title: Co-prescribing of proton pump inhibitors among chronic users of NSAIDs in the UK.
abstract: OBJECTIVE
  Co-prescribing of proton pump inhibitors (PPIs) with non-selective NSAIDs (nsNSAIDs) is recommended in patients at risk of gastrointestinal (GI) events. This study estimated usage of PPI co-therapy among chronic nsNSAID users and determined factors associated with concurrent nsNSAID-PPI use.
  
  
  METHODS
  The retrospective study was based on the Intercontinental Marketing Services (IMS) Health UK MediPlus database and included subjects > or = 40 yrs of age who received their first oral nsNSAID prescription between July and December 2002 and who had > or = 60 days of nsNSAID supply during the following year. Days with nsNSAID-PPI overlap were calculated and logistic regression was used to identify factors associated with nsNSAID-PPI overlap. A generalized linear model was used to assess the degree of association of GI risk factors with the nsNSAID-PPI overlap ratio among PPI users.
  
  
  RESULTS
  Of 16,344 patients included, 1586 received at least one PPI prescription. Among PPI users, PPIs were available on approximately 50% of the days with nsNSAID therapy. After multivariate adjustment, age > or = 65 yrs, history of any hospitalization and co-prescriptions for anti-coagulants or oral corticosteroids increased the odds of any nsNSAID-PPI overlap by 21-68%. Prior gastroprotective agent (GPA) use increased the odds of any PPI use during follow-up 16-fold and nsNSAID-PPI overlap 19-fold. Among PPI users, patients with prior use of any GPA had a 2.46 times higher nsNSAID-PPI overlap ratio.
  
  
  CONCLUSIONS
  PPI utilization correlates poorly with nsNSAID use in the UK. GI safety of nsNSAID-PPI co-therapy observed in controlled trials may therefore not be achieved in clinical practice.
authors.affiliation: School of Pharmacy, Rutgers University, Piscataway, NJ, USA.
authors.forename: D-C
authors.initials: DC
authors.lastname: Suh
authors.forename: E
authors.initials: E
authors.lastname: Hunsche
authors.forename: H-C
authors.initials: HC
authors.lastname: Shin
authors.forename: P
authors.initials: P
authors.lastname: Mavros
mesh_terms: D000328:Adult; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D054328:Proton Pump Inhibitors