Prevention of NSAID gastropathy in elderly patients. An observational study in general practice and nursing homes

Abstract

Patients in nursing homes had more risk factors for NSAID gastropathy than patients in old people's homes or outpatients (>65 years). Although in nursing homes co-prescription of prophylaxis during NSAID use is more common, in general the Dutch guidelines on adequate NSAID use are still not fully implemented at this moment. The results also showed that pantoprazole was effective in diminishing gastrointestinal complaints, as well as preventing symptomatic NSAID gastropathy. Moreover, pantoprazole showed to be a safe and well-tolerated drug in our treatment group.

Time‐trends in gastroprotection with nonsteroidal anti‐inflammatory drugs (NSAIDs)

“…Our findings are consistent with other Dutch studies reporting under‐prescription of preventive strategies in patients who would benefit from appropriate protection at a range of 43–87% 33, 36–41 . Consistently low rates of prescription of preventive strategies have also been reported in studies from other countries 28, 42–45 .…”

Co-prescription of Gastroprotective Agents and Their Efficacy in Elderly Patients Taking Nonsteroidal Anti-inflammatory Drugs: A Systematic Review of Observational Studies

“…37 and 38 The other 2 consisted of a referral center population 35 and a national sample from participating general practices. 36 The forest plot in Figure 3 shows little overlap in the CIs, indicating high heterogeneity (I 2 = 97%). The study investigating low-dose aspirin 35 was included in the analysis because aspirin has also been shown to be associated with GI bleeding (mitigated by use of PPIs), 58 and excluding this study did not reduce the heterogeneity (I 2 = 98%).…”

“…60 Likewise, the funnel plot ( Supplementary Figure 1) is not considered reliable with fewer than 10 studies. 61 Potential sources of heterogeneity include differences in the choice of outcome measure (self-reported GI complaints, 36 GI hospitalization rate, 37 and 38 hospitalization with upper GI event, 39 and 54 ulcers found on endoscopy, 35 or serious ulcer complications 55 and 56 ), the definitions of drug exposure and co-prescription, and differences in prescribing behavior leading to greater or lesser differences in baseline risk between treated and untreated patients. Three of these 5 37, 38 and 39 plus an additional 2 studies 54 and 55 reported efficacy of PPIs after adjustment for various risk factors (Table 2) but did not report outcome measures that could be combined.…”

“…Five were population-based 37, 38,39 and 54 or included all patients in the hospital database, 57 and 2 included successive patients undergoing endoscopy 35 or visiting participating general practices. 36 One was a case-control study including all admissions to the regional hospital with NSAID-related ulcers, 56 which acknowledged the limitation that no age-matched controls could be found for the oldest patients diagnosed with NSAID-related ulcers. 55 Four studies used sensitivity analysis or comparison of different measures of exposure.…”

Pain Management in the Elderly: An FDA Safe Use Initiative Expert Panel’s View on Preventable Harm Associated with NSAID Therapy

“…For example, in a survey of 615 elderly patients in an outpatient or old age/nursing home setting for the coadministration of an NSAID with a prophylactic product to protect against gastrointestinal side effects, 65.3%, 76.2%, and 42.6% failed to receive necessary prophylaxis in the outpatient, old age, and nursing home settings, respectively [42], even though treatment for such side effects are documented in well-established guidelines put forth by the American Geriatric Society [43]. Another safeguard is the task of proper documentation of medical history.…”