Pasina L, Nobili A, Tettamanti M, Riva E, Lucca U, Piccinelli R, Defendi L, Perego L, Lucifora S, Bulla C
Department of Neuroscience, Mario Negri Institute for Pharmacological Research, Milan, Italy.
Int J Clin Pharmacol Ther. 2010 Nov;48(11):735-43. doi: 10.5414/cpp48735.
To evaluate the prevalence of co-prescription of GPAs (proton pump inhibitors - PPIs and H2-receptor antagonists) and non-selective NSAIDs or COXIBs in patients registered under the local health authority (LHA) of Bergamo, a city in the north of Italy.
A drug utilization analysis was done using the Bergamo prescription Health Services Electronic Database. All patients aged 35 years or older who had received at least one prescription during 2004 for non-selective NSAIDs and/or COXIBs were divided into three groups: occasional, chronic and new users.
Among chronic users, 44.8% were treated with non-selective NSAIDs, 11.6% with COXIBs, and 43.6% with both (mixed NSAIDs). For new users, non-selective NSAIDs were prescribed to 82.7%, COXIBs and mixed NSAIDs to 10.8% and 6.5%. PPIs were co-prescribed to 7.1% of COXIB users and 5.8% of non-selective NSAID occasional users. Among chronic users, the figures were 15.6% and 14%. For new users, prescriptions for COXIBs were associated with less use of GPA for patients who received the first and last prescription for NSAIDs and GPAs on the same day, while for patients who became chronic users COXIBs did not reduce the probability of co-prescription of a GPA: the number of co-prescribed medications and antithrombotics or corticosteroids were independent predictors of GPA use.
COXIBs seem to be used in patients at high risk of GI toxicity. However, the fear of GI adverse reactions and the uncertain safety profile of COXIBs leads many physicians to boost the gastroprotection by prescribing a PPI.
评估意大利北部城市贝加莫当地卫生当局（LHA）登记的患者中，质子泵抑制剂（PPIs）和H2受体拮抗剂（GPAs）与非选择性非甾体抗炎药（NSAIDs）或环氧化酶抑制剂（COXIBs）联合处方的发生率。
利用贝加莫处方健康服务电子数据库进行药物利用分析。所有35岁及以上在2004年期间至少接受过一次非选择性NSAIDs和/或COXIBs处方的患者被分为三组：偶尔使用者、慢性使用者和新使用者。
在慢性使用者中，44.8%接受非选择性NSAIDs治疗，11.6%接受COXIBs治疗，43.6%接受两者联合治疗（混合NSAIDs）。对于新使用者，82.7%被处方非选择性NSAIDs，10.8%被处方COXIBs，6.5%被处方混合NSAIDs。7.1%的COXIB使用者和5.8%的非选择性NSAIDs偶尔使用者同时被处方PPIs。在慢性使用者中，这一比例分别为15.6%和14%。对于新使用者，对于在同一天接受NSAIDs和GPAs首张及最后一张处方的患者，COXIBs处方与较少使用GPA相关，而对于成为慢性使用者的患者，COXIBs并未降低联合处方GPA的可能性：联合处方药物及抗血栓药或皮质类固醇的数量是GPA使用的独立预测因素。
COXIBs似乎用于胃肠道毒性高风险患者。然而，对胃肠道不良反应的担忧以及COXIBs不确定的安全性导致许多医生通过处方PPI来加强胃保护。
