LOS ANGELES — The sharp decline in the use of selective cyclo-oxygenase-2 inhibitors due to concerns about cardiovascular risks has created a “gastroprotection gap” among elderly arthritis patients who require NSAIDs, Dr. Gurkirpal Singh said at the annual Digestive Disease Week.
In California, the percentage of Medicaid participants with arthritis who did not receive concomitant gastroprotective agents with their NSAIDs rose from 14% in 2004 to 35% in 2005.
“An increasing number of elderly patients on NSAID therapy are once again left without gastroprotection,” said Dr. Singh of Stanford University, Palo Alto, Calif. “We are going back to where we were before the advent of COX-2 inhibitors. We believe it is likely that this trend of decreased gastroprotection will result in the increased incidence of GI complications. … We haven't shown that yet, but we are currently working on this data analysis,” said Dr. Singh, who is on the speakers' bureau for Pfizer Inc. He and his associates defined the gastroprotection gap as “the proportion of patients who are elderly and at risk for GI bleeds but are exposed to nonselective NSAID therapy without concomitant protection with either a [proton-pump inhibitor] or misoprostol. These are the highest-risk patients who will get GI complications if they are not properly managed.”
Using Medi-Cal data, they analyzed prescription patterns in Californians older than 65 years who had physician-diagnosed arthritis and who were treated with NSAIDs for at least 30 days. From 1995 to mid-2005, there were 5,194,765 prescriptions for NSAIDs, including 2,634,345 (50.7%) for selective COX-2 inhibitors.
Of the 2,560,420 prescriptions for nonselective NSAIDs, only 1,215,762 (47.5%) had concomitant use of a proton-pump inhibitor or misoprostol. “The increasing implementation of gastroprotection strategies over the past several years reached a peak in 2004 when the percentage of patients not receiving gastroprotection decreased to 14% from 91% in 1995. However, this gap more than doubled to 35% in 2005,” they said.