Ray Wayne A, Chung Cecilia P, Stein C Michael, Smalley Walter E, Hall Kathi, Arbogast Patrick G, Griffin Marie R
Division of Pharmacoepidemiology, Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37212, USA.
Gastroenterology. 2007 Sep;133(3):790-8. doi: 10.1053/j.gastro.2007.06.058. Epub 2007 Jul 3.
BACKGROUND & AIMS: The primary strategies to reduce the risk of serious gastropathy caused by traditional nonsteroidal anti-inflammatory drugs (NSAIDs) are use of a coxib or concurrent use of a proton pump inhibitor or double-dose histamine-2 receptor antagonist. However, the relative clinical effectiveness of these therapeutic alternatives is understudied.
We studied peptic ulcer hospitalizations in a cohort of Tennessee Medicaid enrollees between 1996 and 2004. To decrease potential "channeling" bias, the study included only new episodes of prescribed NSAID or coxib use and controlled for multiple baseline risk factors for upper gastrointestinal disease. There were 234,010 and 48,710 new episodes of NSAID and coxib use, respectively, with 363,037 person-years of follow-up and 1223 peptic ulcer hospitalizations.
Current users of NSAIDs with no gastroprotective cotherapy had an adjusted incidence of peptic ulcer hospitalizations of 5.65 per 1000 person-years, 2.76 (95% confidence interval, 2.35-3.23) times greater than that for persons not currently using either NSAIDs or coxibs. This risk was reduced by 39% (16%-56%, 95% CI) for current users of NSAIDs with gastroprotective cotherapy and 40% (23%-54%) for current users of coxibs without such cotherapy. Concurrent users of NSAIDs and proton pump inhibitors had a 54% (27%-72%) risk reduction, very similar to the 50% (27%-66%) reduction for concurrent users of proton pump inhibitors and coxibs.
These findings suggest that coprescribing a proton pump inhibitor with an NSAID is as effective as use of a coxib for reducing the risk of NSAID-induced gastropathy.
降低传统非甾体抗炎药（NSAIDs）所致严重胃病风险的主要策略是使用环氧化酶-2（COX-2）抑制剂或同时使用质子泵抑制剂或双倍剂量的组胺-2受体拮抗剂。然而，这些治疗方案的相对临床疗效尚未得到充分研究。
我们对1996年至2004年间田纳西州医疗补助计划参保队列中的消化性溃疡住院情况进行了研究。为减少潜在的“渠道”偏倚，该研究仅纳入新开处方使用NSAIDs或COX-2抑制剂的新发病例，并对多种上消化道疾病的基线风险因素进行了控制。分别有234,010例和48,710例新开处方使用NSAIDs和COX-2抑制剂的病例，随访363,037人年，发生1223例消化性溃疡住院。
当前未接受胃保护联合治疗的NSAIDs使用者消化性溃疡住院的校正发病率为每1000人年5.65例，比当前未使用NSAIDs或COX-2抑制剂的人高出2.76倍（95%置信区间，2.35 - 3.23）。对于接受胃保护联合治疗的当前NSAIDs使用者，该风险降低了39%（16% - 56%，95%置信区间），对于未接受此类联合治疗的当前COX-2抑制剂使用者，风险降低了40%（23% - 54%）。同时使用NSAIDs和质子泵抑制剂的使用者风险降低了54%（27% - 72%），与同时使用质子泵抑制剂和COX-2抑制剂的使用者风险降低50%（27% - 66%）非常相似。
这些发现表明，NSAIDs与质子泵抑制剂联合用药在降低NSAIDs所致胃病风险方面与使用COX-2抑制剂同样有效。
