RESEARCH - Co-prescribing of PPIs among chronic users of NSAIDs in the UK

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Rheumatology Advance Access published online on February 7, 2008

Rheumatology, doi:10.1093/rheumatology/kem375

Co-prescribing of proton pump inhibitors among chronic users of NSAIDs in the UK

D.-C. Suh1, E. H. Dipl rer pol2, H.-C. Shin1 and P. Mavros2

1School of Pharmacy, Rutgers University, Piscataway and 2Outcomes

Research, Merck & Co., Inc., Whitehouse Station, NJ, USA.

Abstract

Objectives. Co-prescribing of proton pump inhibitors (PPIs) with

non-selective NSAIDs (nsNSAIDs) is recommended in patients at risk of

gastrointestinal (GI) events. This study estimated usage of PPI

co-therapy among chronic nsNSAID users and determined factors

associated with concurrent nsNSAID–PPI use.

Methods. The retrospective study was based on the Intercontinental

Marketing Services (IMS) Health UK MediPlus® database and included

subjects 40 yrs of age who received their first oral nsNSAID

prescription between July and December 2002 and who had 60 days of

nsNSAID supply during the following year. Days with nsNSAID–PPI

overlap were calculated and logistic regression was used to identify

factors associated with nsNSAID–PPI overlap. A generalized linear

model was used to assess the degree of association of GI risk factors

with the nsNSAID–PPI overlap ratio among PPI users.

Results. Of 16 344 patients included, 1586 received at least one PPI

prescription. Among PPI users, PPIs were available on 50% of the days

with nsNSAID therapy. After multivariate adjustment, age 65 yrs,

history of any hospitalization and co-prescriptions for

anti-coagulants or oral corticosteroids increased the odds of any

nsNSAID–PPI overlap by 21–68%. Prior gastroprotective agent (GPA) use

increased the odds of any PPI use during follow-up 16-fold and

nsNSAID–PPI overlap 19-fold. Among PPI users, patients with prior use

of any GPA had a 2.46 times higher nsNSAID–PPI overlap ratio.

Conclusions. PPI utilization correlates poorly with nsNSAID use in the

UK. GI safety of nsNSAID–PPI co-therapy observed in controlled trials

may therefore not be achieved in clinical practice.

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Read the entire article here:

http://rheumatology.oxfordjournals.org/cgi/content/full/kem375v1

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