Duong Mai, Salvo Francesco, Pariente Antoine, Abouelfath Abdelilah, Lassalle Regis, Droz Cecile, Blin Patrick, Moore Nicholas
INSERM U657, Bordeaux, France.
Br J Clin Pharmacol. 2014 May;77(5):887-95. doi: 10.1111/bcp.12239.
Most risks of nonsteroidal anti-inflammatory drugs (NSAIDs) are pharmacological, dose and duration dependent. Usage patterns of prescription-only (POM) or 'over-the-counter (OTC)' NSAIDs may influence risks, but are not commonly described.
The Echantillon Généraliste de Bénéficiaires database, the permanent 1/97 representative sample from the French national healthcare insurance systems, was queried over 2009-2010 to identify usage patterns, concomitant chronic diseases and cardiovascular medication in OTC and POM NSAID users.
Over 2 years, 229 477 of 526 108 patients had at least one NSAID dispensation; 44 484 patients (19%) were dispensed only OTC NSAIDs (93% ibuprofen) and 121 208 (53%) only POM NSAIDs. The OTC users were younger (39.9 vs. 47.4 years old) and more often female (57 vs. 53%); 69% of OTC users and 49% of POM users had only one dispensation. A mean of 14.6 defined daily doses (DDD) were dispensed over 2 years for OTC vs. 53 for POM; 93% OTC vs. 60% POM patients bought ≤ 30 DDD over 2 years, and 1.5 vs. 12% bought ≥ 90 DDD. Chronic comorbidities were found in 19% of OTC users vs. 28% of POM users; 24 vs. 37% had at least one dispensation of a cardiovascular drug over the 2 years.
Most of the use of NSAIDs appears to be short term, especially for OTC-type NSAIDs, such as ibuprofen. The validity of risk estimates for NSAIDs extrapolated from clinical trials or from observational studies not including OTC-type usage may need to be revised.
非甾体抗炎药（NSAIDs）的大多数风险取决于药理作用、剂量和用药时长。仅凭处方（POM）或“非处方药（OTC）”的NSAIDs使用模式可能会影响风险，但通常未被描述。
查询了法国国家医疗保险系统的长期1/97代表性样本——Echantillon Généraliste de Bénéficiaires数据库，以确定2009年至2010年期间非处方和仅凭处方的NSAIDs使用者的用药模式、伴随的慢性病和心血管药物使用情况。
在两年时间里，526108名患者中有229477人至少有一次NSAIDs配药；44484名患者（19%）仅配用非处方NSAIDs（93%为布洛芬），121208名患者（53%）仅配用仅凭处方的NSAIDs。非处方使用者更年轻（39.9岁对47.4岁），女性比例更高（57%对53%）；69%的非处方使用者和49%的仅凭处方使用者只有一次配药。非处方使用者在两年内平均配用14.6限定日剂量（DDD），而仅凭处方使用者为53；93%的非处方使用者和60%的仅凭处方使用者在两年内购买的DDD≤30，1.5%对12%的使用者购买的DDD≥90。19%的非处方使用者和28%的仅凭处方使用者患有慢性合并症；在两年内，24%对37%的使用者至少有一次心血管药物配药。
大多数NSAIDs的使用似乎是短期的，尤其是非处方类NSAIDs，如布洛芬。从临床试验或不包括非处方类使用情况的观察性研究中推断出的NSAIDs风险估计的有效性可能需要修订。
