| アブストラクト | BACKGROUND: Gastro-protective agents (GPA) are co-prescribed with non-steroidal anti-inflammatory drugs (NSAID) to lower the risk of upper gastrointestinal (UGI) events. It is unknown to what extent the protective effect is influenced by therapy adherence. AIM: To study the association between GPA adherence and UGI events among non-selective (ns) NSAID users. METHODS: The General Practice Research Database (UK 1998-2008), the Integrated Primary Care Information database (the Netherlands 1996-2007) and the Health Search/CSD Longitudinal Patient Database (Italy 2000-2007) were used. A nested case-control design was employed within a cohort of nsNSAID users aged >/=50 years, who also used a GPA. UGI event cases (UGI bleeding and/or symptomatic ulcer with/without obstruction/perforation) were matched to event-free members of the cohort for age, sex, database and calendar time. Adherence to GPA was calculated as the proportion of nsNSAID treatment days covered by a GPA prescription. Adjusted OR with 95% CI were calculated. RESULTS: The cohort consisted of 618 684 NSAID users, generating 1 107 266 nsNSAID episodes. Of these, 117 307 (10.6%) were (partly) covered by GPA, 4.9% of which with a GPA coverage <20% (non-adherence), and 68.1% with a GPA coverage >80% (full adherence). 339 patients experienced an event. Among non-adherers, the OR was 2.39 (95% CI 1.66 to 3.44) for all UGI events and 1.89 (95% CI 1.09 to 3.28) for UGI bleeding alone, compared to full adherers. CONCLUSIONS: The risk of UGI events was significantly higher in nsNSAID users with GPA non-adherence. This underlines the importance of strategies to improve GPA adherence. |
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| ジャーナル名 | Gut |
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| 投稿日 | 2011/6/4 |
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| 投稿者 | van Soest, Eva M; Valkhoff, Vera E; Mazzaglia, Giampiero; Schade, Rene; Molokhia, Mariam; Goldstein, Jay L; Hernandez-Diaz, Sonia; Trifiro, Gianluca; Dieleman, Jeanne P; Kuipers, Ernst J; Sturkenboom, Miriam C J M |
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| 組織名 | Department of Medical Informatics, Erasmus University Medical Center, Rotterdam,;The Netherlands. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/21636644/ |
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