Association between eupatilin and reduction in small bowel bleeding in aspirin users and aspirin plus acid suppressant users

Lee, Hyun Seok; Nam, Ji Hyung; Oh, Dong Jun; Ahn, Hyun Young; Lim, Yun Jeong

doi:10.3904/kjim.2022.340

Cited by 3 publications

(4 citation statements)

References 23 publications

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“…DA-9601 demonstrated a protective effect against NSAIDs-induced gastroduodenal injury that was not inferior to that of misoprostol in previous double-blinded randomized clinical trials [16,17] with a significant reduction in small bowel bleeding in patients taking aspirin in a previous study using the Korean claim database. [18] However, unlike our study, which focused on patients with RA, these previous studies did not exclusively analyze individuals with arthritis. Previous studies have suggested that arthritis such as RA or osteoarthritis (OA) may render the GI tract more susceptible to damage by NSAIDs; [19–21] therefore, our data provide more pertinent information for preventive measures against serious GI complications in patients with arthritis receiving long-term NSAIDs.…”

Section: Discussionmentioning

confidence: 96%

DA-9601 has protective effects comparable to those of proton pump inhibitor and rebamipide against nonsteroidal anti-inflammatory drugs-induced upper and lower gastrointestinal bleeding in patients with rheumatoid arthritis: A nationwide study using Korean Health Insurance Review and Assessment Service database

So,

Kim,

Lee

2024

Medicine

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DA-9601 extracted from Artemisia asiatica contains a bioactive compound – eupatilin – that can protect against gastric mucosal damage through anti-inflammatory and anti-oxidative properties and is approved for treating acute and chronic gastritis in Korea, but their ability to protect gastrointestinal (GI) bleeding caused by nonsteroidal anti-inflammatory drugs (NSAIDs) is unclear. We aimed to compare the protective effects of DA-9601 to those of proton pump inhibitors (PPI) and rebamipide against upper and lower GI bleeding in patients with rheumatoid arthritis (RA) undergoing long-term NSAIDs therapy using the Korean Health Insurance Review and Assessment database. In this nationwide retrospective cohort study, we evaluated patients with RA who concurrently received NSAIDs for >3 months with DA-9601, PPI, or rebamipide between January 2015 and December 2017. The index date was the date of NSAIDs initiation, and all patients were followed up until December 2020 to detect upper and lower GI bleeding. In total, 24,258 patients with RA were eligible, and 5468 (22.5%), 4417 (18.2%), and 14,373 (59.3%) received DA-9601, PPI, or rebamipide, respectively, on the index date. During follow-up, upper and lower GI bleeding occurred in 508 (2.1%) and 402 (1.6%) patients with RA, respectively. The incidence rate of upper and lower GI bleeding was 615/100,000 and 485/100,000 person-years, respectively. Among patients with RA receiving DA-9601, PPI, or rebamipide, the frequencies of NSAIDs-induced upper GI bleeding were 0.5%, 0.4%, and 1.2%, respectively. The frequencies of NSAIDs-induced lower GI bleeding were 0.4%, 0.4%, and 0.9%, respectively. The incidence of NSAIDs-induced upper GI bleeding in patients with RA receiving DA-9601, PPI, and rebamipide was 601/100,000, 705/100,000, and 596/100,000 person-years, respectively, while the incidence of NSAIDs-induced lower GI bleeding in the same groups was 449/100,000, 608/100,000, and 465/100,000 person-years, respectively. In the multivariate Cox regression analysis, no significant difference was observed in lower and upper GI bleeding hazards between patients with RA using DA-9601, PPI, and rebamipide. Our results suggest that DA-9601 may exhibit protection against NSAIDs-induced GI bleeding that is comparable to those of PPI and rebamipide in patients with RA.

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Section: Discussionmentioning

confidence: 96%

DA-9601 has protective effects comparable to those of proton pump inhibitor and rebamipide against nonsteroidal anti-inflammatory drugs-induced upper and lower gastrointestinal bleeding in patients with rheumatoid arthritis: A nationwide study using Korean Health Insurance Review and Assessment Service database

So,

Kim,

Lee

2024

Medicine

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“…Although the study was limited by a small cohort, the number of diagnoses of NSAID enteropathy had increased, and this increase could be attributed to the aging population [ 30 ]. Our study group, using the nationwide database of claims data from the NHIS, found that MPAs had a protective effect against small bowel bleeding in patients using aspirin [ 31 ]. In that study, patients with anemia, melena, or hematochezia that occurred within 4 weeks before and after CE were suspected to have small bowel bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Small bowel bleeding occurred more frequently in patients who used acid suppressants concurrently with PPIs than in those who did not use acid suppressants concurrently with PPIs (1.3 vs. 0.5%). Subgroup analysis revealed that eupatilin significantly reduced the risk of small bowel bleeding in patients using aspirin concurrently with acid suppressants (HR, 0.23 vs. 2.55) [ 31 ]. However, the numbers of patients taking aspirin and those with small bowel bleeding were relatively small.…”

