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Rheumatology Advance Access published online on February 7, 2008
Rheumatology, doi:10.1093/rheumatology/kem375
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© 2008 The Author(s)
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Co-prescribing of proton pump inhibitors among chronic users of NSAIDs in the UK

D.-C. Suh1, E. H. Dipl rer pol2, H.-C. Shin1 and P. Mavros2

1School of Pharmacy, Rutgers University, Piscataway and 2Outcomes Research, Merck & Co., Inc., Whitehouse Station, NJ, USA.

Correspondence to: P. Mavros, Outcomes Research, Merck & Co., Inc., One Merck Drive, WS2E-76, Whitehouse Station, NJ 08889, USA. E-mail: panagiotis_mavros{at}merck.com.


  Abstract

Objectives. Co-prescribing of proton pump inhibitors (PPIs) with non-selective NSAIDs (nsNSAIDs) is recommended in patients at risk of gastrointestinal (GI) events. This study estimated usage of PPI co-therapy among chronic nsNSAID users and determined factors associated with concurrent nsNSAID–PPI use.

Methods. The retrospective study was based on the Intercontinental Marketing Services (IMS) Health UK MediPlus® database and included subjects ≥40 yrs of age who received their first oral nsNSAID prescription between July and December 2002 and who had ≥60 days of nsNSAID supply during the following year. Days with nsNSAID–PPI overlap were calculated and logistic regression was used to identify factors associated with nsNSAID–PPI overlap. A generalized linear model was used to assess the degree of association of GI risk factors with the nsNSAID–PPI overlap ratio among PPI users.

Results. Of 16 344 patients included, 1586 received at least one PPI prescription. Among PPI users, PPIs were available on ~50% of the days with nsNSAID therapy. After multivariate adjustment, age ≥65 yrs, history of any hospitalization and co-prescriptions for anti-coagulants or oral corticosteroids increased the odds of any nsNSAID–PPI overlap by 21–68%. Prior gastroprotective agent (GPA) use increased the odds of any PPI use during follow-up 16-fold and nsNSAID–PPI overlap 19-fold. Among PPI users, patients with prior use of any GPA had a 2.46 times higher nsNSAID–PPI overlap ratio.

Conclusions. PPI utilization correlates poorly with nsNSAID use in the UK. GI safety of nsNSAID–PPI co-therapy observed in controlled trials may therefore not be achieved in clinical practice.

KEY WORDS: NSAIDs, PPIs, Retrospective observational study, Drug utilization

Submitted 5 May 2006; revised version accepted 12 December 2007.
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