A 2007 Questionnaire-based Survey of Prescription of Non-steroidal Anti-inflammatory Drugs by Physicians in East Asian Countries

Abstract

Purpose: Non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin are widely used clinically but increase the risk of gastrointestinal (GI) complications. Recent evidence concerning NSAIDs and their associated factors might affect physicians' decision about prescription of either NSAIDs or drugs used to prevent GI complications caused by NSAIDs. To examine current prescription of NSAIDs and co-medication to prevent GI complications of NSAIDs within East Asia using a questionnaire survey. Methods: Representative members of the Committee of the IGICS provided a questionnaire to physicians in six East Asian countries including China, Indonesia, Japan, Korea, Philippines, and Thailand between July 2007 and December 2007. Results: A total of 1568 physicians participated in this survey. Most physicians prescribed nonselective NSAIDs, COX-2 inhibitors or aspirin for more than 5 patients per week in all countries, with the exception of prescription of COX-2 inhibitors in Japan. Of the nonselective NSAIDs, the drug most frequently prescribed as a first choice was loxoprofen (34%), which was mainly prescribed in Japan, followed by diclofenac (30%), meloxicam (14%), piroxicam (6%), indomethacin (5%), sulindac (2%), and etodolac (2%). In the six countries, 25% of physicians ‘always’ prescribed co-medication to prevent GI damage when they prescribed a nonselective NSAID. In addition to the physicians ‘often’ prescribing co-medication, more than half of the physicians paid careful attention to the risk of GI damage caused by nonselective NSAIDs. The frequency of prescription of co-medication with nonselective NSAID was higher compared with that for selective COX-2 inhibitors or aspirin. Overall, the most common ‘drug of first choice’ as co-medication was a proton-pump inhibitor (49%) followed by mucoprotective drugs (29%), H2RA (19%), and prostaglandin-derivative drugs (3%). Physicians in the northern region (China, Japan, and Korea) preferred mucoprotective drugs as co-medication with NSAIDs or aspirin, while those in southern region (Indonesia, Philippines, and Thailand) frequently used proton-pump inhibitors. The proportion of physicians who checked H. pylori status was 19%; the majority did not check for this infection. Eighty-nine percent of physicians who checked H. pylori status intended to eradicate this organism. Conclusion: Among the East Asian countries, there are both similarities and differences in the prescription of NSAIDs, and of co-medication to prevent GI complications.