PMID- 14585915
OWN - NLM
STAT- MEDLINE
DCOM- 20040123
LR  - 20181130
IS  - 1462-0324 (Print)
IS  - 1462-0324 (Linking)
VI  - 42 Suppl 3
DP  - 2003 Nov
TI  - Underutilization of preventive strategies in patients receiving NSAIDs.
PG  - iii23-31
AB  - BACKGROUND: Multiple treatment guidelines for non-steroidal anti-inflammatory 
      drugs (NSAIDs) suggest that patients with one or more risk factors for 
      NSAID-associated upper gastrointestinal (UGI) ulcer complications should be 
      prescribed preventive strategies such as acid-suppressive drugs, misoprostol or 
      cyclooxygenase (COX)-2-specific inhibitors to reduce their risk of serious ulcer 
      complications. The purpose of the present study was to evaluate the extent to 
      which new NSAID users receive recommended preventive strategies and to assess the 
      association between risk factors and a prescription of acid suppressive drugs or 
      misoprostol. METHOD: A retrospective observational cohort study was conducted 
      using the Integrated Primary Care Information (IPCI) database, a longitudinal 
      database of electronic general practitioner patient records in The Netherlands. 
      The study population comprised all new NSAID users, defined as users of 
      non-specific NSAIDs, COX-2-preferential NSAIDs and COX-2-specific inhibitors, 
      during the period from January 1996 to April 2002. Subjects were excluded if they 
      had an H2-receptor antagonist (H2RA), proton pump inhibitor (PPI) or misoprostol 
      prescription in the 3 months prior to the first NSAID prescription. Preventive 
      use of acid-suppressive drugs or misoprostol was identified by the coprescription 
      for these drugs on the same day (+/-2 days) as the NSAID prescription. The drug 
      use for each patient was validated as having a preventive indication by reviewing 
      the physician-recorded symptoms and diagnoses. Risk factors for UGI ulcer events 
      were defined as age >65 yr, UGI history (gastroduodenal ulcer, UGI bleeding, 
      dyspepsia) and concomitant medications (anticoagulants, aspirin, oral 
      corticosteroids). The study population comprised 69 648 new NSAID users. RESULTS: 
      Overall, 7.9% of NSAID users received a preventive strategy (6.6% received a 
      gastroprotective agent and an additional 1.3% received COX-2-specific 
      inhibitors). Patients using preventive drugs had higher odds of having one or 
      more UGI risk factors than patients without preventive drugs [adjusted odds ratio 
      (OR) 1.78, 95% confidence interval 1.66-1.92]. Despite the greater rate of 
      preventive drug prescriptions in patients who may have been at higher risk, 86.6% 
      of patients with one risk factor and 81.2% with two or more risk factors received 
      no preventive strategies. In contrast to non-specific NSAIDs, patients who 
      received a prescription for a COX-2-specific inhibitor had significantly lower 
      adjusted odds (OR = 0.22) of having H2RA/PPI or misoprostol coprescribed. 
      CONCLUSIONS: Although patients who are treated with preventive strategies have 
      higher odds of having gastrointestinal risk factors than those not prescribed 
      preventive therapies, the majority (>80%) of patients with one or more 
      gastrointestinal risk factors do not receive the recommended NSAID treatment 
      regimen of a COX-2-specific inhibitor or NSAID + H2RA/PPI or misoprostol and are 
      therefore undertreated.
FAU - Sturkenboom, M C J M
AU  - Sturkenboom MC
AD  - Department of Epidemiology & Biostatistics, Erasmus University Medical Center, 
      Rotterdam, The Netherlands. m.sturkenboom@erasmusmc.nl
FAU - Burke, T A
AU  - Burke TA
FAU - Dieleman, J P
AU  - Dieleman JP
FAU - Tangelder, M J D
AU  - Tangelder MJ
FAU - Lee, F
AU  - Lee F
FAU - Goldstein, J L
AU  - Goldstein JL
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Rheumatology (Oxford)
JT  - Rheumatology (Oxford, England)
JID - 100883501
RN  - 0 (Antacids)
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Anti-Ulcer Agents)
RN  - 0 (Cyclooxygenase Inhibitors)
RN  - 0 (Lactones)
RN  - 0 (Pyrazoles)
RN  - 0 (Sulfonamides)
RN  - 0 (Sulfones)
RN  - 0E43V0BB57 (Misoprostol)
RN  - 0QTW8Z7MCR (rofecoxib)
RN  - JCX84Q7J1L (Celecoxib)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Antacids/therapeutic use
MH  - Anti-Inflammatory Agents, Non-Steroidal/*adverse effects
MH  - Anti-Ulcer Agents/*therapeutic use
MH  - Celecoxib
MH  - Cohort Studies
MH  - Cyclooxygenase Inhibitors/*adverse effects
MH  - Drug Utilization
MH  - Female
MH  - Humans
MH  - Lactones/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Misoprostol/*therapeutic use
MH  - Netherlands
MH  - Peptic Ulcer/chemically induced/*prevention & control
MH  - Prognosis
MH  - Pyrazoles
MH  - Referral and Consultation/statistics & numerical data
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sulfonamides/therapeutic use
MH  - Sulfones
EDAT- 2003/10/31 05:00
MHDA- 2004/01/24 05:00
CRDT- 2003/10/31 05:00
PHST- 2003/10/31 05:00 [pubmed]
PHST- 2004/01/24 05:00 [medline]
PHST- 2003/10/31 05:00 [entrez]
AID - 42/suppl_3/iii23 [pii]
AID - 10.1093/rheumatology/keg495 [doi]
PST - ppublish
SO  - Rheumatology (Oxford). 2003 Nov;42 Suppl 3:iii23-31. doi: 
      10.1093/rheumatology/keg495.