Prescribing of gastroprotective drugs among elderly NSAID users in the Netherlands

Background: Use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of gastrointestinal toxicity, in particular when risk factors are present. Methods: A study was performed to investigate concomitant prescribing of gastroprotective agents (H-2-receptor antagonists, proton pump inhibitors, or misoprostol) in an ambulatory cohort of NSAID users aged 65 years and over. The prevalence of concomitant prescribing was studied, as well as the prophylactic prescribing of gastroprotective drugs. A stepwise logistic regression was performed to determine predictive variables of prophylactic and concomitant gastroprotective drug prescribing. Results: Co-prescribing of gastroprotective drugs occurred in 1522 (23%) (of which 944 concerned prophylactic prescribing) of the NSAID users (n=6557), with an average duration of 67 days per 100 days of NSAID use. Co-prescribing of gastroprotective drugs varied among individual NSAIDs. Concomitant use of oral corticosteroids (ORadj 2.4; CI95 2.0-2.9), coumarins (ORadj 1.6; CI95 1.3-2.0), and low dose aspirin (ORadj 1.6; CI95 1.4-1.9) were significantly associated with both prophylactic and concomitant prescribing of gastroprotective agents during NSAID therapy. Discussion: Despite current guidelines recommending gastroprotective drug prescribing among high risk groups, the rate of concomitant prescribing of gastroprotective agents in NSAID users aged 65 years and over is low. Feedback to prescribers should be given to improve prescribing practices in this high risk group.