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Rheumatology Advance Access originally published online on November 22, 2005
Rheumatology 2006 45(4):493; doi:10.1093/rheumatology/kei236
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

LETTER TO THE EDITOR

Under-representation of the oldest people in NSAID therapy trials

M. Davidovic

Geriatric Clinic, KBC Zvezdara, 11050 Beograd, Rifata Burdzevica 31, Serbia and Montenegro

Correspondence to: davidovi{at}EUnet.yu

SIR, I read with interest the report by Thompson et al. [1] examining the long-term use of NSAIDs in primary care. Generally, the number of patients hospitalized due to peptic ulcer disease has decreased, but the number of hospitalizations due to bleeding or perforation has increased especially in older women, probably due to increased NSAID consumption. The same applies to mortality [2]. It is possible that the elderly are more sensitive to NSAIDs, because bleeding occurs seven times more frequently in them than in younger users of NSAIDs [3]. The risk of upper gastrointestinal bleeding in elderly patients is significantly higher with acute use of NSAIDs compared with chronic use.

One of the problems is the under-representation of the oldest people in most trials. On average, the age of the group of elderly people in research studies is no greater than 60 yr. The oldest group is usually from one cohort [4, 5]. This is especially important regarding investigations of the use and side-effects of NSAIDs [6].
Figure 1

The authors have declared no conflicts of interest.

References

  1. Thompson PW, Tee L, McBride J, Quincey D, Strat Liddiard G. Long-term NSAID use in primary care: changes over a decade and NICE risk factors for gastrointestinal adverse events. Rheumatology 2005;44:1308–10.[Abstract/Free Full Text]
  2. Davidovic M, Svorcan P, Milanovic P, Antovic A, Milosevic PD. Specifics of helicobacter pylori infection in the elderly. Rom J Gastroenterol 2005;14:253–8.[Medline]
  3. Roth SH. From peptic ulcer disease to NSAID gastropathy. An evolving nosology. Drugs Aging 1995;6: 358–67.[Medline]
  4. Soumerai SB, McLaughlin, Ross-Degnan D, Christiansen CL, Gurwitz JH. Effectiveness of thrombolytic therapy for acute myocardial infarction in the elderly: cause for concern in the old-old. Arch Intern Med 2002;161:561–8.[Free Full Text]
  5. Davidovic M, Erceg P, Trailov D, Djurica S, Milosevic D, Stevic R. The privilege to be old. Gerontology 2003;49:335–9.[Medline]
  6. Bartlett C, Doyal L, Ebrahim S et al. The causes and effects of socio-demographic exclusions from clinical trials. Health Technol Assess 2005;9:1–168.[Medline]
Accepted 28 October 2005


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This Article
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