Reference | Study design | Population | Main outcomes | Main results |
---|---|---|---|---|
Adherence and appropriateness of gastroprotection prescribing | ||||
Sturkenboom et al. Aliment Pharm Ther 2003 18: 1137–1147 Holland [36] | Retrospective cohort study using primary care database between 1997 and 2003 | Patients aged ≥18 years with 12 months data in database (382,000 patients; 80,000 users of NSAIDs) | Adherence to gastroprotective agents | Of 65,190 patients taking NSAIDs, 784 had PPI or H2A, in about equal numbers. Patients prescribed gastroprotection were significantly older, had more risk factors, and had more cardiovascular disease 85% of H2A prescriptions were below recommended dose 31% of patients receiving PPI were non-adherent intially, but only about 40% took PPI long term |
Appropriateness of gastroprotection prescribing | ||||
Smalley et al. Arthritis Rheum 2002 46: 2195–2200 USA [37] | Retrospective cohort study using Medicaid database during 1999–2000 | Patients aged ≥ 50 years, with 12 months data, filled one NSAID prescription (319,000, of whom 107,000 received at least one NSAID prescription) | Frequency of use of gastroprotective measures according to NSAID use and risk factors | Recommended gastroprotection in 9% of patients with one risk factor, 11% of those with two risk factors. Most patients had no gastroprotection, whilst about 25% had inadequate gastroprotection. No information about adherence |
Pilotto et al. Drugs Aging 2003 20:701–710 Italy [38] | Prospective study of drug use by patients aged ≥ 65 years. 3,200 patients of 63 randomly chosen general practitioners, in 1999 | Patients aged ≥ 65 years Of 3,200 patients, 800 prescribed NSAID | Use of prescribed medicines | NSAID and high-dose aspirin prescribed for 25% of patients Use of GI protective drugs was 24% of NSAID users with at least one risk factor by virtue of age, slightly higher than for non users of NSAIDs No information about adherence |
Sturkenboom et al. Rheumatology 2003 42 (Suppl 3):iii23–iii31 Holland [39] | Retrospective cohort study using primary care database between 1997 and 2002 | Patients aged ≥18 years with 12 months data in database (382,000 patients; 80,000 users of NSAIDs) | Prevalence of prophylactic gastro-protective strategies, and association with risk factors | In patients with at least one risk factor, 87% had no gastroprotective strategy Proportion with no gastroprotection reduced over time No information about adherence |
Hartnell et al, Am J Geriatr Pharmacother 2004 2: 171–180 Canada [40] | Retrospective cross-sectional study of pharmacy database for older people, 2001–2002 | Patients aged ≥ 65 years with 12 months data who filled prescription for NSAID, coxib, or high-dose aspirin (14,600 older patients using NSAID or coxib) | Use of gastroprotective strategies | Of 11,000 NSAID users, 14% received gastroprotection Of 3,600 coxib users, 5% received gastroprotection Gastroprotection not used in 65% NSAID alone used in 67% of patients with only age as a risk factor, falling to 63% with one additional, and 52% with two additional risk factors No information about adherence |
Dominick et al. Ann Pharmacother 2004 38: 1159–1164 USA [41] | Retrospective cohort study of sample of 4,338 veterans with GI bleeding in 1999 | Patients had ICD code for GI ulceration or bleeding. Veterans were predominantly male, 50% aged 65 years or older | Use of gastroprotective strategies and prescribing NSAIDs in six months following event | 1% prescribed coxib 20% prescribed NSAID; of these 75% prescribed gastroprotection, 25% no gastroprotection No information about adherence |
Herings & Goettsch. Ann Pharmacother 2004 38: 760–763 Holland [42] | Nested case control analysis of database (1 million people; 10,000 patients included), 2000 to 2001 | Patients had to have at least two prescriptions for NSAID, with total duration > 100 days | Adequate gastroprotection (> 400 μg misoprostol; ≥ 2 times recommended dose of H2A; ≥ 1 times recommended dose of PPI) | One or more gastroprotective strategies used in 43% of NSAID users. Of these 65% were adequate, and 35% inadequate Use of gastroprotection was linked to having 2 or more risk factors, history of ulcers, and older age 25% of NSAID users were also taking anticoagulants, corticosteroids, or low dose aspirin No information about adherence |
