Time-trends in gastroprotection with NSAIDs

Vera E. Valkhoff (1, 2) , Eva Marianne van Soest (3) , Miriam C Sturkenboom , Ernst J Kuipers (4)

1 Gastroenterology and Hepatology
2 Medical Informatics
3 Gastroenterology and Hepatology
4 Gastroenterology &Hepatology

Background: Preventive strategies are advocated in patients at risk of upper gastrointestinal (UGI) complications associated with non-steroidal anti-inflammatory drugs (NSAIDs). Aim: We examined time trends in preventive strategies. Methods: In a study population comprising of 50,126 NSAID users ≥ 50 yrs from the Integrated Primary Care Information database, we considered two preventive strategies: co-prescription of gastroprotective agents and prescription of a cyclooxygenase-2-selective inhibitor. In patients with ≥1 risk factor (history of UGI bleeding/ulceration, age>65 yrs, use of anticoagulants, aspirin, or corticosteroids), correct prescription was defined as the presence of a preventive strategy, and under-prescription as the absence of one. In patients with no risk factors, correct prescription was defined as the lack of a preventive strategy, and over-prescription as the presence of one. Results: Correct prescription rose from 6.9% in 1996 to 39.4% in 2006 (p<0.01) in high risk NSAID users. Under-prescription fell from 93.1% to 59.9% (p<0.01). In the complete cohort, over-prescription rose from 2.9% to 12.3% (p<0.01). Conclusions: Under-prescription of preventive strategies has steadily decreased between 1996 and 2006, however 60% of NSAID users at increased risk of NSAID complication still does not receive adequate protection.

Mots clés: Medicine

Vera E. Valkhoff, Eva Marianne van Soest, Miriam C Sturkenboom, Ernst J Kuipers. Time-trends in gastroprotection with NSAIDs. Alimentary Pharmacology and Therapeutics, 2010, 31 (11), pp.1218. ⟨10.1111/j.1365-2036.2010.04281.x⟩. ⟨hal-00552539⟩