Adherence to gastroprotection and the risk of NSAID-related upper gastrointestinal ulcers and haemorrhage

作者：Van Soest E M^*; Sturkenboom M C J M; Dieleman J P; Verhamme K M C; Siersema P D; Kuipers E J

来源：Alimentary Pharmacology and Therapeutics, 2007, 26(2): 265-275.

DOI：10.1111/j.1365-2036.2007.03358.x

Background Upper gastrointestinal (UGI) complications are a well-recognized risk of NSAID treatment, requiring preventive measures in high-risk patients. Adherence to gastroprotective agents (GPAs) in NSAID users has been suggested to be suboptimal.
Aim To investigate the association between adherence to GPAs ( proton pump inhibitors or H-2-receptor antagonists) and the risk of NSAID-related UGI ulcers or haemorrhage in high-risk patients.
Methods A population-based nested case-control study was conducted within a cohort of new NSAID users with at least one risk factor for a NSAID-related UGI complication, identified in the Dutch IPCI database during 1996-2005. Adherence to GPAs was calculated as the proportion of NSAID treatment days covered (PDC) by a GPA prescription. Multivariate conditional logistic regression analysis was used to calculate odds ratios with 95% confidence intervals ( 95% CI).
Results Fifteen percent of the non-selective NSAID users received GPAs. The risk of a NSAID-related UGI complication among NSAID users increased 16% for every 10% decrease in adherence. Compared to patients with a PDC of > 80%, patients with PDCs of 20-80% and < 20% had a 2.5- fold (95% CI: 1.0-6.7) respectively 4.0-fold (95% CI: 1.2-13.0) increased risk.
Conclusion There is a strong inverse relationship between adherence to GPAs and the risk of UGI complications in high-risk NSAID users.

• 出版日期2007-7-15