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NEW YORK (Reuters Health) Aug 31 - Gastropathy associated with
nonsteroidal anti-inflammatory drug (NSAID) use has declined with
the increased use of safer NSAIDs and proton-pump inhibitors, according
to a report in the August issue of Arthritis & Rheumatism.
Earlier estimates suggested an annual incidence of NSAID-associated
gastropathy of 1.2% to 1.6% in rheumatoid arthritis (RA) patients,
the authors explain, but whether the incidence has changed after
recent preventive approaches is unknown.
Dr. James F. Fries and colleagues from Stanford University Medical
School, Palo Alto, California looked into the question by studying
5598 RA patients enrolled in the Arthritis, Rheumatism, and Aging
Medical Information System (ARAMIS) who have been followed since
1980.
Annual GI-related hospitalizations increased from 0.6% in 1981,
peaked at 1.5% in 1992, and declined to 0.5% by 2000, the authors
report. Similarly, GI hospitalizations as a percentage of all hospitalizations
decreased from 7.3% in 1981 to 5.7% in 1992 to 4.8% in 2000.
These declines came despite the increase in the average age of
the group during this interval.
Although the percentage of patients receiving NSAIDs remained the
same between 1992 and 2000, the researchers note, the dosages of
ibuprofen and noncardiac aspirin declined by about 40%.
Five NSAIDs showing an increased use were among the least toxic
of the NSAIDs, whereas the 8 NSAIDs prespecified as more toxic had
a decline in market share.
H2 receptor antagonists and proton-pump inhibitors use increased
markedly during the years covered by this study, the report indicates.
The investigators recommend five approaches to "continue and
even accelerate these declines" in NSAID-associated gastropathy:
-more selective use of NSAIDs, particularly in high-risk patients;
-continued introduction of newer and safer agents;
- aggressive, continued migration from more toxic to less toxic
NSAIDs;
- substantially increased use of proton-pump inhibitors for prophylaxis,
particularly in high-risk patients; and
- use of the lowest effective dose for any NSAID.
"As long as trends continue toward the use of safer NSAIDs,
more frequent use of proton-pump inhibitors, and de-escalation of
dosages, particularly in high-risk patients, the trend toward reduction
in the incidence of NSAID gastropathy is likely to continue,"
the authors conclude.
Arthritis Rheum 2004;50:2433-2440.
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