Article : Failure to Renew Prescriptions for Gastroprotective Agents...

Failure to Renew Prescriptions for Gastroprotective Agents to Patients on Continuous Non-Steroidal Anti-Inflammatory Drugs Increases Rate of Upper Gastrointestinal Injury

Le Ray I, Barkun AN, Vauzelle-Kervroëdan F, Bardou M


BACKGROUND & AIMS: Patients with risk factors for gastrointestinal (GI) disorders who continuously use non-steroidal anti-inflammatory drugs (NSAIDs) should also take gastroprotective agents (GPAs), such as proton-pump inhibitors (PPIs). However, it is not clear how many physicians continue to prescribe GPAs to these patients, and whether stopping the prescription increases GI complications.

METHODS: We performed a retrospective, observational, longitudinal study using a validated electronic database of representative general practitioners in France. We analyzed data for 1856 patients at risk for GI events (older than 65 years, past history of GI ulcer, or receiving antiplatelet agents) who received prescriptions for a NSAID and PPI from 2007 to 2009. Kaplan-Meier curves were used to determine the probability of still being prescribed a GPA at 12 and 24 months after the first prescription. Multivariate logistic regression analysis was used to identify factor associated with non-persistence. GI complications rates were compared using the Student t test.

RESULTS: The probability of still being prescribed a PPI along with a NSAID 1 year after the study began was 77.5% (95% confidence interval [CI], 75.6%-79.4%) and 68.3% after 2 years (95% CI, 66.1%-70.4%). Risk factors for no longer receiving a prescription for a PPI included switching to a COX2-selective inhibitor (hazard ratio [HR], 2.50; 95% CI, 1.91-3.28; P<.001) or to a non-selective NSAID (HR, 1.63; 95% CI, 1.33-1.99; P<.001), and female sex (HR, 1.25; 95% CI, 1.05-1.45; P<.05). In 50% of these cases, the PPI was reintroduced within 6 months, without a specific reason in 70% of the cases. The risk for upper GI injury was higher among patients with discontinued prescriptions for PPIs (odds ratio, 1.45; 95% CI, 1.06-2.09; P=.02)

CONCLUSIONS: Within 2 years after prescribing a PPI, physicians do not renew this prescription for about 33% of patients receiving continuous NSAIDs. This increases the risk for GI adverse events among these patients.

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