Browse > Article

Evaluation of NSAID Usage and Appropriateness for Prevention of NSAID-Related Ulcer Complications  

Cho, Jungwon (Department of Pharmacy, Seoul National University Bundang Hospital)
Lee, Eunsook (Department of Pharmacy, Seoul National University Bundang Hospital)
Shin, Wan Gyoon (College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University)
Publication Information
Korean Journal of Clinical Pharmacy / v.22, no.3, 2012 , pp. 211-219 More about this Journal
Abstract
Nonsteroidal antiinflammatory drugs (NSAIDs) are used in the treatment of extensive diseases related to various symptoms; inflammation, pain and fever. NSAIDs work by blocking prostaglandin synthesis, but adverse drug events (ADEs) have been increasing dramatically such as gastrointestinal bleeding, perforation and stenosis, a kind of serious ADEs. Therefore, NSAID-related ulcer complication guidelines have been announced containing various risk factors and symptoms. Thus, this study aims to evaluate of NSAID usage and appropriateness for prevention of NSAID-related ulcer complication based on American journal of gastroenterology (AJG) guideline 2009. Further, the study suggests Korean guideline for prevention of NSAID-related ulcer compared to AJG guideline. For this study, data was collected through electronic medical record (EMR) at Seoul national university of Bundang hospital. The primary end point was a composite of NSAID-related ulcer risk factor, types of NSAIDs, co-prescribed NSAID ulcer prevention drugs and NSAID-related ulcer after taking NSAID. The risk factors include over 65 years, high dose NSAID, previous ulcer history and taking drugs (e.g. aspirin, anticoagulant and steroid) causing ulcer. If a patient has 3 or 4 factors, that patient was classified high risk group. And if 1 or 2 factors that patient was classified moderate risk group. The patient who has no risk factor was in low risk group. I studied 8,120 patients who received NSAID from 1 January 2009 to 31 December 2009. High risk group was 16(0.2%), moderate risk group was 4,364(53.7%), and low risk group was 3,740(46.1%). The results show that high risk group should be prescribed COX-2 inhibitors with ulcer prevention drugs, and moderate or low risk group need traditional NSAIDs with ulcer prevention drugs. This may be different with 2009 AJG guideline because AJG guideline suggested taking COX-2 inhibitor alone in moderate group or taking traditional NSAID alone in low risk group could get higher ulcer complication. The results indicated that choosing preventive drug is important in case that how many risk factors the patients have. The proper drugs would be helpful for safe and effective NSAID usage in each patient group.
Keywords
NSAID; COX-2; gastrointestinal ulcer; ulcer complication; prevention; guideline;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Van Groeneandael JHLM, Markusse HM, Dijkmans BAC, et al., The effect of ranitidine on NSAID-related dyspeptic symptoms with and without peptic ulcer disease of patients with rheumatoid arthritis or osteoarthritis. Clin Rheumatol 1996; 15: 450-456.   DOI   ScienceOn
2 Taha AS, Hudson N, Hawkey CJ, et al., Famotidine for the prevention of gastric a duodenal ulcers caused by nonsteroidal antiinflammatory drugs. N Engl J Med 1996; 334: 1435-1439.   DOI   ScienceOn
3 Singh G, Triadafilopoulus G. Epidemiology of NSAID induced GI complications. J Rheumatol 1999; 26: 18-24.
4 Yun HR, Corzillius M, Kim SY, Bae SC. Korean costeffectiveness analysis of NSAIDs, NSAIDs with cotreatments to prevent gastrointestinal toxicity, and COX-2 specific inhibitors in the treatment of rheumatoid arthritis. Korean J Med 2001; 60: 574-588.
5 Yeomans ND, Tulassay Z, Juhasz L et al., A comparison of omeprazole with ranitidine for ulcers associated with nonsteroidal anti-inflammatory drugs. Acid Suppression Trial: Ranitidine vs. Omeprazole for NSAID associated Ulcer Treatment (ASTRONAUT) Study Group. N Engl J Med 1998; 338: 719-726.   DOI   ScienceOn
6 Hawkey CJ, Karrasch JA, Szczepanski L et al., Omeprazole compared with misoprostol for ulcers associated with nonsteroidal anti-inflammatory drugs. Omeprazole vs. Misoprostol for NSAID-Induced Ulcer Management (OMNIUM) Study Group. N Engl J Med 1998; 33: 727-734.
