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

Abstract

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. The retrospective study was based on the Intercontinental Marketing Services (IMS) Health UK MediPlus database and included subjects > or = 40 yrs of age who received their first oral nsNSAID prescription between July and December 2002 and who had > or = 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. Of 16,344 patients included, 1586 received at least one PPI prescription. Among PPI users, PPIs were available on approximately 50% of the days with nsNSAID therapy. After multivariate adjustment, age > or = 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. 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.