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Frequent users of nonsteroidal antiinflammatory drugs may need medications to prevent associated ulcers

About 1 to 2 percent of older patients taking traditional nonsteroidal antiinflammatory drugs (NSAIDs) regularly for 1 year develop serious gastrointestinal complications such as perforation, obstruction, or bleeding. Another 2 to 3 percent develop uncomplicated ulcers or other gastrointestinal problems. Yet, doctors don't commonly prescribe gastroprotective medications even for the highest risk patients, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10384).

Researchers from AHRQ's Center for Education and Research on Therapeutics at Vanderbilt University used Tennessee Medicaid data to analyze use of gastroprotective therapies for 76,765 recurrent users of NSAIDs (50 years or older), who received medications from January 1999 through June 2000.

The researchers calculated the frequency of either of two recommended gastroprotective strategies: traditional NSAIDs combined with recommended antiulcer cotherapy or use of a selective cyclooxygenase 2-inhibiting drug (coxib) such as misoprostol. They categorized use of these therapies by patient risk for ulcer complication. Coxib users were, on average, older, had been hospitalized more frequently, and had more coexisting medical conditions than users of traditional NSAIDs.

Among the recurrent NSAID users (more than one prescription), only 16 percent received one of the two recommended gastroprotective therapies: 10 percent received traditional NSAIDs along with antiulcer drugs at the recommended doses, and 6 percent received coxibs. Only 30 percent of patients with two or more risk factors for ulcer complications (for example, 75 years or older and peptic ulcer in the past year) received gastroprotective therapy.

See "Underutilization of gastroprotective measures in patients receiving nonsteroidal antiinflammatory drugs," by Walter Smalley, M.D., M.P.H., C. Michael Stein, M.D., Patrick G. Arbogast, Ph.D., and others, in the August 2002 Arthritis & Rheumatism 46(8), pp. 215-220.

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