University of Zaragoza, Zaragoza, Spain.
Am J Gastroenterol. 2012 May;107(5):707-14. doi: 10.1038/ajg.2012.13. Epub 2012 Feb 14.
Patients with gastrointestinal (GI) risk factors who take non-steroidal anti-inflammatory drugs (NSAIDs) should also take gastroprotective agents (GPAs). No studies have evaluated adherence and reasons for non-adherence to GPA and NSAID therapies.
This was a prospective, multicenter, observational, longitudinal study. Patients attending rheumatology/orthopedic clinics who were co-prescribed NSAID plus GPA for at least 15 days and had risk factors for GI complications were followed up by telephone call. Optimal adherence was defined as taking the drug for ≥ 80% of prescribed days. Multivariate logistic regression analysis was used to determine factors associated with non-adherence.
Of 1,232 patients interviewed, 192 were excluded because of inaccurate data. Of the remaining 1,040 patients, 74 % were prescribed low-dose NSAIDs and 99.8 % were prescribed a standard or high-dose GPA. In all, 70 % of NSAIDs and 63.1 % of GPA prescriptions were short term (< 30 days). The majority of patients who were prescribed either an NSAID (92.5 % ) or GPA (85.9 % ) started therapy. Optimal adherence to GPA or NSAIDs was reported by 79.7 % (95 % confidence interval (CI): 76.9-82.2 % ) and 84.1 % (95 % CI: 81.7-86.3 % ) of patients, respectively. More adverse events occurred among patients who reported non-optimal adherence than among patients with optimal adherence to GPA (22.1 vs. 1.9 % , P < 0.0001). As reasons for non-adherence, patients most frequently cited infrequent/low-intensity rheumatic pain (NSAIDs) or forgetfulness (GPAs). Adverse events and short-term treatment were independent factors associated with poor adherence for both NSAIDs and GPAs. History of uncomplicated peptic ulcer and frequent dosing were additional factors associated with non-adherence to NSAIDs.
Most frequent reasons for non-adherence are infrequent/low-intensity rheumatic pain (NSAIDs) or forgetfulness (GPAs). Short-term treatment and adverse events were associated with poor adherence for both therapies.
有胃肠道（GI）风险因素的患者在服用非甾体抗炎药（NSAIDs）时也应服用胃保护剂（GPAs）。目前尚无研究评估 GPA 和 NSAID 治疗的依从性及其不依从的原因。
这是一项前瞻性、多中心、观察性、纵向研究。共纳入了 1232 名接受风湿科/骨科门诊治疗且至少同时开具 NSAID 和 GPA 处方且有 GI 并发症风险因素的患者。通过电话随访评估患者的依从性。最佳依从性定义为服药天数≥处方规定天数的 80%。采用多变量逻辑回归分析确定与不依从相关的因素。
在接受电话访谈的 1232 名患者中，有 192 名患者因数据不准确而被排除。在其余的 1040 名患者中，74%服用的是低剂量 NSAIDs，99.8%服用的是标准或高剂量 GPA。所有 NSAIDs 处方中 70%（95%CI：67.1-73.0%）和 GPA 处方中 63.1%（95%CI：60.1-66.1%）为短期处方（<30 天）。大多数患者开始接受 NSAID（92.5%）或 GPA（85.9%）治疗。分别有 79.7%（95%CI：76.9-82.2%）和 84.1%（95%CI：81.7-86.3%）的患者报告了最佳依从性。与 GPA 最佳依从性的患者相比，报告非最佳依从性的患者更易发生不良事件（22.1% vs. 1.9%，P<0.0001）。患者不依从的主要原因是风湿痛发作频率低/强度低（NSAIDs）或健忘（GPAs）。不良事件和短期治疗是 NSAIDs 和 GPA 依从性差的独立相关因素。无并发症消化性溃疡史和频繁用药是 NSAIDs 不依从的其他相关因素。
最常见的不依从原因是风湿痛发作频率低/强度低（NSAIDs）或健忘（GPAs）。短期治疗和不良事件与两种治疗的依从性差有关。
