Improving the risk-benefit ratio of NSAID therapy in the elderly

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed to elderly patients. This population may have a decreased capacity to metabolize and excrete NSAIDs and other agents. Furthermore, older patients frequently use NSAIDs concomitantly with other commonly prescribed drugs, thereby increasing the potential for drug interactions. A major challenge in rheumatology is to improve the risk-benefit ratio of NSAID therapy in older patients. Clinicians first must identify which patients are at increased risk. Several studies have shown that compromised cardiovascular and renal functions in older individuals may be important factors in increasing their vulnerability to the adverse effects of NSAIDs. Epidemiologic studies have provided valuable information concerning risk factors for adverse drug reactions in the elderly. Older patients with rheumatic diseases, osteoporosis, degenerative changes and certain autoimmune diseases and neoplasms should be treated less aggressively than younger patients. Statistical analyses of data bases correlating specific adverse events with NSAID use in the elderly may help clinicians in their therapeutic decisions. These data bases are now available in several readily accessible forms.