Inadequate prevention of NSAID-induced gastrointestinal events.
BACKGROUND
Use of nonsteroidal antiinflammatory drugs (NSAIDs) is a well-known cause of gastrointestinal (GI) adverse events. To protect patients at risk, several strategies are advised, including concomitant treatment with proton-pump inhibitors or switching to cyclooxygenase (COX)-2 selective NSAIDs. It is as yet unknown how many patients at risk for NSAID-induced events are protected.


OBJECTIVE
To estimate the number of patients using GI preventive treatment while at risk for NSAID-induced GI events.


METHODS
Records of patients using NSAIDs consecutively for at least 100 days (from 2001 to 2002) were obtained from the PHARMO system in the Netherlands (N = 1,000,000). GI preventive treatments were classified as adequate or inadequate based on evidence-based criteria. Adequate treatment was defined as concomitant use of misoprostol (>400 microg daily), histamine2-antagonists (> or =2 times recommended dose) or proton-pump inhibitors (> or =1 recommended dose), or alternative treatment with COX-2 selective inhibitors.


RESULTS
A total of 10,121 patients met the study inclusion criteria; 70% were women. One or more preventive strategies were prescribed in 4340 patients (42.9%), of which 2799 (64.5%) were adequate and 1541 (35.5%) inadequate. Prescribing of adequate preventive treatments increased with the number of risk factors, from 13.3% among those with no additional risk factors to 61.9% for those with > or =4 risk factors.


CONCLUSIONS
Although risk factors for GI damage were recognized, a large number of patients in the Netherlands were not or were inadequately protected against potential NSAID-associated GI damage. Despite recommendations, and even in the presence of > or =4 risk factors, almost 40% of these patients were not prescribed adequate GI preventive treatment.
Herings
Ron M C
RM
PHARMO Institute for Drug Outcomes Studies, Utrecht, Netherlands. Ron.Herings@PHARMO.NL
Goettsch
Wim G
WG
D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D016022:Case-Control Studies; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage; D004347:Drug Interactions; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007527:Isoenzymes / Q000037:antagonists & inhibitors; D008297:Male; D008565:Membrane Proteins; D008875:Middle Aged; D010437:Peptic Ulcer / Q000139:chemically induced* / Q000517:prevention & control*; D010818:Practice Patterns, Physicians'; D011451:Prostaglandin-Endoperoxide Synthases; D054328:Proton Pump Inhibitors; D012189:Retrospective Studies; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D007527:Isoenzymes; D008565:Membrane Proteins; D054328:Proton Pump Inhibitors; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases