title: Gastroprotection among new chronic users of non-steroidal anti-inflammatory drugs: a study of utilization and adherence in The Netherlands.
abstract: OBJECTIVE
  To describe the use of gastroprotection (GP) among new chronic users of NSAIDs in the Netherlands by gastrointestinal (GI) risk factor (RF) score.
  
  
  METHODS
  Data for this retrospective follow-up study were extracted from the PHARMO database. We selected new chronic users of COX-2 inhibitors (coxibs) or traditional NSAIDs (tNSAIDs) between 1st January 2000 and 31st December 2004. GP strategies were defined as: use of proton pump inhibitors (PPI), coxibs or both. GI RF score at index date was based on: history of GI drug use, high dose of NSAIDs, age > 60 years, use of corticosteroids/anticoagulants/SSRIs, rheumatoid arthritis, heart failure or diabetes, with each condition accounting for one factor. Switching was assessed among those with > or = 1 GI RF during the first year of follow-up.
  
  
  RESULTS
  Among 58,770 new chronic NSAID users at index date, 80% used tNSAIDs alone, 8% used tNSAID + PPI, 10% used a coxib alone and 2% used coxib + PPI. Mean (SD) number of GI RF among these groups was 1.6 (2.1), 3.1 (1.3), 1.5 (1.5) and 2.8 (1.3), respectively. Among 48 390 patients (82.3%) with a GI RF score of > or = 1, 20.9% used a GP strategy, this increased with number of GI RFs. Within the first year, 5.3% (n = 2067) and 4.8%(n = 1 843) of tNSAID users with > or = 1 GI RF switched to tNSAID+PPI and coxib alone, respectively.
  
  
  CONCLUSIONS
  Gastroprotection in users of tNSAIDs was inadequate. Over 80% of NSAID users with > or = 1 GI RF did not receive any gastroprotection, and even when prescribed, a PPI is used only half the time. More research should show if gastroprotection was used for prevention.
authors.affiliation: PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands.
authors.forename: Michiel W
authors.initials: MW
authors.lastname: Van der Linden
authors.forename: Sabine
authors.initials: S
authors.lastname: Gaugris
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Bart J F
authors.initials: BJ
authors.lastname: Van den Bemt
authors.forename: Myrthe P P
authors.initials: MP
authors.lastname: van Herk-Sukel
authors.forename: Ron M C
authors.initials: RM
authors.lastname: Herings
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D015331:Cohort Studies; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects*; D017723:Drug Utilization Review; D006801:Humans; D009426:Netherlands; D010349:Patient Compliance; D012189:Retrospective Studies; D013276:Stomach Ulcer / Q000517:prevention & control*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016861:Cyclooxygenase Inhibitors