title: Prescription patterns and appropriateness of NSAID therapy according to gastrointestinal risk and cardiovascular history in patients with diagnoses of osteoarthritis.
abstract: BACKGROUND
  Prescription of non-steroidal anti-inflammatory drugs (NSAIDs) should be based on the assessment of both gastrointestinal (GI) and cardiovascular (CV) risk for the individual patient. We aimed to assess the GI/CV risk profile and the pharmacological management of patients with osteoarthritis (OA) in clinical practice.
  
  
  METHODS
  We conducted a cross-sectional, multicentre, observational study of consecutive OA patients that visited 1,760 doctors throughout the Spanish National Health System (NHS) in a single day. The presence of GI risk factors, CV histories, hypertension and current pharmacological treatments was recorded.
  
  
  RESULTS
  Of the 60,868 patients, 17,105 had a diagnosis of OA and were evaluable. The majority (93.4%) had more than one GI risk factor and 60.3% were defined to be at high-GI risk. Thirty-two percent had a history of CV events, 57.6% were treated with anti-hypertensive therapy and 22.6% had uncontrolled hypertension. One-fifth of patients were treated with non-NSAID therapies, whereas the remaining patients received NSAIDs. Non-selective NSAIDs (nsNSAID) plus proton pump inhibitor (PPI) or cyclooxigenase-2 (COX-2)-selective NSAIDs alone were more frequently prescribed in patients at increased GI risk. Patients with a positive CV history received nsNSAIDs or COX-2-selective NSAIDs in 41.3% and 31.7% of cases, respectively. When both the GI and CV histories were combined, 51% of the overall population was being prescribed drugs that were either not recommended or contraindicated.
  
  
  CONCLUSIONS
  Over 90% of patients with OA are at increased GI and/or CV risk. In over half of these patients, the prescription of NSAIDs was not in accordance with current guidelines or recommendations made by regulatory agencies.
authors.affiliation: University of Zaragoza Medical School, Aragón Health Research Institute, CIBERehd, Zaragoza, Spain. angel.lanas@gmail.com
authors.forename: Angel
authors.initials: A
authors.lastname: Lanas
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Tell
authors.forename: Beatriz
authors.initials: B
authors.lastname: Armada
authors.forename: Angel
authors.initials: A
authors.lastname: Oteo-Alvaro
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000150:complications / Q000453:epidemiology*; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000188:drug therapy*; D055656:Prescriptions / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018570:Risk Assessment; D013030:Spain
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal