title: Failure to renew prescriptions for gastroprotective agents to patients on continuous nonsteroidal anti-inflammatory drugs increases rate of upper gastrointestinal injury.
abstract: OBJECTIVE
  Patients with risk factors for gastrointestinal (GI) disorders who continuously use nonsteroidal anti-inflammatory drugs (NSAIDs) also should take gastroprotective agents (GPAs), such as proton pump inhibitors (PPIs). However, it is not clear how many physicians continue to prescribe GPAs to these patients, and whether stopping the GPA prescription increases GI complications.
  
  
  METHODS
  We performed a retrospective, observational, longitudinal study using a validated electronic database of representative general practitioners in France. We analyzed data for 1856 patients at risk for GI events (>65 y, past history of GI ulcer, or receiving antiplatelet agents) who received prescriptions for an NSAID and PPI from 2007 to 2009. Kaplan-Meier curves were used to determine the probability of still being prescribed a GPA at 12 and 24 months after the first prescription. Multivariate logistic regression analysis was used to identify factors associated with nonpersistence. GI complication rates were compared using the Student t test.
  
  
  RESULTS
  The probability of still being prescribed a PPI along with an NSAID 1 year after the study began was 77.5% (95% confidence interval [CI], 75.6%-79.4%) and 68.3% after 2 years (95% CI, 66.1%-70.4%). Risk factors for no longer receiving a prescription for a PPI included switching to a cyclooxygenase-2-selective inhibitor (hazard ratio [HR], 2.50; 95% CI, 1.91-3.28; P < .001) or to a nonselective NSAID (HR, 1.63; 95% CI, 1.33-1.99; P < .001), and female sex (HR, 1.25; 95% CI, 1.05-1.45; P < .05). In 50% of these cases, the PPI was reintroduced within 6 months, without a specific reason in 70% of the cases. The risk for upper GI injury was higher among patients with discontinued prescriptions for PPIs (odds ratio, 1.45; 95% CI, 1.06-2.09; P = .02).
  
  
  CONCLUSIONS
  Within 2 years after prescribing a PPI, physicians do not renew this prescription for approximately 33% of patients receiving continuous NSAIDs. This increases the risk for GI adverse events among these patients.
authors: INSERM Centre d'Investigations Cliniques Plurithématique 803, Centre Hospitalier Universitaire du Bocage, Dijon, France.
authors: Isabelle
authors: I
authors: Le Ray
authors: Alan N
authors: AN
authors: Barkun
authors: Françoise
authors: F
authors: Vauzelle-Kervroëdan
authors: Marc
authors: M
authors: Bardou
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D005260:Female; D005602:France; D005765:Gastrointestinal Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D005767:Gastrointestinal Diseases / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005765:Gastrointestinal Agents