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Adherence to concomitant PPI therapy in NSAID users influences upper GI complications

A study in the latest issue of the European Journal of Gastroenterology & Hepatology investigates the association between adherence to concomitant PPI therapy in current NSAID users, and upper gastrointestinal complications.

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Proton pump inhibitors play a well-documented role as a gastroprotective agent among NSAID users at an increased risk of peptic ulcer and bleeding.

Observational studies have, however, suggested that the clinical efficacy of Proton pump inhibitors therapy may be reduced because of poor adherence.

Dr Christian Jonasson and colleagues studied the association between adherence to concomitant Proton pump inhibitors in current NSAID users, and the risk of peptic ulcer and bleeding.

The team performed a case–control study linking nationwide data from the Swedish Patient Registry with the Swedish Drug Prescription Database.

The research team assessed that the study population included patients admitted for a first-time peptic ulcer or bleeding, and who were incident users of NSAID.

Each case was matched on age, sex, NSAID duration, and calendar month with 5 controls.

The risk of an event increased with 6% points for every 10% decrease in PPI adherence
European Journal of Gastroenterology & Hepatology

The team of doctors reported that PPI adherence was calculated as the proportion of NSAID days being covered by PPI therapy.

Matched and adjusted odds ratios with 95% confidence intervals were calculated using conditional logistic regression.

A total of 3649 cases were identified.

The researchers noted that patients with poor adherence had a significantly increased risk of upper gastrointestinal complications compared with fully adherent patients.

As a continuous variable, the risk of an event increased with 6% points for every 10% decrease in PPI adherence.

Dr Jonasson's team concluded, "The gastroprotective effect of PPIs in NSAID users is highly dependent on adherence, with about twice the risk in patients with poor adherence."

"Efforts to increase adherence should be an integrated part of clinical practice."

Eur J Gastroenterol Hepatol 2013: 25(5): 531-538
16 April 2013

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