Gastroprotection among new chronic users of non-steroidal anti-inflammatory drugs: a study of utilization and adherence in the Netherlands^*

ABSTRACT

Objective: To describe the use of gastroprotection (GP) among new chronic users of NSAIDs in the Netherlands by gastrointestinal (GI) risk factor (RF) score.

Methods: Data for this retrospective follow-up study were extracted from the PHARMO database. We selected new chronic users of COX-2 inhibitors (coxibs) or traditional NSAIDs (tNSAIDs) between 1st January 2000 and 31st December 2004. GP strategies were defined as: use of proton pump inhibitors (PPI), coxibs or both. GI RF score at index date was based on: history of GI drug use, high dose of NSAIDs, age > 60 years, use of corticosteroids/anticoagulants/SSRIs, rheumatoid arthritis, heart failure or diabetes, with each condition accounting for one factor. Switching was assessed among those with ≥ 1 GI RF during the first year of follow-up.

Results: Among 58 770 new chronic NSAID users at index date, 80% used tNSAIDs alone, 8% used tNSAID + PPI, 10% used a coxib alone and 2% used coxib + PPI. Mean (SD) number of GI RF among these groups was 1.6 (2.1), 3.1 (1.3), 1.5 (1.5) and 2.8 (1.3), respectively. Among 48 390 patients (82.3%) with a GI RF score of ≥ 1, 20.9% used a GP strategy, this increased with number of GI RFs. Within the first year, 5.3% (n = 2067) and 4.8%(n = 1 843) of tNSAID users with ≥ 1 GI RF switched to tNSAID+PPI and coxib alone, respectively.

Conclusions: Gastroprotection in users of tNSAIDs was inadequate. Over 80% of NSAID users with ≥ 1 GI RF did not receive any gastroprotection, and even when prescribed, a PPI is used only half the time. More research should show if gastroprotection was used for prevention.

Key words: :

• Adherence
• Cyclo-oxygenase-2 inhibitors
• Drug utilization
• Gastrointestinal
• Non-steroidal anti-inflammatory drugs
• Pharmacy database

Acknowledgements

Declaration of interest: This study was financially supported by an unrestricted grant from Merck & Co., Inc., Whitehouse Station, NJ, USA. No financial limitations were set with regards to the conduct of the study and the writing of the manuscript. M. W. vd L., M. P. P. v H-S. and R. M. C. H. are employees of the PHARMO Institute for Drug Outcomes Research. This research institute performs financially supported studies for several pharmaceutical companies. S. G. is employee of Merck & Co., Inc. E. J. K. and B. J. F. vd B. have no conflicts of interest to declare with respect to the contents of this article.

The authors thank H. M. P. M. Straatman (statistician at the PHARMO Institute for Drug Outcomes Research) for statistical advice.

Notes

* Previously presented as a Poster at the 15th United European Gastroenterology Week (UEGW), Oct 27–31, 2007, Paris, France, and at the 13th International Society for Pharmacoeconomics and Outcomes Research (ISPOR) annual meeting, May 3–7, 2008, Toronto, Canada