Risk of peptic ulcer hospitalizations in users of NSAIDs with gastroprotective cotherapy versus coxibs
Risk of peptic ulcer hospitalizations in users of NSAIDs with gastroprotective cotherapy versus coxibs
复制标题
DOI：
10.1053/j.gastro.2007.06.058
复制
发表时间：
2007-09-01
期刊：
影响因子：
29.4
通讯作者：
Griffin, Marie R.
中科院分区：
文献类型：
--
作者：
Ray, Wayne A.;Chung, Cecilia P.;Griffin, Marie R.
背景与目的：降低传统非甾体抗炎药（NSAIDs）引起的严重胃病风险的主要策略是使用coxib或同时使用质子泵抑制剂或双剂量组胺-2受体拮抗剂。然而，这些治疗方案的相对临床效果尚未得到充分研究。方法：我们研究了1996年至2004年间田纳西州医疗补助计划入选者的消化性溃疡住院情况。为了减少潜在的“通道”偏差，该研究仅纳入了处方NSAID或coxib使用的新发作，并控制了上消化道疾病的多个基线危险因素。NSAID和coxib分别有234,010和48,710例新发作，随访363,037人年，1223例消化性溃疡住院。结果：目前使用非甾体抗炎药且未进行胃保护辅助治疗的患者消化性溃疡住院率为5.65 / 1000人-年，是目前未使用非甾体抗炎药或coxibs患者的2.76倍（95%可信区间，2.35-3.23）。对于目前使用非甾体抗炎药并进行胃保护联合治疗的患者，这一风险降低39% (16%-56%,95% CI)，对于目前使用coxibs而不进行这种联合治疗的患者，这一风险降低40%（23% - 54%）。同时使用非甾体抗炎药和质子泵抑制剂的患者风险降低54%(27%-72%)，与同时使用质子泵抑制剂和coxib的患者风险降低50%（27%- 66%）非常相似。结论：这些研究结果表明，质子泵抑制剂与非甾体抗炎药联合使用在降低非甾体抗炎药引起的胃病风险方面与使用coxib一样有效。
Background & AiMS: The primary strategies to reduce the risk of serious gastropathy caused by traditional nonsteroidal anti-inflammatory drugs (NSAIDs) are use of a coxib or concurrent use of a proton pump inhibitor or double-dose histamine-2 receptor antagonist. However, the relative clinical effectiveness of these therapeutic alternatives is understudied. Methods: We studied peptic ulcer hospitalizations in a cohort of Tennessee Medicaid enrollees between 1996 and 2004. To decrease potential '' channeling '' bias, the study included only new episodes of prescribed NSAID or coxib use and controlled for multiple baseline risk factors for upper gastrointestinal disease. There were 234,010 and 48,710 new episodes of NSAID and coxib use, respectively, with 363,037 person-years of follow-up and 1223 peptic ulcer hospitalizations. Results: Current users of NSAIDs with no gastroprotective cotherapy had an adjusted incidence of peptic ulcer hospitalizations of 5.65 per 1000 person-years, 2.76 (95% confidence interval, 2.35-3.23) times greater than that for persons not currently using either NSAIDs or coxibs. This risk was reduced by 39% (16%-56%, 95% CI) for current users of NSAIDs with gastroprotective cotherapy and 40% (23%54%) for current users of coxibs without such cotherapy. Concurrent users of NSAIDs and proton pump inhibitors had a 54% (27%-72%) risk reduction, very similar to the 50% (27%- 66%) reduction for concurrent users of proton pump inhibitors and coxibs. Conclusions: These findings suggest that coprescribing a proton pump inhibitor with an NSAID is as effective as use of a coxib for reducing the risk of NSAID-induced gastropathy.