Rheumatology Advance Access originally published online on July 13, 2006
Rheumatology 2007 46(2):265-272; doi:10.1093/rheumatology/kel223
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Hospitalization for gastrointestinal bleeding associated with non-steroidal anti-inflammatory drugs among elderly patients using low-dose aspirin: a retrospective cohort study
1Division of Clinical Epidemiology, McGill University Health Centre, Montreal General Hospital Site, Montreal, QC, Canada, 2Clinical Pharmacology Unit, Faculté de Médecine de Dijon, Dijon, France and 3Division of Gastroenterology, McGill University Health Centre, Montreal General Hospital Site, Montreal, QC, Canada
Correspondence to: Elham Rahme, Division of Clinical Epidemiology, Montreal General Hospital L10-408, 1650 Cedar Ave., Montreal, Quebec H3G 1A4, Canada. E-mail: elham.rahme{at}mcgill.ca
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Abstract |
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Objectives. Many elderly patients are prescribed both low-dose aspirin (ASA), for cardiovascular protection and non-steroidal anti-inflammatory drugs (NSAIDs) for pain control. Compared with non-selective NSAIDs (NS-NSAIDs), celecoxib has a superior gastrointestinal (GI) safety profile in general. It is unclear, however, whether this fact holds good among patients taking ASA.
We compared GI hospitalization rates among elderly patients taking celecoxib, NS-NSAIDs, celecoxib and ASA or NS-NSAIDs and ASA.
Methods. This was a retrospective cohort study using Quebec government databases. All patients 65 yrs of age or older who filled a prescription for celecoxib or an NS-NSAID between April 1999 and December 2002 were included. Cox regression models were used to compare the GI hospitalization rates between the four exposure categories adjusting for potential confounders.
Results. A total of 332 491 patients were included. Among 1 522 307 celecoxib prescriptions, 430 214 were filled by patients concurrently receiving ASA (celecoxib and ASA); 195 369 of 863 646 NS-NSAID prescriptions were filled by patients receiving ASA (NS-NSAID and ASA). Celecoxib without ASA was less likely than NS-NSAID without ASA to be associated with GI hospitalization [hazard ratio (HR) 0.41, 95% confidence interval (CI) 0.33–0.50]; celecoxib and ASA was also less likely to be associated with GI hospitalization than NS-NSAID and ASA (HR 0.62, 95% CI 0.48–0.80); GI hospitalization rates were similar for celecoxib and ASA and NS-NSAID without ASA (HR 1.01, 95% CI 0.81–1.25).
Conclusion. Among elderly patients receiving cardiovascular protection with ASA and pain control with anti-inflammatory drugs, celecoxib may be safer with regards to GI toxicity than NS-NSAIDs.
KEY WORDS: Cox-2 inhibitors, NSAIDs, Aspirin, Gastrointestinal bleeding, Administrative databases, Elderly
Submitted 24 November 2005;
revised version accepted 23 May 2006.
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