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

• Published in: Rheumatology (Oxford, England) Vol. 47; no. 4; pp. 458 - 463
• Main Authors: Suh, D.-C., Hunsche, E., Shin, H.-C., Mavros, P.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-04-2008; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage; Anti-Inflammatory Agents, Non-Steroidal - adverse effects; Biological and medical sciences; Bones, joints and connective tissue. Antiinflammatory agents; Diseases of the osteoarticular system; Drug Administration Schedule; Drug Prescriptions - statistics & numerical data; Drug Therapy, Combination; Drug utilization; Drug Utilization - statistics & numerical data; Female; Gastrointestinal Diseases - chemically induced; Gastrointestinal Diseases - prevention & control; Humans; Male; Medical sciences; Middle Aged; NSAIDs; Pharmacology. Drug treatments; PPIs; Proton Pump Inhibitors - administration & dosage; Proton Pump Inhibitors - therapeutic use; Retrospective observational study; Retrospective Studies; Risk Factors; Non steroidal antiinflammatory agent; Chronic; NSAIDs; Rheumatology; Drug utilization; Retrospective observational study; PPIs
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kem375

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.