Patino Fausto G, Olivieri Jason, Allison Jeroan J, Mikuls Ted R, Moreland Larry, Kovac Stacey H, Juarez Lucia, Person Sharina, Curtis Jeffrey, Saag Kenneth G
Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL 35294-3408, USA.
J Rheumatol. 2003 Dec;30(12):2680-8.
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.
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).
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.
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.
非甾体抗炎药（NSAID）相关的胃肠道（GI）和肾脏不良事件屡有报道。尽管已发布的指南建议进行定期实验室监测，但尚未在人群层面调查医生的NSAID安全 practices。我们研究了医生专业和患者特征与NSAID安全 practices之间的关联。
利用来自一个地区性管理式医疗组织的行政数据和病历审查，我们对373名频繁使用NSAID的患者（连续≥3次NSAID处方且连续使用NSAID≥1个月并进行随访）进行了回顾性队列研究。NSAID安全措施包括：全血细胞计数（CBC）检测、肌酐检测、使用胃肠道细胞保护剂以及不同NSAID无同时处方（NSAID重叠）。
患者累积使用NSAID的平均时长为14.4±7.7个月/患者，患者年龄为62.0±11.4岁，63%为女性。约三分之二的患者接受了CBC（238例，63.8%）和肌酐监测（263例，70.5%），三分之一（120例，32.2%）被开具了细胞保护剂，四分之一（97例，26%）至少有一次NSAID重叠。经过多变量调整后，同时使用改善病情抗风湿药物（比值比[OR]2.5，95%置信区间[CI]1.1 - 5.8）、更长的NSAID暴露时间（OR 1.3，95% CI 1.1 - 1.4）以及每年更多的医生就诊次数（OR 1.1，95% CI 1.0 - 1.2）与接受CBC检测显著相关。高血压病史（OR 2.0，95% CI 1.2 - 3.2）、更长的NSAID暴露时间（OR 1.3，95% CI 1.2 - 1.4）以及每年更多的医生就诊次数（OR 1.1，95% CI 1.0 - 1.2）与血清肌酐检测显著相关。与家庭/全科医生相比，风湿病学家以及程度稍轻的内科医生更倾向于进行更多的NSAID毒性监测。然而，在有肾脏危险因素的患者中，家庭/全科医生和内科医生比风湿病学家更有可能监测肌酐。
虽然风湿病学家和内科医生更倾向于进行更多的CBC和肌酐检测，但就诊频率、NSAID使用时长和合并症是与安全监测最始终相关的因素。
