2012
DOI: 10.1002/art.34433
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Adherence to gastroprotection during cyclooxygenase 2 inhibitor treatment and the risk of upper gastrointestinal tract events: A population‐based study

Abstract: Objective. Guidelines recommend coprescription of gastroprotective agents (GPAs) in patients receiving cyclooxygenase 2 inhibitors (coxibs) who are at high risk of upper gastrointestinal (UGI) tract complications (i.e., patients with a previous complicated ulcer or with multiple risk factors). Suboptimal GPA adherence has been shown to diminish the gastroprotective effect during use of nonselective nonsteroidal antiinflammatory drugs, but little is known about the effect of GPA adherence during coxib treatment… Show more

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Cited by 18 publications
(20 citation statements)
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“…Moreover, for every 10% decrease in adherence to PPI, the risk of upper gastrointestinal bleeding/ulcers and upper gastrointestinal bleeding alone increases by 9% and 6%, respectively 27. Similar results were shown in other studies 19,26. Since the risk of gastrointestinal events and death in nonadherent patients is increased and also associated with a societal economic burden,12,1820 further studies on how to alleviate the problem of poor adherence to coprescribed PPI gastroprotective therapy in this vulnerable population of patients are needed.…”
Section: Discussionsupporting
confidence: 85%
“…Moreover, for every 10% decrease in adherence to PPI, the risk of upper gastrointestinal bleeding/ulcers and upper gastrointestinal bleeding alone increases by 9% and 6%, respectively 27. Similar results were shown in other studies 19,26. Since the risk of gastrointestinal events and death in nonadherent patients is increased and also associated with a societal economic burden,12,1820 further studies on how to alleviate the problem of poor adherence to coprescribed PPI gastroprotective therapy in this vulnerable population of patients are needed.…”
Section: Discussionsupporting
confidence: 85%
“…However, as highlighted by Rostom et al,21 direct comparisons of the magnitudes of prevalence should be avoided as all studies had different patient populations, GI risk factors consideration or guidelines used. Since this study used the ACG guidelines as the reference, the utilization of gastroprotective strategies was determined based on both the nature and number of GI risk factors present,20 and not separately as reported by most other studies 27,3032. Furthermore, this study adopted the ACG stratification of NSAID users into low, moderate and high GI risk groups, each entailing different gastroprotective strategy approaches.…”
Section: Discussionmentioning
confidence: 99%
“…Furthermore, this study adopted the ACG stratification of NSAID users into low, moderate and high GI risk groups, each entailing different gastroprotective strategy approaches. Such stratification of GI risk was also not commonly adopted by the other studies mentioned 27,3032. For instance, patients with a single risk factor of a previous history of complicated GI ulcer are deemed at high risk of developing NSAID-induced ulcer complication and hence, need to be prescribed a COX-2 inhibitor plus a PPI or misoprostol.…”
Section: Discussionmentioning
confidence: 99%
“…We have previously shown the validity to combine and to compare data from these databases. 17,19 For GPRD, the READ dictionary was used to identify medical diagnosis and symptoms, whereas the International Classification for Primary Care 20 and the International Classification of Diseases, 9 th Revision, Clinical Modification (ICD-9-CM) 2121 were used for that purpose in IPCI and HSD, respectively. In IPCI and HSD information on drug prescription was coded according to the Anatomical Therapeutical Chemical (ATC) classification.…”
Section: Description Of Data Sourcesmentioning
confidence: 99%
“…Overall, in 83.4% of coxib episodes no GPA was used concomitantly. 19 This resulted in a cohort including only nsNSAID plus GPA (≥80 % adherence) and coxib (alone) users.…”
Section: Determination Of Nsaid Cohortmentioning
confidence: 99%