Factors Associated with Gastroprotective Agent Use and Adherence among Adults with Arthritis Taking NSAIDs in the United States

Abstract

Purpose: To examine factors associated with gastroprotective agent (GPA) use and adherence among adults with arthritis taking NSAIDs. Methods: A Web-based community panel of US men and women age ≥40 with self-reported arthritis was invited via e-mail to participate in a Web survey. Interested panelists consented and completed the screening questions. Respondents who reported NSAID use in the last 30 days were eligible to continue the survey. NSAID and GPA use were asked, as were questions about comorbid conditions, gastrointestinal (GI) history, and other risk factors. Logistic regressions were performed to assess the associations of predictor variables with GPA use and adherence. Results: Invitations were sent to 7,605 adults with arthritis; 4,108 (54%) responded; 2,208 completed. The final sample consisted of 2,000 participants: 1,525 (76%) with osteoarthritis, 354 (18%) with rheumatoid arthritis and 121 (6%) with both. Mean age was 62.0 years; 64% were female; 83% were white; 25% worked full-time and 39% were retired. Mean duration with arthritis was 13.0 years; 47% and 19% experienced arthritis symptoms “daily” and “almost always”, respectively. The most frequently-used NSAIDs were ibuprofen (54%), aspirin (35%) and naproxen (33%). GPA use was more frequent among higher frequency NSAID users; 36% of single NSAID users and 43% of participants taking 4+ NSAIDs reported taking GPAs. The most frequently-used GPAs were omeprazole (48%), esomeprazole (17%), and ranitidine (17%); 39% of daily NSAID users reported taking a GPA. Variables significantly associated with GPA use were: older age (odds ratio (OR) 1.02); male gender (OR 0.76); being white (vs. Hispanic) (OR 0.24); taking an NSAID at least daily (OR 1.5 for daily use; 2.2 for 2x daily use; and 1.8 for use ≥ 3 times per day); taking fewer NSAIDs (OR 0.83); taking a COX-2 inhibitor (OR 1.6) or a prescription NSAID (OR 1.9); history of ulcer (OR 2.2), Barrett's esophagus (OR 8.8), or GERD (OR 12.6); prescription antiplatelet use (OR 1.9); and more frequent GI symptoms as indicated by GSRS total score (OR 1.5). Variables significantly associated with GPA adherence were: (OR 1.02); inflammatory bowel disease (OR 1.57); GERD (OR 1.72); less frequent GI symptoms (OR 0.62); prescription antiplatelet use (OR 1.97); and prescription NSAID use (OR 1.65). Conclusion: Slightly more than 1/3 of daily NSAID users routinely take GPAs. Older age; taking a prescription NSAID; history of GERD; prescription antiplatelet use; and GI symptoms were all associated with GPA use and adherence to GPA regimen in this sample of adults with arthritis using NSAIDs. These data may be useful for clinicians treating patients with arthritis. Disclosure: Karin S. Coyne, Mary Kay Margolis, and Ray Hsieh are employees of United BioSource Corporation who were paid scientific consultants to Pfizer in connection with this research. Joseph C. Cappelleri, Margaret Noyes Essex, Peter W. Park and Ashish V. Joshi are employees and stockholders of Pfizer Inc. This study was funded by Pfizer Inc. This research was supported by an industry grant from Pfizer Inc.