Among patients who continuously take nonsteroidal anti-inflammatory drugs (NSAIDs), a third of co-prescriptions for drugs to prevent gastrointestinal (GI) damage are not renewed within the next 2 years. This discontinuation increases patients’ risk of stomach pain, inflammation, or ulcers, according to the May issue of Clinical Gastroenterology and Hepatology.
Patients with risk factors for GI disorders who continuously take NSAIDs (such as diclofenac, ketoprofen, piroxicam, and naproxen) should also take gastroprotective agents, such as a proton pump inhibitor (PPI), according to current guidelines.
However, it is not clear how many physicians continue to prescribe gastroprotective drugs to their patients, or whether stopping the prescription increases GI complications.
Isabelle Le Ray et al. assessed prescription data from 1856 patients in France who were at risk for GI events and had received prescriptions for an NSAID and PPI, from 2007 to 2009.
They found that about 78% of patients were still being prescribed a PPI along with an NSAID after 1 year, but only about 68% were still being co-prescribed the PPI after 2 years (see below figure).
The risk for upper GI injury (gastralgia, gastritis, ulcer) increased by almost 50% among patients that stopped receiving the PPI co-prescription. This finding was consistent with a recent study reporting higher rates of GI adverse events and shorter NSAID treatment among patients who were noncompliant with their PPI therapy.
The patients most likely to no longer receive a prescription for a PPI were those who had switched to a cyclooxygenase (COX)-2–selective inhibitor or nonselective NSAID. This is a concern, because international guidelines recommend co-prescription of a PPI with a COX-2 inhibitor for patients at high risk for GI complications. Women were also more likely to stop receiving a PPI prescription.
Half that patients that stopped receiving a prescription for PPI received it again within 6 months, indicating that the change was unintentional. It could be that these patients reported dyspepsia or another symptoms, such as gastroesophageal reflux, to their doctors.
In an editorial that accompanies the article, Angel Lanas says that failure to renew prescriptions for gastroprotective agents is an important factor to consider in planning strategies to reduce the GI damage induced by NSAIDs.
Le Ray et al. conclude that the increased frequency of GI adverse events among patients without appropriate PPI coverage indicates the need to optimize the PPI prescription procedure. One way that under-prescription might be avoided would be to create a combination pill, which contains an NSAID and a PPI.
Read the article online.
Le Ray I, Barkun AN, Vauzelle–Kervroëdan F, et al. Failure to renew prescriptions for gastroprotective agents to patients on continuous nonsteroidal anti-inflammatory drugs increases rate of upper gastrointestinal injury. Clin Gastroenterol Hepatol 2013;11:499–504.e1.
Read the accompanying editorial.
Lanas A. Compliance with prescriptions of appropriate therapy for NSAID users: is the glass half empty or half full? Clin Gastroenterol Hepatol 2013;11:505–506.