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

Abstract

Objectives. 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. Methods. The retrospective study was based on the Intercontinental Marketing Services (IMS) Health UK MediPlusa® database and included subjects a40 yrs of age who received their first oral nsNSAID prescription between July and December 2002 and who had a60 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. Results. Of 16 344 patients included, 1586 received at least one PPI prescription. Among PPI users, PPIs were available on ∼50% of the days with nsNSAID therapy. After multivariate adjustment, age ≥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. Conclusions. 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.