PMID- 19214672
OWN - NLM
STAT- MEDLINE
DCOM- 20090423
LR  - 20211020
IS  - 0944-1174 (Print)
IS  - 0944-1174 (Linking)
VI  - 44
IP  - 2
DP  - 2009
TI  - Bisphosphonate increases risk of gastroduodenal ulcer in rheumatoid arthritis 
      patients on long-term nonsteroidal antiinflammatory drug therapy.
PG  - 113-20
LID - 10.1007/s00535-008-2278-2 [doi]
AB  - BACKGROUND: Rheumatoid arthritis (RA) patients are at increased risk of peptic 
      ulcers (PU) induced by nonsteroidal antiinflammatory drugs (NSAIDs). However, the 
      impact of potential drug interactions on the development of PU has yet to be 
      determined in a daily clinical setting. The aim was to estimate the clinical 
      important interactions for PU presented by comedication in Japanese RA 
      outpatients on long-term NSAID treatment. METHODS: This retrospective cohort 
      study enrolled 196 consecutive RA outpatients on NSAID medication for at least 3 
      months. Potential risk factors for endoscopic PU were analyzed in RA outpatients 
      on longterm NSAID treatment. RESULTS: PU incidence was 31% with bisphosphonate 
      co-therapy and 17% without the co-therapy. PU incidence was only 5% in subjects 
      with proton pump inhibitors (PPI) or prostaglandin E1 analogues (PG) co-therapy, 
      14% with histamine-H(2) receptor antagonists(H2RA) co-therapy, and 27% without 
      anti-ulcer agents. In multivariate logistic regression analysis, bisphosphonate 
      co-therapy remained a significant risk factor for PU (OR, 2.29; 95% CI, 
      1.09-4.81). Other risk factors for ulcer development were advanced age (greater 
      than 60 years) and smoking (OR, 2.58; 95% CI, 1.03-6.49 and OR, 2.71; 95% CI, 
      1.13-5.53, respectively.) Factors that significantly reduced the incidence of PU 
      were H2RA or PPI/PG cotherapies (OR, 0.29; 95% CI, 0.12-0.68.). CONCLUSIONS: 
      Bisphosphonate co-therapy as well as advanced age and smoking was found to be a 
      significant risk factor in PU, while co-therapies of standard-dose H2RA or PPI/PG 
      proved effective in preventing PU in Japanese RA patients on long-term NSAID 
      treatment.
FAU - Miyake, Kazumasa
AU  - Miyake K
AD  - Department of Internal Medicine, Division of Gastroenterology, Nippon Medical 
      School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan.
FAU - Kusunoki, Masanori
AU  - Kusunoki M
FAU - Shinji, Yoko
AU  - Shinji Y
FAU - Shindo, Tomotaka
AU  - Shindo T
FAU - Kawagoe, Tetsuro
AU  - Kawagoe T
FAU - Futagami, Seiji
AU  - Futagami S
FAU - Gudis, Katya
AU  - Gudis K
FAU - Tsukui, Taku
AU  - Tsukui T
FAU - Nakajima, Atsushi
AU  - Nakajima A
FAU - Sakamoto, Choitsu
AU  - Sakamoto C
LA  - eng
PT  - Journal Article
DEP - 20090213
PL  - Japan
TA  - J Gastroenterol
JT  - Journal of gastroenterology
JID - 9430794
RN  - 0 (Anti-Inflammatory Agents, Non-Steroidal)
RN  - 0 (Bone Density Conservation Agents)
RN  - 0 (Diphosphonates)
SB  - IM
MH  - Aged
MH  - Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage
MH  - Arthritis, Rheumatoid/*drug therapy
MH  - Bone Density Conservation Agents/*administration & dosage
MH  - Cohort Studies
MH  - Diphosphonates/*administration & dosage
MH  - Drug Administration Schedule
MH  - Endoscopy, Digestive System
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Peptic Ulcer/diagnosis/*epidemiology
MH  - Polypharmacy
MH  - Retrospective Studies
MH  - Risk Factors
EDAT- 2009/02/14 09:00
MHDA- 2009/04/25 09:00
CRDT- 2009/02/14 09:00
PHST- 2008/04/12 00:00 [received]
PHST- 2008/08/10 00:00 [accepted]
PHST- 2009/02/14 09:00 [entrez]
PHST- 2009/02/14 09:00 [pubmed]
PHST- 2009/04/25 09:00 [medline]
AID - 10.1007/s00535-008-2278-2 [doi]
PST - ppublish
SO  - J Gastroenterol. 2009;44(2):113-20. doi: 10.1007/s00535-008-2278-2. Epub 2009 Feb 
      13.