Sebaldt et al. Am J Manag Care 2004 10:742–750 Canada [43] | Cross-sectional study of 5,459 patients of 119 physicians | Primary care physicians with hgih volume NSAID prescribing practices. OA patients had to be prescribed an NSAID | Adherence to appropriate prescribing of coxibs and NSAIDs, with or without gastroprotection | In patients with no GI risk factors (39% of total), 33% of prescribing was appropriate In patients with at least one GI risk factor (61% of total), 74% of prescribing was appropriate More use of coxibs with prior bleed, more severe pain, or with concomitant warfarin |
Abraham et al. Gastroenterol 2005 129: 1171–1178 USA [44] | Cross-sectional study of database, linked to other files (707,000 NSAID users, 303,000 high risk patients), 2002 | Various definitions of high gastrointestinal risk, including age ≥ 65 years | Adherence to gastroprotection guidelines | 43% of NSAID users were at high risk of GI complications 73% of these not prescribed gastroprotection 27% of these prescribed gastroprotection (18% NSAID plus PPI, 9% coxib) Greater gastroprotection use with two or more risk factors Predictors of gastroprotection were previous upper gastrointestinal event, anticoagulant use, aspirin use, rheumatological disease |
Thompson et al. Rheumatology 2005 44:1308–1310 UK [45] | Cross-sectional survey of primary care practice 7,598 patients in practice in total | 267 patients receiving repeat prescriptions for coxib or NSAID 204 NSAID 63 coxib | Prescribing according to NICE guidance | 69% NSAID users had one or more GI risk factors; antacids prescribed in 24% of those with a risk factor 74% coxib users had one or more GI risk factors; antacids prescribed in 6% of those with a risk factor |
Price-Forbes et al. Rheumatology 2005 44:921–924 UK [46] | Questionnaire survey of all patients attending clinics in 18 rheumatology units over 2 weeks | 2,846 patients, of whom 791 were taking NSAIDs and 373 coxibs. 65% of users had diagnosis of OA or RA | Prescribing according to GI risk factors | Of NSAID users, 92% had at least one GI risk factor (mostly prolonged use, and age ≥ 65 years); only 8% received appropriate treatment. Gastroprotective drug prescribed for 191 patients (24%), of which 56% were PPI Of coxib users, 97% of prescribing was appropriate, with 77 (21%) taking gastroprotective drug |
Pilotto et al. Aliment Pharmacol Ther 2005 22: 147–155 Italy [[47] | Prospective study of drug use by patients aged ≥ 65 years. 5,500 patients of 133 general practitioners, in 2003 | Patients aged ≥ 65 years | Use of prescribed NSAIDs, and GI symptoms | NSAID use in 6% Coxib use in 3% New prescriptions for drugs for acid-related disorders in 13% of NSAID users, 6% of coxib users No information on adherence |
General information about gastroprotection prescribing | ||||
Schnitzer et al. Clin Ther 2001 23: 1984–1998 USA [48] | Retrospective analysis of prescription database for 1998. 3 million new users of NSAIDs | At least one NSAID prescription during 1998, and no use in prior 120 days (< 30 days acute; > 30 days chronic); 34% of chronic users 60 years or older | Use of gastroprotective medicines, by NSAID | In 1.4 million chronic users, the mean prescription was for 67 days supply. Gastroprotection was prescribed for 14%, covering 22% of NSAID days No information about risk factors or adherence |
Teeling et al. Br J Clin Pharmacol 2004 57: 337–343 Ireland [49] | Retrospective analysis of prescription database, 2000–2001 (1.2 million people). About 25,000 NSAID/coxib users | Patients aged 16 years or older prescribed an NSAID | Use of gastroprotective medicines, by NSAID | No gastroprotection in about 80%. PPI used in about 15%. Use of PPI higher with coxibs than with non-selective NSAIDs. Coxibs much more likely to be prescribed in over 65s. No information about risk factors or adherence |
Pilotto et al. Aliment Pharmacol Ther 2005 22: 147–155 Italy [47] | Prospective study of drug use by patients aged ≥ 65 years. 5,500 patients of 133 general practitioners, in 2003 | Patients aged ≥ 65 years | Use of prescribed NSAIDS, and GI symptoms | Non-selective NSAID use in 6% Coxibs use in 3% New prescriptions of drugs for acid-related disorders in 13% of NSAID users, 6% of coxib users No information about adherence |