• V E Valkhoff, E M van Soest, M C J M Sturkenboom, and E J Kuipers.
• Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands. v.valkhoff@erasmusmc.nl <v.valkhoff@erasmusmc.nl>
• Aliment. Pharmacol. Ther. 2010 Jun 1; 31 (11): 1218-28.

BackgroundPreventive strategies are advocated in patients at risk of upper-gastrointestinal complications associated with nonsteroidal anti-inflammatory drugs (NSAIDs).AimTo examine time-trends in preventive strategies.MethodsIn a study population comprising 50 126 NSAID users > or =50 years from the Integrated Primary Care Information database, we considered two preventive strategies: co-prescription of gastroprotective agents and prescription of a cyclooxygenase-2-selective inhibitor. In patients with > or =1 risk factor (history of upper-gastrointestinal bleeding/ulceration, age >65 years, use of anticoagulants, aspirin, or corticosteroids), correct prescription was defined as the presence of a preventive strategy and under-prescription as the absence of one. In patients with no risk factors, correct prescription was defined as the lack of a preventive strategy, and over-prescription as the presence of one.ResultsCorrect prescription rose from 6.9% in 1996 to 39.4% in 2006 (P < 0.01) in high-risk NSAID users. Under-prescription fell from 93.1% to 59.9% (P < 0.01). In the complete cohort, over-prescription rose from 2.9% to 12.3% (P < 0.01).ConclusionsUnder-prescription of preventive strategies has steadily decreased between 1996 and 2006; however, 60% of NSAID users at increased risk of NSAID complications still do not receive adequate protection.

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