Background Beside life-threatening gastrointestinal (GI) adverse events (e.g. perforation, ulcer or bleeding), non-steroidal anti-inflammatory drug (NSAID) use is associated with less severe GI symptoms, which may result in the concurrent use of GI protective agents (GPAs) and/or antacids and therefore increased medical costs.
Objectives Analyse the patterns of use of GI protective agents among NSAID users.
Methods During ten days of consultation, 913 NSAID users were identified among 20,668 patients seen by 103 general practitioners in the Sicily region of Italy from December 1998 to June 1999. Physicians filled out data collection forms regarding the type and indication of NSAIDs and the use of adjuvant therapy to prevent or treat adverse GI effects of NSAID therapy during the past 6 months.
Results The mean age of the patients was 61 years and 61% were females. Indications for NSAID therapy included osteoarthritis/arthrosis in 61% of the patients, rheumatoid arthritis in 9%, and other reasons, most notably non-articular pain in 28%. Based on the number of prescriptions (Rx) and the number of patients (pts), the most frequently prescribed NSAID was nimesulide (24% Rx, 37% pts), followed by diclofenac (24% Rx, 32% pts), piroxicam (17% Rx, 24% pts), and ketoprofen (9% Rx, 12% pts) accounting for 75% of all NSAID prescriptions. The mean duration of all NSAID therapy varied between 60 to 120 days depending on the specific NSAIDs used by the patients during the 6 months prior to the visit. Of all NSAID users, 50.3% used a GI medication, including GPAs [including proton pump inhibitors (PPI), H2-antagonists, and misoprostol] and antacids (Rx or OTC). Although certain variations existed, the use of GPAs and antacids was consistent across all NSAIDs including those newer products such as ArthrotecÒ and meloxicam. Concomitant use of H2-antagonists occurred in 14% of all NSAID users, PPI in 8%, misoprostol in 15%, and antacids in 22%. The mean duration of GPA use varied between 73 to 96 days during the 6-month period. About 40% of H2 antagonists, 21% PPI, 86% misoprostol, and 62% antacids were prescribed to prevent NSAID adverse events and the remaining were for treatment.
Conclusion Concurrent use of gastroprotective agents and antacids was observed in more than half of the patients taking NSAIDs, and their use was consistent across individual products. The concomitant use of GPAs and/or antacids with NSAIDs does not only incur inconvenience to the patients because of polypharmacy but also increase healthcare costs.
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