Section: Discussionmentioning

confidence: 99%

Reduced risk of gastrointestinal bleeding associated with eupatilin in aspirin plus acid suppressant users: nationwide population-based study

Lee,

Nam,

et al. 2024

Korean J Intern Med

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Background/Aims: Mucoprotective agents, such as eupatilin, are often prescribed to prevent gastrointestinal (GI) bleeding in addition to an acid suppressant despite the absence of a large-scale study. We evaluated the additional effect of eupatilin on the prevention of GI bleeding in both the upper and lower GI tract in concomitant aspirin and acid suppressant users using the nationwide database of national claims data from the Korean National Health Insurance Service (NHIS).Methods: An aspirin cohort was constructed using the NHIS claims data from 2013 to 2020. Patients who manifested with hematemesis, melena, or hematochezia were considered to have GI bleeding. A Cox proportional hazards regression model was used to determine the risk factors for GI bleeding associated with the concomitant use of GI drugs and other covariates among aspirin users.Results: Overall, a total of 432,208 aspirin users were included. The concurrent use of an acid suppressant and eupatilin (hazard ratio [HR] = 0.85, <i>p</i> = 0.016, vs. acid suppressant only) was a statistically significant preventive factor for GI bleeding. Moreover, a more than 3-month duration (HR = 0.88, <i>p</i> = 0.030) of acid suppressant and eupatilin prescription (vs. acid suppressant only) was a statistically significant preventive factor for GI bleeding.Conclusions: Eupatilin administration for ≥ 3 months showed additional preventive effect on GI bleeding in concomitant aspirin and acid suppressant users. Thus, cotreatment with eupatilin with a duration of 3 months or longer is recommended for reducing GI bleeding among aspirin plus acid suppressant users.

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“…In this nationwide cohort study, we used data from the KNHIS database 6 . The KNHIS database is considered to represent the entire South Korean population, and the details of this database have been previously described 7,8 . All insured Korean people undergo annual or biennial health examinations that are supported by the KNHIS.…”

Section: Data Sourcesmentioning

confidence: 99%

Uncontrolled hypertension is associated with an increased risk of end-stage renal disease in patients with type 2 diabetes who underwent postpercutaneous coronary intervention: A nationwide population-based study

Kim,

Park,

et al. 2024

Preprint

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Background: Little is known about the use of hypertension to predict end-stage renal disease (ESRD) in patients with type 2 diabetes mellitus (T2DM) and established coronary artery disease who underwent percutaneous coronary intervention (PCI). Here, we evaluated the effect of differential blood pressure (BP) levels on future ESRD in this population. Methods: Using nationwide health check-up data from the Korean National Health Insurance Service between 2015 and 2016, we obtained data for 80,187 patients with T2DM who underwent previous PCI. Patients were classified into four groups according to BP level measured within at least 2 years after PCI: systolic BP <120 (reference), <130, <140, <160, and ≥160 mm Hg; diastolic BP <80 (reference), <90, <100, and ≥100 mm Hg. The primary outcome was incident ESRD, defined as a combination of the relevant disease code and the initiation of renal replacement therapy. Multivariate Cox proportional hazard regression analysis was used to estimate the adjusted hazard ratio (HR) (95% CI) according to BP group. Results: The mean age was 67.7 years, and 80.9% of the participants were treated with antihypertensive medication. ESRD occurred in 1,362 (1.70%) patients during the 4.7-year follow-up. After adjustment for confounding factors, the HR of ESRD patients significantly and sequentially increased in the higher BP groups. Similar findings were noted regarding the relationship between incident ESRD and pulse pressure (PP). According to the subgroup analysis, this relationship was more significant for SBP in those aged <65 years than in those who were aged 65 years or older (P for interaction=0.0498). ESRD risk was linearly associated with systolic BP and had a J-shaped association with diastolic BP in patients with baseline values of 70 and 68 mm Hg. Conclusions: In this nationwide population-based study, elevated systolic and diastolic BP and PP were associated with the risk of developing ESRD in a dose–response manner among T2DM patients who underwent PCI. To prevent ESRD, more strict BP control is needed in T2DM patients who underwent PCI. Keywords: Diabetes mellitus; Korean National Health Insurance Service; ESRD; PCI

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Association between eupatilin and reduction in small bowel bleeding in aspirin users and aspirin plus acid suppressant users

Cited by 3 publications

References 23 publications

Reduced risk of gastrointestinal bleeding associated with eupatilin in aspirin plus acid suppressant users: nationwide population-based study

Uncontrolled hypertension is associated with an increased risk of end-stage renal disease in patients with type 2 diabetes who underwent postpercutaneous coronary intervention: A nationwide population-based study

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