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Nonsteroidal antiinflammatory drug toxicity monitoring and safety practices
Fausto G Patino1, Jason Olivieri, Jeroan J Allison
1Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35294-3408, USA.
Objective:
Nonsteroidal antiinflammatory drug (NSAID) related gastrointestinal (GI) and renal adverse events are commonly reported. Although published guidelines recommend periodic laboratory monitoring, NSAID safety practices of physicians have not been investigated at a population level. We examined the associations of physician specialty and patient characteristics with NSAID safety practices.
Methods:
Using administrative data and medical record review from a regional managed care organization, we studied a retrospective cohort of 373 frequent NSAID users (> or = 3 consecutive NSAID prescriptions and > or = 1 month of continuous NSAID use and followup). NSAID safety measures included: complete blood count (CBC) testing, creatinine testing, use of GI cytoprotective agents, and lack of simultaneous prescriptions for different NSAID (NSAID overlap).
Results:
The mean duration of cumulative NSAID use was 14.4 +/- 7.7 months/patient, patient age was 62.0 +/- 11.4 years, and 63% were women. About two-thirds of patients received CBC (238, 63.8%) and creatinine monitoring (263, 70.5%), one-third (120, 32.2%) were prescribed cytoprotective agents, and one-fourth (97, 26%) had at least one NSAID overlap. After multivariable adjustments, concomitant use of disease-modifying antirheumatic drugs (OR 2.5, 95% CI 1.1-5.8), longer NSAID exposure (OR 1.3, 95% CI 1.1-1.4), and a greater number of physician visits/year (OR 1.1, 95% CI 1.0-1.2) were significantly associated with receipt of a CBC. A history of hypertension (OR 2.0, 95% CI 1.2-3.2), longer NSAID exposure (OR 1.3, 95% CI 1.2-1.4), and more physician visits/year (OR 1.1, 95% CI 1.0-1.2) were significantly associated with serum creatinine testing. Rheumatologists, and to a lesser extent internists, trended toward more NSAID toxicity monitoring than family/general practitioners. However, family/general practitioners and internists were more likely to monitor creatinine than rheumatologists among patients with renal risk factors.
Conclusion:
While rheumatologists and internists trended toward more CBC and creatinine testing, visit frequency, duration of NSAID use, and comorbidities were the factors most consistently associated with safety monitoring.
Insights
Physician specialty and patient factors like comorbidities and NSAID use duration influence safety monitoring for nonsteroidal antiinflammatory drug (NSAID) users. Increased visits and longer NSAID exposure correlate with more lab testing.
Area of Science:
- Pharmacovigilance
- Clinical Practice Research
- Health Services Research
Background:
- Nonsteroidal antiinflammatory drugs (NSAIDs) are associated with significant gastrointestinal (GI) and renal adverse events.
- Published guidelines recommend periodic laboratory monitoring for NSAID users, but physician practices are not well understood at a population level.
Purpose of the Study:
- To investigate physician safety practices for nonsteroidal antiinflammatory drug (NSAID) users.
- To examine associations between physician specialty, patient characteristics, and NSAID safety monitoring.
Main Methods:
- Retrospective cohort study of 373 frequent NSAID users from a regional managed care organization.
- NSAID safety measures included complete blood count (CBC) testing, creatinine testing, GI cytoprotective agent use, and NSAID overlap.
- Multivariable analysis adjusted for patient and physician factors.
Main Results:
- Two-thirds of patients received CBC and creatinine monitoring; one-third received cytoprotective agents; one-fourth experienced NSAID overlap.
- Concomitant disease-modifying antirheumatic drug use, longer NSAID exposure, and more physician visits were associated with CBC testing.
- Hypertension history, longer NSAID exposure, and more physician visits were associated with creatinine testing.
Conclusions:
- Rheumatologists and internists showed a trend toward increased CBC and creatinine testing compared to family/general practitioners.
- Physician specialty alone was less consistently associated with monitoring than visit frequency, NSAID duration, and comorbidities.
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