EC Pharmacology and Toxicology

Introduction: Acid-related disorders are common, and the arrival of proton pump inhibitors (PPIs) has revolutionized their treatment. Their efficacy and good tolerance have led to widespread adoption, particularly in Europe, with a significant increase in healthcare spending. This study aims to analyze the evolution of PPI consumption in Morocco between 2020 and 2024, and to compare it with international trends.

Materials and Methods: This is a retrospective descriptive study, based on private sales data of PPIs in Morocco from 2020 to 2024, provided by IQVIA. The analysis is based on the defined daily dose (DDD) indicator.

Results: Between 2020 and 2024, PPI sales in Morocco increased from 11.7 to 16.5 million units, representing a compound annual growth rate (CAGR) of 9.1%. DDIs increased from 471 to 645 million (CAGR of 8.5%). Consumption per 1,000 inhabitants/day increased from 35 to 48 DDIs, representing an increase of 37.1%. All PPI classes show increasing consumption, with the exception of Lansoprazole and Rabeprazole. Omeprazole remains dominant, but its share is decreasing in favor of Esomeprazole, which is growing strongly (+78.4%).

Conclusion: The increasing use of PPIs raises concerns about cost and misuse. Strategies such as treatment reassessment, deprescribing, or reimbursement reforms have been shown to be effective in several countries.

 Keywords: Proton Pump Inhibitors; Consumption; Pharmacoepidemiology; Morocco; IQVIA; Trends; Health Expenditure; Misuse; Deprescription

1. Lassalle M., et al. “Use of proton pump inhibitors in adults in France: a nationwide drug utilization study”. European Journal of Clinical Pharmacology 3 (2020): 449-457.
2. Lam SK. “Antacids: the past, the present, and the future”. Baillière's Clinical Gastroenterology 3 (1988): 641-654.
3. Salvo EM., et al. “Umbrella review of 42 systematic reviews with meta-analyses: the safety of proton pump inhibitors”. Alimentary Pharmacology and Therapeutics 2 (2021): 129-143.
4. Amorim DC., et al. Adverse Reactions.
5. Thorel J., et al. “Les inhibiteurs de pompe à protons: vraie indication ou prescription banalisée?” Therapie6 (2016): 589-593.
6. Agence Nationale de Sécurité du Médicament et des produits de santé (ANSM). Analyse des ventes de médicaments en France en 2013 (2014).
7. Boucherie Q., et al. “Proton pump inhibitors prescriptions in France: Main trends from 2006 to 2016 on French health insurance database”. Therapie5 (2018): 385-388.
8. Torres-Bondia F., et al. “Evolution of the consumption trend of proton pump inhibitors in the Lleida Health Region between 2002 and 2015”. BMC Public Health1 (2022): 818.
9. Garuolienė K., et al. “Differences in utilization rates between commercial and administrative databases: implications for future health-economic and cross-national studies”. Expert Review of Pharmacoeconomics and Outcomes Research 2 (2016): 149-152.
10. Luo H., et al. “Awareness, attitude and behavior regarding proton pump inhibitor among medical staff in the Southwest of China”. BMC Health Services Research 1 (2019): 880.
11. Bennie M., et al. “Multiple initiatives continue to enhance the prescribing efficiency for the proton pump inhibitors and statins in Scotland”. Expert Review of Pharmacoeconomics and Outcomes Research 1 (2012): 125-130.
12. Martínez Gorostiaga J., et al. “[Analysis of proton pump inhibitors anti-ulcer drugs use in the Araba district primary care area]”. Revista Española de Salud Pública 92 (2018): e201808047.
13. Mishuk AU., et al. “National trends in prescription proton pump inhibitor use and expenditure in the United States in 2002-2017”. Journal of the American Pharmacists Association 1 (2021): 87-94.e7.
14. Farcas A., et al. “P061 A Nationwide Study in Romania on the Use of Proton Pump Inhibitors between 2012 and 2018”.
15. Agreus L., et al. “Significant over-and misuse of ppis”. Lakartidningen 118 (2021): 20220.
16. Savarino V., et al. “Latest insights into the hot question of proton pump inhibitor safety-a narrative review”. Digestive and Liver Disease8 (2020): 842-852.
17. Scarpignato C., et al. “Effective and safe proton pump inhibitor therapy in acid-related diseases-a position paper addressing benefits and potential harms of acid suppression”. BMC Medicine 14 (2016): 35.
18. Alameri MA., et al. “Awareness, knowledge and behaviour of Jordanian public regarding misuse and overuse of proton pump inhibitors”. Pharmacy Practice 2 (2024): 1-6.
19. Chau SH., et al. “Cost-utility and budget impact analysis for stopping the inappropriate use of proton pump inhibitors after cessation of NSAID or low-dose acetylsalicylic acid treatment”. Drugs Aging1 (2020): 67-74.
20. , et al. “Proton pump inhibitor use: systematic review of global trends and practices”. European Journal of Clinical Pharmacology 79.9 (2023): 1159-1172.
21. National Institute for Health and Care Excellence (NICE) (2019) Gastro-oesophageal Reflux disease and dyspepsia in adults: investigation and management Clinical guideline (CG184) (2021).
22. Farrell B., et al. “Deprescribing proton pump inhibitors: evidence-based clinical practice guideline”. Canadian Family Physician 5 (2017): 354-364.
23. National institute for health and care excellence (nice). Guidance for safe and effective use of proton pump inhibitors (ppis) (2020).
24. Dills H., et al. “Deprescribing medications for chronic diseases management in primary care settings: a systematic review of randomized controlled trials”. Journal of the American Medical Directors Association 11 (2018): 923-935.e2.