Gastroenterology

Gastroenterology

Volume 134, Issue 4, April 2008, Pages 937-944.e1
Gastroenterology

Clinical–Alimentary Tract
The Relative Efficacies of Gastroprotective Strategies in Chronic Users of Nonsteroidal Anti-inflammatory Drugs

https://doi.org/10.1053/j.gastro.2008.01.010Get rights and content

Background & Aims: There are numerous gastroprotective strategies recommended for reducing the risk of upper gastrointestinal (GI) complications in long-term users of nonsteroidal anti-inflammatory drugs (NSAIDs). The relative efficacy of the different strategies alone or in combination is uncertain. Methods: We used the Manitoba Population Health Research Data Repository to perform a population-based matched case-control analysis. All NSAID users (nonselective and cyclooxygenase [COX]-2–specific) users admitted to the hospital with a primary diagnosis for an upper gastrointestinal complication were matched to NSAID-using controls in the community. We used conditional logistic regression analysis to determine the relative efficacy of different gastroprotective strategies (proton pump inhibitors [PPIs], COX-2 inhibitors, and low-dose/high-dose misoprostol) either alone or in combination and to adjust for multiple pertinent covariates. Results: A total of 1382 NSAID/COX-2 users with upper GI complications were matched to 33,957 age- and sex-matched controls. Cotherapy with PPIs or misoprostol or use of a COX-2 inhibitor all significantly reduced the risk of upper GI complications. COX-2 inhibitors were not statistically more likely to prevent upper GI complications than PPIs, although they were superior to low-dose misoprostol. The combination of COX-2 inhibitors with a PPI was associated with the greatest degree of upper GI complication risk reduction. Conclusions: All of the commonly accepted gastroprotective strategies reduce the risk of upper GI complications in NSAID users, although the combination of COX-2 inhibitors with PPIs promotes the greatest risk reduction for NSAID-related upper GI complications. Celecoxib use specifically may be superior to the combination of nonselective NSAIDs with a PPI.

Section snippets

Description of Data Sets

In Manitoba, the Manitoba Centre for Health Policy maintains a comprehensive health utilization data set called the Population Health Research Data Repository.19, 20 This data set contains health care utilization data on all residents of Manitoba, provided by the provincial department of health. The Population Health Research Data Repository is composed of a number of distinct data sets containing information on patient demographics, all outpatient and hospital visits since April 1984 including

Results

We identified 466,187 adults who had filled at least one NSAID prescription between April 1995 and March 2006. Within this cohort of individuals, we identified 1382 admitted with upper GI complications and 736 with peptic ulcer diseases who had hospital stays exceeding 1 day. The 1382 upper GI complication cases were matched to 33,957 age- and sex-matched controls, each of whom was also using an nsNSAID or COX-2 inhibitor within 14 days of his or her case’s event date.

The baseline

Discussion

Based on our results, use of any of the commonly recommended basic gastroprotective strategies, including nsNSAID + PPI, nsNSAID + low-dose misoprostol, and COX-2 inhibitor alone, was associated with a significant reduction in the risk of developing an overall upper GI complication or upper GI complication secondary to peptic ulcer disease. Among the basic gastroprotective strategies, COX-2 inhibitor alone was numerically superior to nsNSAID + PPI, but the difference was not statistically

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  • Cited by (0)

    Supported by grants from the Manitoba Medical Services Foundation, the Health Sciences Centre Foundation (Winnipeg), and the Canadian Institutes of Health Sciences Regional Partnership Program. This study was not funded in any part by private industry. L.T. is the recipient of the University of Manitoba Rudy Falk Clinical Scholar Award and has previously received grant support from Astra-Zeneca Canada, Janssen-Ortho Canada, and Altana Canada.

    The results and conclusions are those of the authors, and no official endorsement by Manitoba Health or the Manitoba Centre for Health Policy is intended or should be inferred.

    1

    L.T. has served on advisory panels for Janssen-Ortho Canada and Novartis Canada. The other authors have no financial conflicts of interest to disclose.

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