Background Non-steroid anti-inflammatory drugs (NSAIDs) are used as pain relievers and anti-inflammatory treatment for patients with osteoarthritis (OA), rheumatoid arthritis (RA) and ankylosing spondylitis (AS). NSAID treatment may however cause an increased risk of dyspeptic symptoms and serious gastrointestinal (GI) complications, such as peptic ulcers and bleedings. Co-prescribed therapy with a gastro protective agent, such as a proton pump inhibitor (PPI), decreases the risk for dyspeptic symptoms and serious upper GI complications. Current guidelines recommend NSAID treatment to be co-prescribed with a PPI for patients with an increased risk of GI complications. An important challenge in clinical practice is patient adherence to prescribed therapy. Knowledge on actual real life patient adherence of co-prescribed PPI medication to NSAID treatment in patients with OA, RA and AS is lacking.
Objectives To assess patient reported adherence to co-prescribed PPI treatment on actual NSAID treatment days for patients with OA, RA or AS.
Methods Patients with OA, RA or AS were identified in medical records and could be included in this multicentre, retrospective non-interventional study (NCT01519375). The patients had to have current prescriptions of oral NSAID treatment and PPI for prevention of NSAID associated upper GI ulcers. Patients needed to have an instruction of PPI use on the same day as NSAID intake. Adherence was assessed for the past 7 days by a patient reported questionnaire. Only patients taking NSAIDs on at least 3 of the reported days could be included in the analyses.
Results A total of 180 patients received a questionnaire; 134 completed and submitted it. A total of 96 patients (69% females, mean age 67 years) fulfilled all inclusion criteria. Of these, 72% had a diagnosis of OA, 16% RA and 12% AS. In all, 39% had a medical record history of dyspepsia and 22% a history of GERD. The three most common NSAIDs were diclofenac (34%), naproxen (24%) and ketoprofen (20%). Most common PPI was omeprazole, prescribed to 94% of the patients. Mean patient reported adherence of co-prescribed PPI when taking NSAID was between 73% and 81%. The proportion of patients with a patient reported adherence ≤80% was 26%. Adherence differences between high and low dose, type of NSAID drug, gender and disease were tested but no significant differences were detected. It was not possible to define patient characteristics predicting low adherence to co-prescribed PPI-treatment.
Conclusions The adherence level in this population of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis patients with instructions of concomitant PPI use to NSAID intake was still not optimal. More can be done in order to increase patient adherence to PPI, when used as prevention of NSAID associated upper GI ulcers.
Study sponsored by AstraZeneca
Disclosure of Interest K. Henriksson Consultant for: Lecture Fees from Astra Zeneca and Abbott Scandinavia, L. Jörgensen Employee of: Astra Zeneca, J. From Employee of: Astra Zeneca, G. Stratelis Employee of: Astra Zeneca