J Prev Med Public Health.
2025 Jan;58(1):21-30. 10.3961/jpmph.24.357.
Utilization of Acid Suppressants After Withdrawal of Ranitidine in Korea: An Interrupted Time Series Analysis
- Affiliations
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- 1Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
- 2Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea
- 3Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
- 4Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
- 5Department of Health Convergence, Ewha Womans University, Seoul, Korea
- 6Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- KMID: 2564060
- DOI: http://doi.org/10.3961/jpmph.24.357
Abstract
Objectives
This study was performed to evaluate the utilization patterns of acid suppressants following the withdrawal of ranitidine in Korea.
Methods
Health Insurance Review & Assessment Service (HIRA) data from January 2016 to May 2023 were utilized to assess the usage of histamine H2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) for acid-related diseases. Drug utilization was calculated for each agent based on the defined daily dose (DDD). To evaluate changes in utilization following the ranitidine recall, an interrupted time series analysis was conducted using segmented linear regression and an autoregressive integrated moving average model.
Results
Before the withdrawal of ranitidine, the DDD per 100 000 inhabitants per day was increasing by 6.9 (95% confidence interval [CI], 4.7 to 9.0) for H2RAs and by 19.3 (95% CI, 16.9 to 21.8) for PPIs each month. After the recall, H2RA utilization immediately declined by -1041.7 (95% CI, -1115.8 to -967.7), followed by a monthly increase of 6.6 (95% CI, 3.7 to 9.6) above the previous trend. PPI utilization temporarily surged by 235.2 (95% CI, 149.1 to 321.3), then displayed a monthly increase of 4.1 (95% CI, 0.7 to 7.6) on top of the pre-recall trend. Among PPIs, esomeprazole and rabeprazole demonstrated notable increases, representing the most commonly used acid suppressants in 2023.
Conclusions
PPI usage rose prominently following the withdrawal of ranitidine from the market. Considering the potential adverse effects of PPIs, further research is necessary to evaluate the public health implications of shifts in the utilization of acid suppressants.
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