RESEARCH - The rise and decline of NSAID-associated gastropathy in RA

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Arthritis Rheum. 2004 Aug;50(8):2433-40.

The rise and decline of nonsteroidal antiinflammatory drug-associated

gastropathy in rheumatoid arthritis.

Fries JF, Murtagh KN, M, Zatarain E, Lingala B, Bruce B.

Stanford University, Stanford, California, USA. jff@...

OBJECTIVE: Nonsteroidal antiinflammatory drug (NSAID)-associated

gastropathy is a major cause of hospitalization and death. This study

was undertaken to examine whether recent preventive approaches have been

associated with a declining incidence of NSAID gastropathy, and, if so,

what measures may have caused the decline. METHODS: We studied 5,598

patients with rheumatoid arthritis (RA) over 31,262 patient-years at 8

sites. We obtained standardized longitudinal information on the patients

that had been previously used to establish the incidence of NSAID

gastropathy, and also information on patient risk factors and

differences in toxicity between NSAIDs. Consecutive patients were

followed up with biannual Health Assessment Questionnaires and medical

record audits between 1981 and 2000. The major outcome measure was the

annual rate of hospitalization involving bleeding, obstruction, or

perforation of the gastrointestinal (GI) tract and related conditions.

RESULTS: Rates of GI-related hospitalizations rose from 0.6% in 1981 to

1.5% in 1992 (P < 0.001), and then declined to 0.5% in 2000 (P < 0.001).

The fitted spline curve fit the data well (R2 = 0.70). The period of

rise was mainly associated with increasing patient age and the GI risk

propensity score. The period of decline was associated with lower doses

of ibuprofen and aspirin, a decline in the use of " more toxic " NSAIDs

from 52% to 42% of patients, a rise in the use of " safer " NSAIDs from

19% to 48% of patients, and increasing use of proton-pump inhibitors,

but not with change in age, NSAID exposure, or GI risk propensity score.

CONCLUSION: The risk of serious NSAID gastropathy has declined by 67% in

these cohorts since 1992. We estimate that 24% of this decline was the

result of lower doses of NSAIDs, while 18% was associated with the use

of proton-pump inhibitors and 14% with the use of less toxic NSAIDs.

These declines in the incidence of NSAID gastropathy are likely to

continue.

PMID: 15334455

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5334455 & dopt=Abstract

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