BACKGROUND: Gastro-protective agents (GPA) are co-prescribed with non-steroidal anti-inflammatory drugs (NSAID) to lower the risk of upper gastrointestinal (UGI) events. It is unknown to what extent the protective effect is influenced by therapy adherence. AIM: To study the association between GPA adherence and UGI events among non-selective (ns) NSAID users. METHODS: The General Practice Research Database (UK 1998-2008), the Integrated Primary Care Information database (the Netherlands 1996-2007) and the Health Search/CSD Longitudinal Patient Database (Italy 2000-2007) were used. A nested case-control design was employed within a cohort of nsNSAID users aged ≥50 years, who also used a GPA. UGI event cases (UGI bleeding and/or symptomatic ulcer with/without obstruction/perforation) were matched to event-free members of the cohort for age, sex, database and calendar time. Adherence to GPA was calculated as the proportion of nsNSAID treatment days covered by a GPA prescription. Adjusted OR with 95% CI were calculated. RESULTS: The cohort consisted of 618 684 NSAID users, generating 1 107 266 nsNSAID episodes. Of these, 117 307 (10.6%) were (partly) covered by GPA, 4.9% of which with a GPA coverage <20% (non-adherence), and 68.1% with a GPA coverage >80% (full adherence). 339 patients experienced an event. Among non-adherers, the OR was 2.39 (95% CI 1.66 to 3.44) for all UGI events and 1.89 (95% CI 1.09 to 3.28) for UGI bleeding alone, compared to full adherers. CONCLUSIONS: The risk of UGI events was significantly higher in nsNSAID users with GPA non-adherence. This underlines the importance of strategies to improve GPA adherence.
BACKGROUND: Gastro-protective agents (GPA) are co-prescribed with non-steroidal anti-inflammatory drugs (NSAID) to lower the risk of upper gastrointestinal (UGI) events. It is unknown to what extent the protective effect is influenced by therapy adherence. AIM: To study the association between GPA adherence and UGI events among non-selective (ns) NSAID users. METHODS: The General Practice Research Database (UK 1998-2008), the Integrated Primary Care Information database (the Netherlands 1996-2007) and the Health Search/CSD LongitudinalPatient Database (Italy 2000-2007) were used. A nested case-control design was employed within a cohort of nsNSAID users aged ≥50 years, who also used a GPA. UGI event cases (UGI bleeding and/or symptomatic ulcer with/without obstruction/perforation) were matched to event-free members of the cohort for age, sex, database and calendar time. Adherence to GPA was calculated as the proportion of nsNSAID treatment days covered by a GPA prescription. Adjusted OR with 95% CI were calculated. RESULTS: The cohort consisted of 618 684 NSAID users, generating 1 107 266 nsNSAID episodes. Of these, 117 307 (10.6%) were (partly) covered by GPA, 4.9% of which with a GPA coverage <20% (non-adherence), and 68.1% with a GPA coverage >80% (full adherence). 339 patients experienced an event. Among non-adherers, the OR was 2.39 (95% CI 1.66 to 3.44) for all UGI events and 1.89 (95% CI 1.09 to 3.28) for UGI bleeding alone, compared to full adherers. CONCLUSIONS: The risk of UGI events was significantly higher in nsNSAID users with GPA non-adherence. This underlines the importance of strategies to improve GPA adherence.
Authors: Anton Pottegård; Anne Broe; Jesper Hallas; Ove B Schaffalitzky de Muckadell; Annmarie T Lassen; Anders B Lødrup Journal: Therap Adv Gastroenterol Date: 2016-05-26 Impact factor: 4.409
Authors: G M C Masclee; V E Valkhoff; E M van Soest; R Schade; G Mazzaglia; M Molokhia; G Trifirò; J L Goldstein; S Hernández-Díaz; E J Kuipers; M C J M Sturkenboom Journal: Aliment Pharmacol Ther Date: 2013-05-28 Impact factor: 8.171
Authors: Carmen Ferrajolo; Katia M C Verhamme; Gianluca Trifirò; Geert W 't Jong; Carlo Giaquinto; Gino Picelli; Alessandro Oteri; Sandra de Bie; Vera E Valkhoff; Martijn J Schuemie; Giampiero Mazzaglia; Claudio Cricelli; Francesco Rossi; Annalisa Capuano; Miriam C J M Sturkenboom Journal: Drug Saf Date: 2013-10 Impact factor: 5.606