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Multicenter Study
. 2011 Apr 14:9:38.
doi: 10.1186/1741-7015-9-38.

Prescription patterns and appropriateness of NSAID therapy according to gastrointestinal risk and cardiovascular history in patients with diagnoses of osteoarthritis

Angel Lanas  1 , Guillermo Garcia-Tell, Beatriz Armada, Angel Oteo-Alvaro
Affiliations
Multicenter Study

Prescription patterns and appropriateness of NSAID therapy according to gastrointestinal risk and cardiovascular history in patients with diagnoses of osteoarthritis

Angel Lanas et al. BMC Med. .

Abstract

Background: Prescription of non-steroidal anti-inflammatory drugs (NSAIDs) should be based on the assessment of both gastrointestinal (GI) and cardiovascular (CV) risk for the individual patient. We aimed to assess the GI/CV risk profile and the pharmacological management of patients with osteoarthritis (OA) in clinical practice.

Methods: We conducted a cross-sectional, multicentre, observational study of consecutive OA patients that visited 1,760 doctors throughout the Spanish National Health System (NHS) in a single day. The presence of GI risk factors, CV histories, hypertension and current pharmacological treatments was recorded.

Results: Of the 60,868 patients, 17,105 had a diagnosis of OA and were evaluable. The majority (93.4%) had more than one GI risk factor and 60.3% were defined to be at high-GI risk. Thirty-two percent had a history of CV events, 57.6% were treated with anti-hypertensive therapy and 22.6% had uncontrolled hypertension. One-fifth of patients were treated with non-NSAID therapies, whereas the remaining patients received NSAIDs. Non-selective NSAIDs (nsNSAID) plus proton pump inhibitor (PPI) or cyclooxigenase-2 (COX-2)-selective NSAIDs alone were more frequently prescribed in patients at increased GI risk. Patients with a positive CV history received nsNSAIDs or COX-2-selective NSAIDs in 41.3% and 31.7% of cases, respectively. When both the GI and CV histories were combined, 51% of the overall population was being prescribed drugs that were either not recommended or contraindicated.

Conclusions: Over 90% of patients with OA are at increased GI and/or CV risk. In over half of these patients, the prescription of NSAIDs was not in accordance with current guidelines or recommendations made by regulatory agencies.

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Figures

Figure 1
Figure 1
GI risk factors in the study population (N = 17,105). Percentage of patients with each GI risk factor.
Figure 2
Figure 2
Number of GI risk factors by number of patients (N = 17,105).
Figure 3
Figure 3
Gastrointestinal risk and CV history in the OA study population.
See this image and copyright information in PMC

References

    1. Pendleton A, Arden N, Dougados M, Doherty M, Bannwarth B, Bijlsma JW, Cluzeau F, Cooper C, Dieppe PA, Günther KP, Hauselmann HJ, Herrero-Beaumont G, Kaklamanis PM, Leeb B, Lequesne M, Lohmander S, Mazieres B, Mola EM, Pavelka K, Serni U, Swoboda B, Verbruggen AA, Weseloh G, Zimmermann-Gorska. EULAR recommendations for the management of knee osteoarthritis: report of a task force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT) Ann Rheum Dis. 2000;9:936–944. doi: 10.1136/ard.59.12.936. - DOI - PMC - PubMed
    1. Schnitzer TJ. Update of ACR guidelines for osteoarthritis: role of the coxibs. J Pain Symptom Manage. 2002;23:S24–30. doi: 10.1016/S0885-3924(02)00372-X. discussion: S31-34. - DOI - PubMed
    1. Lanas A. Prevention and treatment of NSAID-induced gastroduodenal injury. Curr Treat Options Gastroenterol. 2006;9:147–156. doi: 10.1007/s11938-006-0033-4. - DOI - PubMed
    1. Rostom A, Muir K, Dubé C, Jolicoeur E, Boucher M, Joyce J, Tugwell P, Wells GW. Gastrointestinal safety of cyclooxygenase-2 inhibitors: a Cochrane Collaboration systematic review. Clin Gastroenterol Hepatol. 2007;5:818–828. doi: 10.1016/j.cgh.2007.03.011. - DOI - PubMed
    1. Kearney PM, Baigent C, Godwin J, Halls H, Emberson JR, Patrono C. Do selective cyclo-oxygenase-2 inhibitors and traditional non-steroidal anti-infl ammatory drugs increase the risk of atherothrombosis? Meta-analysis of randomised trials. BMJ. 2006;332:1302–1308. doi: 10.1136/bmj.332.7553.1302. - DOI - PMC - PubMed

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