Underutilization of gastrointestinal prophylaxis in high-risk chronic nonsteroidal anti-inflammatory drug users in
Woo-Youn Kim1, Suhyun Lee1, Kwanghee Jun1
1College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1, Gwanak-ro, Seoul, 08826, Republic of Korea.
Insights
Gastroprotective agents (GPAs) are underutilized in older adults using chronic nonsteroidal anti-inflammatory drugs (NSAIDs), especially those at ultra-high risk for gastrointestinal (GI) bleeding. Interventions should consider patient age, indication, and prescriber specialty.
Area of Science:
- Geriatric Medicine
- Pharmacology
- Gastroenterology
Background:
- Increasing use of antithrombotic therapies in older adults elevates gastrointestinal (GI) bleeding risk among chronic nonsteroidal anti-inflammatory drug (NSAID) users.
- A critical need exists for effective GI prophylaxis in this high-risk patient population.
Purpose of the Study:
- To investigate prescribing patterns of gastroprotective agents (GPAs) in high-risk, chronic NSAID users.
- To identify factors associated with the appropriate use of GPAs for GI prophylaxis.
Main Methods:
- Cross-sectional analysis of a national claims database (20% of Korean population ≥65 years).
- Identification of chronic traditional NSAID users (>90 days), categorized into high-risk (1 GI risk factor) and ultra-high-risk (≥2 GI risk factors).
- Appropriate GI prophylaxis defined as proton pump inhibitors or misoprostol use for >80% of NSAID treatment days.
Main Results:
- Among 69,992 chronic NSAID users, 38.8% were high-risk and 9.4% were ultra-high-risk.
- Appropriate GI prophylaxis was received by 13.2% of high-risk and 19.9% of ultra-high-risk patients.
- Histamine H2 antagonists were the most common GPA. Concomitant antiplatelets/anticoagulants, multiple NSAID use, and prior GI ulcers increased appropriate GPA use, while advanced age (≥85), non-arthritis indications, and neurology specialists decreased it.
Conclusions:
- Less than one-fifth of ultra-high-risk chronic NSAID users in Korea receive appropriate GI prophylaxis.
- Intervention strategies should target specific patient demographics (age, indication) and prescriber specialties to improve GPA utilization.
Abstract:
Background The increasing use of antithrombotic therapies in older patients has led to an increased risk of gastrointestinal (GI) bleeding in chronic nonsteroidal anti-inflammatory drug (NSAID) users. Therefore, there is a pressing need for GI prophylaxis in these high-risk patients. Objective To analyze prescribing patterns and factors associated with the use of gastroprotective agents (GPAs) among high-risk, chronic NSAID users. Setting National claims database including 20% of the total Korean population aged ≥ 65 years. Method In this cross-sectional study, we identified older adults prescribed traditional NSAIDs for > 90 days and classified them into high- and ultra-high-risk groups if they had one or two or more GI risk factors, respectively. Proton pump inhibitors or misoprostol prescribed for more than 80% of traditional NSAID treatment days was regarded as appropriate GI prophylaxis. Main outcome measure Prevalence and associated factors with appropriate GI prophylaxis. Results Among 69,992 chronic traditional NSAID users, 38.8% and 9.4% belonged to the high and ultra-high-risk groups; 13.2% and 19.9% received appropriate GI prophylaxis, respectively. The most frequently used GPA was histamine H2 antagonists. Multiple NSAID use, concomitant antiplatelets and anticoagulants, and prior GI ulcer history increased the likelihood of receiving appropriate GI prophylaxis. Advanced age (≥ 85 years), indications other than arthritis, and neurology specialists negatively affected appropriate GI prophylaxis use. Conclusion Approximately one in five chronic NSAID users, considered ultra-high risk, are prescribed appropriate GI prophylaxis in Korea. Advanced age, indications, and specialties of the prescriber all need to be considered when selecting target populations for interventions.
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