RT Journal Article
SR Electronic
T1 Suboptimal gastroprotective coverage of NSAID use and the risk of upper gastrointestinal bleeding and ulcers: an observational study using three European databases
JF Gut
JO Gut
FD BMJ Publishing Group Ltd and British Society of Gastroenterology
SP 1650
OP 1659
DO 10.1136/gut.2011.239848
VO 60
IS 12
A1 van Soest, Eva M
A1 Valkhoff, Vera E
A1 Mazzaglia, Giampiero
A1 Schade, René
A1 Molokhia, Mariam
A1 Goldstein, Jay L
A1 Hernández-Díaz, Sonia
A1 Trifirò, Gianluca
A1 Dieleman, Jeanne P
A1 Kuipers, Ernst J
A1 Sturkenboom, Miriam C J M
YR 2011
UL http://gut.bmj.com/content/60/12/1650.abstract
AB Background Gastro-protective agents (GPA) are co-prescribed with non-steroidal anti-inflammatory drugs (NSAID) to lower the risk of upper gastrointestinal (UGI) events. It is unknown to what extent the protective effect is influenced by therapy adherence.Aim To study the association between GPA adherence and UGI events among non-selective (ns) NSAID users.Methods The General Practice Research Database (UK 1998–2008), the Integrated Primary Care Information database (the Netherlands 1996–2007) and the Health Search/CSD Longitudinal Patient Database (Italy 2000–2007) were used. A nested case-control design was employed within a cohort of nsNSAID users aged ≥50 years, who also used a GPA. UGI event cases (UGI bleeding and/or symptomatic ulcer with/without obstruction/perforation) were matched to event-free members of the cohort for age, sex, database and calendar time. Adherence to GPA was calculated as the proportion of nsNSAID treatment days covered by a GPA prescription. Adjusted OR with 95% CI were calculated.Results The cohort consisted of 618 684 NSAID users, generating 1 107 266 nsNSAID episodes. Of these, 117 307 (10.6%) were (partly) covered by GPA, 4.9% of which with a GPA coverage <20% (non-adherence), and 68.1% with a GPA coverage >80% (full adherence). 339 patients experienced an event. Among non-adherers, the OR was 2.39 (95% CI 1.66 to 3.44) for all UGI events and 1.89 (95% CI 1.09 to 3.28) for UGI bleeding alone, compared to full adherers.Conclusions The risk of UGI events was significantly higher in nsNSAID users with GPA non-adherence. This underlines the importance of strategies to improve GPA adherence.