The rate of prescribing gastrointestinal prophylaxis with either a proton pump inhibitor or an H2-receptor antagonist in Nova Scotia seniors starting nonsteroidal anti-inflammatory drug therapy

BACKGROUND: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used agents that can cause serious gastrointestinal (GI) side effects For patients at increased risk of NSAID-related GI complications, prophylaxis with either a nonselective NSAID plus gastroprotective agent (GP) or, alternatively, therapy with a cyclooxygenase-2 selective inhibitor with or without a GPA such as a proton pump inhibitor (PPI), is recommended AIM: To describe the rate, timing and duration of GI prophylaxis in Nova Scotia seniors receiving nonselective NSAIDs METHODS: The Nova Scotia Seniors' Pharmacare Program beneficiaries for the years 1998 to 2002 were studied A cohort of incident NSAID and GPA users was selected from all nonselective NSAID users (no prescribed NSAID dispensed 12 months before the index month and no GPA dispensed two months before the index prescription) Monthly coprescribing rates were calculated by dividing the number of patients in the cohort using GPAs by the number of NSAID users GI prophylactic coprescribing was defined as the coprescribing rate present at the first month (index month) of prescribing an NSAID RESULTS: The cohort consisted of 12,906 patients Seventy-five per cent of die nonselective NSAID prescriptions dispensed were for up to two months duration, with only 2 3% longer than one year Cl prophylaxis was given to only 3 8% of patients starting NSAIDs who were not on a GPA in the two months before starting NSAIDs Of this 3 8%, 92 7% of the patients received H-2-receptor antagonists (H2RAs), and 7% received PPIs The rate of H(2)RA coprescribing increased with the number of consecutive months on an NSAID from 3.5% in the first month to 24 1% at 48 months For PPIs, the coprescribing rate increased from 0 3% to 1 996 of all NSAID users in the cohort The rate of gastroprophylaxis coprescribing for patients receiving NSAIDs did not rise with increasing age CONCLUSION: In Nova Scotian seniors using nonselective NSAIDs. the rate of GI prophylaxis was low Most patients received H2RAs as GPAs despite evidence that they offer insufficient protection.