Adherence to proton pump inhibitors or H₂‐receptor antagonists during the use of non‐steroidal anti‐inflammatory drugs

Abstract

SUMMARYBackground: The efficacy of proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H 2 RAs) prescribed as prophylaxis for NSAID-related upper gastrointestinal (UGI) toxicity is dependent upon patient adherence. Aim: To describe patient adherence to prophylactically prescribed PPIs and H 2 RAs in the clinical setting. Methods: We conducted a retrospective observational cohort study using the Integrated Primary Care Information Project database. The study population consisted of incident non-specific NSAID users prescribed a PPI or H 2 RA specifically as prophylaxis for NSAID-related UGI toxicity. Patients were classified as non-adherent if < 75% of days of NSAID use were covered by one of these agents, and as continuing users after discontinuation of NSAID use if they had a renewed prescription for these agents after their last NSAID prescription. Results: The study cohort comprised 784 patients: 374 with H 2 RAs, 405 with PPIs, and 5 with both PPI and

Clinical trial: the incidence of NSAID‐associated endoscopic gastric ulcers in patients treated with PN 400 (naproxen plus esomeprazole magnesium) vs. enteric‐coated naproxen alone

“…[4][5][6][7][8][9]17 However, despite these guidelines, gastroprotective cotherapies are often underprescribed or prescribed at inadequate doses by physicians even in at-risk patients [18][19][20][21][22][23] and, among those who do receive gastroprotection, adherence is suboptimal, resulting in poorer clinical outcomes. 21,24,25 Thus, beyond physician and patient education regarding the importance of adherence, there is a need for effective therapies to address the issue of NSAID-associated gastrointestinal (GI) toxicity in at-risk patients.…”

“…24,25 As a result, there is a need for greater physician and patient education, and strategies to improve patient compliance reliably and consistently, particularly among those receiving chronic NSAID therapy where adherence to co-prescribed gastroprotective agents decreases markedly over time. 24,25 Beyond education, the use of fixed-dose combinations of NSAIDs and gastroprotective agents is one strategy with potential to address the issue of adherence directly. Other attempts to provide NSAID therapy with gastroprotection include combinations of diclofenac plus misoprostol (Arthrotec) 40 and ibuprofen plus high-dose famotidine.…”

Clinical trial: evaluation of gastric acid suppression with three doses of immediate‐release esomeprazole in the fixed‐dose combination of PN 400 (naproxen/esomeprazole magnesium) compared with naproxen 500 mg and enteric‐coated esomeprazole 20 mg: a randomized, open‐label, Phase I study in healthy volunteers

“…4 However, despite clinical guidelines, evidence from practice suggests that gastroprotective co-therapy strategies are underutilized by physicians 7 and poorly adhered to by patients. [8][9][10][11] Partly as a result of this, there has been growing interest in the use of fixed-dose combination therapies of NSAIDs with gastroprotective agents in a single tablet to, among other potential benefits, improve patient adherence. PN 400 (VIMOVO; AstraZeneca, Wilmington, DE, USA and POZEN, Inc., Chapel Hill, NC, USA) is a fixed-dose combination of EC naproxen 500 mg and immediate-release (IR) esomeprazole 20 mg that is in development for the treatment of the signs and symptoms of osteoarthritis, rheumatoid arthritis and ankylosing spondylitis in patients at risk for developing NSAIDassociated gastric ulcers.…”

Comparison of the Effectiveness of Geranylgeranylacetone with Cimetidine in Gastritis Patients with Dyspeptic Symptoms and Gastric Lesions: A Randomized, Double-Blind Trial in Japan

“…H 2 -receptor antagonists (H 2 RAs) and proton-pump inhibitors (PPIs) have been shown to be effective therapeutics in patients with gastric or duodenal ulcers [1, 2]. Mucoprotective drugs have also been shown to be as effective as H 2 RAs in the treatment of gastric ulcers and thus are the routine therapy of choice in Asian countries [3, 4].…”