The rise and decline of nonsteroidal antiinflammatory drug-associated gastropathy in rheumatoid arthritis
The rise and decline of nonsteroidal antiinflammatory drug-associated gastropathy in rheumatoid arthritis
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DOI：
10.1002/art.20440
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发表时间：
2004-08-01
影响因子：
--
通讯作者：
Bruce, B
中科院分区：
文献类型：
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作者：
Fries, JF;Murtagh, KN;Bruce, B
目标。非甾体抗炎药（NSAID）相关胃病是住院和死亡的主要原因。本研究旨在研究近期的预防措施是否与非甾体抗炎药胃病发病率的下降有关，如果是这样，哪些措施可能导致发病率的下降。我们在8个地点研究了5,598例类风湿性关节炎（RA）患者，超过31,262例患者年。我们获得了以前用于确定非甾体抗炎药胃病发生率的患者的标准化纵向信息，以及患者危险因素和不同非甾体抗炎药毒性差异的信息。在1981年至2000年期间，连续的患者进行了一年两次的健康评估问卷和医疗记录审计。主要结局指标是涉及出血、梗阻或胃肠道穿孔及相关疾病的年住院率。gi相关住院率从1981年的0.6%上升到1992年的1.5% (P < 0.001)，然后下降到2000年的0.5% （P < 0.001）。拟合的样条曲线与数据拟合良好（R-2 = 0.70）。上升的时间主要与患者年龄和GI风险倾向评分的增加有关。下降的时间与布洛芬和阿司匹林的剂量降低，“毒性更强”的非甾体抗炎药的使用从52%下降到42%，“更安全”的非甾体抗炎药的使用从19%上升到48%，质子泵抑制剂的使用增加有关，但与年龄、非甾体抗炎药暴露或GI风险倾向评分无关。自1992年以来，这些队列中发生严重非甾体抗炎药胃病的风险下降了67%。我们估计24%的下降是低剂量非甾体抗炎药的结果，18%与使用质子泵抑制剂有关，14%与使用毒性较低的非甾体抗炎药有关。非甾体抗炎药胃病发病率的下降可能会持续下去。
Objective. Nonsteroidal antiinflammatory drug (NSAID)-associated gastropathy is a major cause of hospitalization and death. This study was undertaken to examine whether recent preventive approaches have been associated with a declining incidence of NSAID gastropathy, and, if so, what measures may have caused the decline.Methods. We studied 5,598 patients with rheumatoid arthritis (RA) over 31,262 patient-years at 8 sites. We obtained standardized longitudinal information on the patients that had been previously used to establish the incidence of NSAID gastropathy, and also information on patient risk factors and differences in toxicity between NSAIDs. Consecutive patients were followed up with biannual Health Assessment Questionnaires and medical record audits between 1981 and 2000. The major outcome measure was the annual rate of hospitalization involving bleeding, obstruction, or perforation of the gastrointestinal (GI) tract and related conditions.Results. Rates of GI-related hospitalizations rose from 0.6% in 1981 to 1.5% in 1992 (P < 0.001), and then declined to 0.5% in 2000 (P < 0.001). The fitted spline curve fit the data well (R-2 = 0.70). The period of rise was mainly associated with increasing patient age and the GI risk propensity score. The period of decline was associated with lower doses of ibuprofen and aspirin, a decline in the use of "more toxic" NSAIDs from 52% to 42% of patients, a rise in the use of "safer" NSAIDs from 19% to 48% of patients, and increasing use of proton-pump inhibitors, but not with change in age, NSAID exposure, or GI risk propensity score.Conclusion. The risk of serious NSAID gastropathy has declined by 67% in these cohorts since 1992. We estimate that 24% of this decline was the result of lower doses of NSAIDs, while 18% was associated with the use of proton-pump inhibitors and 14% with the use of less toxic NSAIDs. These declines in the incidence of NSAID gastropathy are likely to continue.