Adherence to gastroprotection during cyclooxygenase 2 inhibitor treatment and the risk of upper gastrointestinal tract events: A population-based study

Autor: Miriam C. J. M. Sturkenboom, Eva M. van Soest, Giampiero Mazzaglia, Jay L. Goldstein, Vera E. Valkhoff, Gianluca Trifirò, Ernst J. Kuipers, Sonia Hernandez-Diaz, R Schade, Mariam Molokhia
Přispěvatelé: Valkhoff, V, van Soest, E, Mazzaglia, G, Molokhia, M, Schade, R, Trifiro, G, Goldstein, J, Hernandez-Diaz, S, Kuipers, E, Sturkenboom, M, Medical Informatics, Gastroenterology & Hepatology
Jazyk: angličtina
Rok vydání: 2012
Předmět:
Male
Nonsteroidal Antiinflammatory Drug
DATABASES
law.invention
Cohort Studies
Upper Gastrointestinal Tract
Naproxen
Randomized controlled trial
Risk Factors
law
NAPROXENTHERAPY
Immunology and Allergy
Medicine
Pharmacology (medical)
Registries
Netherlands
Aged
80 and over
biology
Incidence
NONSTEROIDAL ANTIINFLAMMATORY DRUGS
Middle Aged
Italy
Rheumatoid arthritis
Cohort
Female
Gastrointestinal Hemorrhage
Double-Blind
DOUBLE-BLINDPREVENTION
medicine.medical_specialty
Immunology
Database
ULCER COMPLICATIONS
Rheumatology
Ulcer Complication
Rheumatic Diseases
Internal medicine
Humans
Upper gastrointestinal
Stomach Ulcer
Medical prescription
Aged
Retrospective Studies
Rheumatoid-Arthriti
Cyclooxygenase 2 Inhibitors
Toxicity
business.industry
Prevention
Proton Pump Inhibitors
Odds ratio
medicine.disease
NONSTEROIDAL ANTIINFLAMMATORY DRUGS
RANDOMIZED CONTROLLED-TRIAL
RHEUMATOID-ARTHRITIS
ULCER COMPLICATIONS
DOUBLE-BLINDPREVENTION
DATABASES
TOXICITY
NAPROXENTHERAPY
United Kingdom
Confidence interval
RHEUMATOID-ARTHRITIS
Surgery
Logistic Models
Case-Control Studies
Randomized Controlled-Trial
biology.protein
Patient Compliance
Cyclooxygenase
Therapy
business
Zdroj: Arthritis & Rheumatism, 64(8), 2792-2802. John Wiley & Sons Ltd.
ISSN: 0004-3591
Popis: Objective Guidelines recommend coprescription of gastroprotective agents (GPAs) in patients receiving cyclooxygenase 2 inhibitors (coxibs) who are at high risk of upper gastrointestinal (UGI) tract complications (i.e., patients with a previous complicated ulcer or with multiple risk factors). Suboptimal GPA adherence has been shown to diminish the gastroprotective effect during use of nonselective nonsteroidal antiinflammatory drugs, but little is known about the effect of GPA adherence during coxib treatment. We undertook this study to determine the association between GPA adherence and UGI tract events among patients receiving coxibs. Methods Using primary care data from 3 databases, we conducted a casecontrol study in a cohort of patients age =50 years who were newly starting treatment with coxibs and concomitantly taking GPAs. Patients who had a UGI tract event (bleeding or symptomatic ulcer) were matched to event-free controls for age, sex, database, and calendar date. Coxib treatment intervals were defined as consecutive coxib prescriptions with intervening gaps not exceeding the duration of the previous coxib prescription. Adherence to GPAs was calculated as the proportion of days of coxib treatment covered by a GPA prescription. Odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated using conditional logistic regression analysis. Results The coxib plus GPAtreated cohort consisted of 14,416 coxib-treated patients who received GPAs for at least 1 day, yielding 16,442 coxib treatment intervals in which a GPA was coprescribed. Most patients were treated with coxibs for 80% adherence to GPAs. For every 10% decrease in GPA adherence, the risk of UGI tract events increased by 9% (OR 1.09 [95% CI 1.001.18]). Conclusion Decreasing GPA adherence among coxib-treated patients is associated with an increased risk of UGI tract events.
Databáze: OpenAIRE
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