期刊
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY
卷 74, 期 2, 页码 370-375出版社
WILEY-BLACKWELL
DOI: 10.1111/j.1365-2125.2012.04191.x
关键词
Clostridium difficile; diclofenac; NSAID; risk factor
资金
- Canadian Institutes of Health Research
- Canadian Foundation for Innovation
- Fonds De La Recherche en Sante du Quebec (FRSQ)
AIM Several case reports have linked diclofenac, a non-steroidal anti-inflammatory drug (NSAID), with Clostridium difficile associated disease (CDAD). We assessed whether NSAID use in general, and diclofenac use in particular, is associated with an increased risk of CDAD. METHODS We used the United Kingdom's General Practice Research Database (GPRD) to conduct a population-based case-control study. All cases of CDAD occurring between 1994 and 2005 were identified and were matched to 10 controls each. Conditional logistic regression was used to estimate the odds ratio of CDAD associated with current NSAID use, adjusting for covariates. RESULTS We identified 1360 CDAD cases and 13 072 controls. We found an increased risk of CDAD associated with diclofenac (adjusted odds ratio (RR) 1.35, 95% confidence interval (CI) 1.10, 1.67). We did not observe an increased risk of CDAD with use of any other NSAID. No dose-response for diclofenac exposure was found. When we analyzed only patients who were not hospitalized in the year before the index date, we found diclofenac to have a similar effect on CDAD risk (adjusted RR 1.43, 95% CI 1.11, 1.84). CONCLUSION Diclofenac use is associated with a modest increase in the risk of CDAD. In patients at risk of CDAD, other NSAIDs could be prescribed.
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