Rahme Elham, Barkun Alan N, Toubouti Youssef, Scalera Alissa, Rochon Sophie, Lelorier Jacques
McGill University, Research Institute of McGill University Health Center, Montreal, Canada.
Arthritis Rheum. 2007 Jun 15;57(5):748-55. doi: 10.1002/art.22764.
Celecoxib has a superior upper-gastrointestinal (GI) safety profile compared with nonselective nonsteroidal antiinflammatory drugs (NS-NSAIDs). It is unclear whether the utilization of a proton-pump inhibitor (PPI) with celecoxib confers additional protection in elderly patients. We assessed the association between GI hospitalizations and use of celecoxib with a PPI versus celecoxib alone, and NS-NSAIDs with a PPI or NS-NSAIDs alone in elderly patients.
We conducted a population-based retrospective cohort study using the government of Quebec health services administrative databases. Elderly patients were included at their first dispensing date for celecoxib or an NS-NSAID between April 1999 and December 2002. Prescriptions were separated into 4 groups: celecoxib, celecoxib plus PPI, NS-NSAIDs, and NS-NSAIDs plus PPI. Cox regression models with time-dependent exposure were used to compare the hazard rates of GI hospitalization between the 4 groups adjusting for patient characteristics at baseline.
There were 1,161,508 prescriptions for celecoxib, 360,799 for celecoxib plus PPI, 715,176 for NS-NSAIDs, and 148,470 for NS-NSAIDs plus PPI. The adjusted hazard ratios (HRs; 95% confidence intervals [95% CIs]) were 0.69 (0.52-0.93) for celecoxib plus PPI versus celecoxib, 0.98 (0.67-1.45) for NS-NSAIDs plus PPI versus celecoxib, and 2.18 (1.82-2.61) for NS-NSAIDs versus celecoxib. Subgroup analyses showed that use of a PPI with celecoxib may be beneficial in patients ages >/=75 years but was not better than celecoxib alone among those ages 66-74 years (HR 0.98, 95% CI 0.63-1.52).
Addition of a PPI to celecoxib conferred extra protection for patients ages >/=75 years. PPI did not seem necessary with celecoxib for patients ages 66-74 years.
与非选择性非甾体抗炎药（NS - NSAIDs）相比，塞来昔布具有更优的上消化道（GI）安全性。尚不清楚在老年患者中，塞来昔布联用质子泵抑制剂（PPI）是否能提供额外的保护。我们评估了老年患者中，GI住院与塞来昔布联用PPI、单独使用塞来昔布、NS - NSAIDs联用PPI或单独使用NS - NSAIDs之间的关联。
我们利用魁北克省政府卫生服务管理数据库进行了一项基于人群的回顾性队列研究。纳入1999年4月至2002年12月首次开具塞来昔布或NS - NSAIDs处方的老年患者。处方分为4组：塞来昔布、塞来昔布加PPI、NS - NSAIDs、NS - NSAIDs加PPI。采用具有时间依赖性暴露的Cox回归模型，在校正基线患者特征后比较4组之间GI住院的风险率。
塞来昔布处方有1,161,508张，塞来昔布加PPI处方有360,799张，NS - NSAIDs处方有715,176张，NS - NSAIDs加PPI处方有148,470张。校正后的风险比（HRs；95%置信区间[95% CIs]）为：塞来昔布加PPI与塞来昔布相比为0.69（0.52 - 0.93），NS - NSAIDs加PPI与塞来昔布相比为0.98（0.67 - 1.45），NS - NSAIDs与塞来昔布相比为2.18（1.82 - 2.61）。亚组分析表明，塞来昔布联用PPI可能对年龄≥75岁的患者有益，但在66 - 74岁的患者中并不比单独使用塞来昔布更好（HR 0.98，95% CI 0.63 - 1.52）。
塞来昔布联用PPI为年龄≥75岁的患者提供了额外保护。对于66 - 74岁的患者，塞来昔布联用PPI似乎没有必要。
