Risk of upper gastrointestinal bleeding with oral bisphosphonates and non steroidal anti-inflammatory drugs: a case-control study
Risk of upper gastrointestinal bleeding with oral bisphosphonates and non steroidal anti-inflammatory drugs: a case-control study
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DOI：
10.1111/j.1365-2036.2009.03989.x
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发表时间：
2009-06-01
影响因子：
7.6
通讯作者：
Brophy, J. M.
中科院分区：
文献类型：
--
作者：
Etminan, M.;Levesque, L.;Brophy, J. M.
胃肠道损伤，包括胃溃疡，已报道与口服双膦酸盐治疗。然而，更严重的上消化道出血（UGB）的风险，特别是在社区环境中使用这些药物仍然未知。同样，社区中双膦酸盐和非甾体抗炎药（NSAIDs）使用者UGB的风险也是未知的。探讨社区中双膦酸盐使用者发生更严重UGB的风险以及双膦酸盐和非甾体抗炎药使用者发生UGB的风险。我们对1995年至2004年间接受过血运重建术的魁北克居民进行了一项病例对照研究。队列成员从他们的第一次手术之日起随访，直到最早：(1)研究结果，(2)死亡日期或(3)医疗保险结束。病例定义为首次诊断为UGB的病例。对于每个病例，选择20个对照，并根据索引日期、年龄和队列条目与病例匹配。计算当前使用双膦酸盐、非甾体抗炎药和两种药物联合治疗的调整优势比。在初始队列中，确定了3253例UGBs事件和相应的65060例匹配对照。目前双膦酸盐使用者UGB的调整优势比（OR）为1.01 （95% CI, 0.72-1.43）。目前使用非甾体抗炎药与UGB风险增加相关OR = 1.75；95% ci, 1.53-1.99。使用双膦酸盐和非甾体抗炎药的OR升高OR = 2.00；95% ci, 1.12-3.57。对于使用双膦酸盐和COX-2抑制剂的患者，这种风险仍然升高[OR = 2.38 (95% CI, 1.26-4.50)]。我们没有发现在目前使用双磷酸盐的人群中UGB风险增加的证据。非甾体抗炎药联合双膦酸盐治疗的风险增加，但这种风险并不高于单独使用非甾体抗炎药的风险。
Gastrointestinal injuries including gastric ulcers have been reported with oral bisphosphonate therapy. However, the risk of the more serious upper gastrointestinal bleeding (UGB) especially in the community setting with these drugs remains unknown. Similarly, the risk of UGB among users of both bisphosphonates and non steroidal anti-inflammatory drugs (NSAIDs) in the community is also unknown.To explore the risk of more serious UGB among users of bisphosphonates and the risk of UGB among users of both bisphosphonates and NSAIDs in the community.We conducted a case-control study within a cohort of Quebec residents who had received a revascularization procedure from 1995 to 2004. Cohort members were followed up from the date of their first procedure until the earliest of: (1) study outcome, (2) date of death or (3) end of health care coverage. Cases were defined as those with the first diagnosis of a UGB. For each case, 20 controls were selected and matched to the cases by index date, age and cohort entry. Adjusted odds ratios for current use of bisphosphonates, NSAIDs and co-therapy of both drugs were computed.Within the initial cohort, 3253 incident cases of UGBs and corresponding 65 060 matched controls were identified. The adjusted odds ratio (OR) for UGB by current users of bisphosphonates was 1.01 (95% CI, 0.72-1.43). Current NSAID use was associated with an increased risk of UGB OR = 1.75; 95% CI, 1.53-1.99. The OR for use of bisphosphonates and NSAIDs was elevated OR = 2.00; 95% CI, 1.12-3.57. This risk was still elevated for users of bisphosphonates and COX-2 inhibitors [OR = 2.38 (95% CI, 1.26-4.50)].We found no evidence of an increase in the risk of UGB among current users of bisphosphonates. The risk of combined NSAID and bisphosphonate therapy was increased, but this risk was not higher than the risk for NSAID users alone.