.38, respectively) and oral corticosteroid use in both databases (OR = 1.45, 95% CI = 1.10–1.92 [THIN]; OR = 2.80, 95% CI = 2.11–3.71 [PHARMO]). Non-steroidal anti-inflammatory drugs, antibiotics, and oral contraceptives were also more common in PPI than in H₂RA cohorts in both databases.

Conclusions: Pediatric patients receiving PPIs and those receiving H₂RAs may represent different patient populations. PPIs may be more commonly prescribed than H₂RAs among patients with respiratory diseases.

Keywords:

• Child
• adolescent
• gastroesophageal reflux
• histamine H2 antagonists
• pharmacoepidemiology
• proton pump inhibitors
• observational study

Transparency

Declaration of funding

The study was supported in part by AstraZeneca, Gothenburg, Sweden.

Declaration of financial/other relationships

AR and LAGR are employed by CEIFE, which has received research funding from AstraZeneca Gothenburg, Sweden, and Bayer Pharma AG, Berlin, Germany. LAGR has also served as a speaker and an advisory board member for Bayer Pharma AG, Berlin, Germany. LMAKH, FJAPB, and RMCH are employed by 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. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Writing support was provided by Dr Rowan Pearce and Dr Anja Becher of Oxford PharmaGenesis, Oxford, UK and was funded by AstraZeneca Gothenburg, Sweden. Trial registration: ClincalTrials.gov Identifier NCT01338363 (PHARMO Database Network analyses).