新斯科舍省开始接受非甾体抗炎药治疗的老年人中，使用质子泵抑制剂或H2受体拮抗剂进行胃肠道预防的处方率。

The rate of prescribing gastrointestinal prophylaxis with either a proton pump inhibitor or an H2-receptor antagonist in Nova Scotia seniors starting nonsteroidal anti-inflammatory drug therapy.

作者信息

Superceanu Bogdan, Veldhuyzen van Zanten Sander, Skedgel Chris, Shepherd Michael, Sketris Ingrid

机构信息

Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia.

出版信息

Can J Gastroenterol. 2010 Aug;24(8):481-8. doi: 10.1155/2010/397610.

DOI:10.1155/2010/397610

PMID:20711527

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2947001/

Abstract

BACKGROUND

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used agents that can cause serious gastrointestinal (GI) side effects. For patients at increased risk of NSAID-related GI complications, prophylaxis with either a nonselective NSAID plus gastroprotective agent (GPA) or, alternatively, therapy with a cyclooxygenase-2 selective inhibitor with or without a GPA such as a proton pump inhibitor (PPI), is recommended.

AIM

To describe the rate, timing and duration of GI prophylaxis in Nova Scotia seniors receiving nonselective NSAIDs.

METHODS

The Nova Scotia Seniors' Pharmacare Program beneficiaries for the years 1998 to 2002 were studied. A cohort of incident NSAID and GPA users was selected from all nonselective NSAID users (no prescribed NSAID dispensed 12 months before the index month and no GPA dispensed two months before the index prescription). Monthly coprescribing rates were calculated by dividing the number of patients in the cohort using GPAs by the number of NSAID users. GI prophylactic coprescribing was defined as the coprescribing rate present at the first month (index month) of prescribing an NSAID.

RESULTS

The cohort consisted of 12,906 patients. Seventy-five per cent of the nonselective NSAID prescriptions dispensed were for up to two months duration, with only 2.3% longer than one year. GI prophylaxis was given to only 3.8% of patients starting NSAIDs who were not on a GPA in the two months before starting NSAIDs. Of this 3.8%, 92.7% of the patients received H2-receptor antagonists (H2RAs), and 7% received PPIs. The rate of H2RA coprescribing increased with the number of consecutive months on an NSAID from 3.5% in the first month to 24.1% at 48 months. For PPIs, the coprescribing rate increased from 0.3% to 1.9% of all NSAID users in the cohort. The rate of gastroprophylaxis coprescribing for patients receiving NSAIDs did not rise with increasing age.

CONCLUSION

In Nova Scotian seniors using nonselective NSAIDs, the rate of GI prophylaxis was low. Most patients received H2RAs as GPAs despite evidence that they offer insufficient protection.

摘要

背景

非甾体抗炎药（NSAIDs）是广泛使用的药物，可引起严重的胃肠道（GI）副作用。对于NSAID相关胃肠道并发症风险增加的患者，建议使用非选择性NSAID加胃保护剂（GPA）进行预防，或者使用环氧化酶-2选择性抑制剂联合或不联合GPA（如质子泵抑制剂（PPI））进行治疗。

目的

描述新斯科舍省使用非选择性NSAIDs的老年人胃肠道预防的发生率、时间和持续时间。

方法

对1998年至2002年新斯科舍省老年人药物护理计划的受益人进行研究。从所有非选择性NSAID使用者中选择一组首次使用NSAID和GPA的人群（在索引月前12个月未开具过NSAID处方，在索引处方前两个月未开具过GPA处方）。每月联合处方率通过将使用GPA的队列患者数量除以NSAID使用者数量来计算。胃肠道预防性联合处方定义为开具NSAID的第一个月（索引月）的联合处方率。

结果

该队列由12906名患者组成。所开具的非选择性NSAID处方中，75%的用药时长为两个月以内，只有2.3%超过一年。在开始使用NSAIDs的患者中，只有3.8%在开始使用NSAIDs前两个月未使用GPA的患者接受了胃肠道预防。在这3.8%的患者中，92.7%的患者接受了H2受体拮抗剂（H2RAs），7%的患者接受了PPI。H2RA联合处方率随着连续使用NSAID的月数增加而增加，从第一个月的3.5%增至48个月时的24.1%。对于PPI，联合处方率从该队列所有NSAID使用者的0.3%增至1.9%。接受NSAIDs治疗的患者的胃肠道预防联合处方率并未随年龄增长而上升。