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. We undertook this study to determine the association between GPA adherence and UGI tract events among patients receiving coxibs.Methods. Using primary care data from 3 databases, we conducted a case-control study in a cohort of patients age >50 years who were newly starting treatment with coxibs and concomitantly taking GPAs. Patients who had a UGI tract event (bleeding or symptomatic ulcer) were matched to event-free controls for age, sex, database, and calendar date. Coxib treatment intervals were defined as consecutive coxib prescriptions with intervening gaps not exceeding the duration of the previous coxib prescription. Adherence to GPAs was calculated as the proportion of days of coxib treatment covered by a GPA prescription. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated using conditional logistic regression analysis.Results. The coxib plus GPA-treated cohort consisted of 14,416 coxib-treated patients who received GPAs for at least 1 day, yielding 16,442 coxib treatment intervals in which a GPA was coprescribed. Most patients were treated with coxibs for <30 days. Seventyfour patients had a UGI tract event during or shortly after a coxib treatment interval in which a GPA was coprescribed, with an incidence rate of 11.9 (95% CI Study results were presented in part by Drs. Valkhoff and

Patient-reported adherence to coprescribed proton pump inhibitor gastroprotection in osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis patients using nonsteroidal anti-inflammatory drugs

“…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,12,18–20 further studies on how to alleviate the problem of poor adherence to coprescribed PPI gastroprotective therapy in this vulnerable population of patients are needed.…”

Utilization of gastroprotective strategies for nonsteroidal anti-inflammatory drug-induced gastrointestinal events in a major teaching hospital

“…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 27,30–32. Furthermore, this study adopted the ACG stratification of NSAID users into low, moderate and high GI risk groups, each entailing different gastroprotective strategy approaches.…”

“…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 27,30–32. 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.…”

1038 Cyclo-Oxygenase-2 Inhibitors or Nonselective NSAIDs Plus Gastroprotective Agents: What to Prescribe in Daily Clinical Practice?

“…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.…”

“…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.…”