7 Lanza FL, Peace K, Gustitus L et al., A blinded endoscopic comparative study of misoprostol vs. sucralfate and placebo in the prevention of aspirin-induced gastric and duodenal ulceration. Am J Gastroenterol 1988; 83: 143-146.
8 Agrawal NM, Roth S, Graham DY et al., Misoprostol compared with sucralfate in the prevention of nonsteroidal anti-inflammatory drug-induced gastric ulcer. a randomized, controlled trial. Ann Intern Med 1991; 115: 195-200.   DOI   ScienceOn
9 McCarthy DM. Sucralfate. N Engl J Med 1991; 325: 1017-1025.   DOI   ScienceOn
10 Garcia Rodriguez LA, Hernandez-Diaz S. Relative risk of upper gastrointestinal complications among users of acetaminophen and nonsteroidal antiinflammatory drugs. Epidemiology 2001; 12: 570-576.   DOI   ScienceOn
11 Hernandez-Diaz S, Rodriguez LA. Association between nonsteroidal antiinflammatory drugs and upper gastrointestinal tract bleeding/perforation: an overview of epidemiologic studies published in the 1990s. Arch Intern Med 2000; 160: 2093-2099.   DOI   ScienceOn
12 de Abajo FJ, Garcia Rodriguez LA. Risk of upper gastrointestinal bleeding and perforation associated with low-dose aspirin as plain and enteric coated formulations. BMC Clin Pharmacol 2001; 1: 1.
13 Rostom A, Dube C, Wells G et al., Prevention of NSAIDinduced gastroduodenal ulcers. Cochrane Database Syst Rev 2002; 4: CD002296.
14 Leontiadis GI, Sreedharan A, Dorward S et al., Systematic reviews of the clinical effectiveness and cost-effectiveness of proton pump inhibitors in acute upper gastrointestinal bleeding. Health Technol Assess 2007; 11: 1-164.
15 Kim JW. NSAID-induced gastroenteropathy. Korean J Gastroenterol 2008; 52: 134-141.
16 Aalykke C, Lauritsen K. Epidemiology of NSAID-related gastroduodenal mucosal injury. Best Pract Res Clin Gastroenterol 2001; 15: 705-722.   DOI
17 Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med 1999; 340: 1888-1899.   DOI   ScienceOn
18 Aalykke C, Lauritsen K. Epidemiology of NSAID-related gastroduodenal mucosal injury. Best Pract Res Clin Gastroenterol 2001; 15: 705-722.   DOI
19 Lanza FL et al., Guidelines for prevention of NSAIDrelated ulcer complications. Am J Gastroenterol. 2009; 104(3): 728-38.   DOI   ScienceOn
20 Macro Lazzaroni and Gabriele Bianchi Porro. Management of NSAID-Induced Gastrointestinal Toxicity. Drugs 2009; 69(1): 51-69.   DOI   ScienceOn
21 Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal antiinflammatory drugs. N Engl J Med 1999; 340: 1888-1899.   DOI   ScienceOn
22 Shorr RI, Ray WA, Daugherty JR, Griffin MR. Concurrent use of nonsteroidal anti-inflammatory drugs and oral anticoagulants places elderly persons at high risk for hemorrhagic peptic ulcer disease. Arch Intern Med 1993;153:1665-1670.   DOI   ScienceOn
23 Chou R, Helfand M, Peterson K, Dana T, Roberts C. Comparative effectiveness and safety of analgesics for osteoarthritis. Comparative effectiveness review no. 4. Rockville, Md.: Agency for Healthcare Research and Quality; September 2006.
24 Gabriel SE, Jaakkimainen L, Bomaberdier C. Risk for serious gastrointestinal complications related to use of nonsteroidal antiinflammatory drugs: a meta analysis. Ann Intern Med 1991; 115: 787-96.   DOI   ScienceOn
25 Silverstein FE, Graham DY, Senior JR, et al., Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal antiinflammatory drugs. A randomized, double-blind, placebocontrolled trial. Ann Intern Med 1995; 123: 241-249.   DOI   ScienceOn
26 Bijlsma JW. Treatment of NSAID-induced gastrointestinal lesions with cimetidine: an international multicenter collaborative study. Aliment Pharmacol Ther 1988; 2: 85-95