The clinical impact of nonadherence to gastroprotective agents coprescribed with anti-inflammatory therapies has not been evaluated.
Dr Jay Goldstein and colleagues from Illinois retrospectively characterized the use of gastroprotective agents in a large, commercial, managed-care database.
The researchers assessed patients receiving nonselective nonsteroidal anti-inflammatory drugs or cyclooxygenase-2-selective inhibitors.
The research team determined the impact of nonadherence on the likelihood of gastroduodenal ulcer complications.
|68% had adherence rates of 80% or more|
|Clinical Gastroenterology & Hepatology|
The team identified the populations of patients with concomitant histamine-2 receptor antagonist or proton pump inhibitor (PPI) therapy.
The researchers determined adherence with the prescribed therapy with respect to the duration of anti-inflammatory treatment.
Multivariate regression analyses modeled the association between adherence with concomitant protective therapy.
The team also evaluated the likelihood of upper gastrointestinal complications including peptic ulcer disease, ulcer, and/or upper-gastrointestinal bleed.
Among 144,203 patients newly prescribed anti-inflammatory therapies, 2% received concomitant gastroprotective agents treatment.
The likelihood of gastroprotective agents use increased with the presence of risk factors such as age older than 65 years, and prior history of peptic ulcer disease.
Esophagitis or gastroesophageal reflux, ulcer and upper-gastrointestinal bleed, or gastritis also increased the use of gastroprotective agents.
Of patients receiving concomitant PPI therapy, 68% had adherence rates of 80% or more.
The team observed a significantly higher risk of upper-gastrointestinal ulcers or complications with nonselective nonsteroidal anti-inflammatory drugs.
The adherence rates of these patients were less than 80%.
However, the team observed no such relationship among patients who took coxibs.
Dr Goldstein's team concludes, “Few patients receive concomitant gastroprotective agents therapy when prescribed anti-inflammatory treatment, although use increased with the presence of risk factors.”
“Adherence to concomitant therapy is paramount to reducing gastrointestinal events among nonselective nonsteroidal anti-inflammatory drugs users.”
“Educational efforts should be undertaken to promote use of and adherence to gastroprotective agents therapy among these patients.”