Adherence to gastroprotection and the risk of NSAID-related upper gastrointestinal ulcers and haemorrhage.
BACKGROUND
Upper gastrointestinal (UGI) complications are a well-recognized risk of NSAID treatment, requiring preventive measures in high-risk patients. Adherence to gastroprotective agents (GPAs) in NSAID users has been suggested to be suboptimal.


OBJECTIVE
To investigate the association between adherence to GPAs (proton pump inhibitors or H(2)-receptor antagonists) and the risk of NSAID-related UGI ulcers or haemorrhage in high-risk patients.


METHODS
A population-based nested case-control study was conducted within a cohort of new NSAID users with at least one risk factor for a NSAID-related UGI complication, identified in the Dutch IPCI database during 1996-2005. Adherence to GPAs was calculated as the proportion of NSAID treatment days covered (PDC) by a GPA prescription. Multivariate conditional logistic regression analysis was used to calculate odds ratios with 95% confidence intervals (95% CI).


RESULTS
Fifteen percent of the non-selective NSAID users received GPAs. The risk of a NSAID-related UGI complication among NSAID users increased 16% for every 10% decrease in adherence. Compared to patients with a PDC of >80%, patients with PDCs of 20-80% and <20% had a 2.5-fold (95% CI: 1.0-6.7) respectively 4.0-fold (95% CI: 1.2-13.0) increased risk.


CONCLUSIONS
There is a strong inverse relationship between adherence to GPAs and the risk of UGI complications in high-risk NSAID users.
van Soest
E M
EM
Department of Gastroenterology and Hepatology, Erasmus MC - University Medical Center, Rotterdam, The Netherlands. e.vansoest@erasmusmc.nl
Sturkenboom
M C J M
MC
Dieleman
J P
JP
Verhamme
K M C
KM
Siersema
P D
PD
Kuipers
E J
EJ
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D016022:Case-Control Studies; D004359:Drug Therapy, Combination; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced*; D006635:Histamine H2 Antagonists / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010437:Peptic Ulcer / Q000139:chemically induced*; D054328:Proton Pump Inhibitors; D017494:Proton Pumps / Q000009:adverse effects; D012044:Regression Analysis; D012307:Risk Factors; D041742:Upper Gastrointestinal Tract / Q000187:drug effects*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D017494:Proton Pumps