Short‐term use of glucocorticoids and risk of peptic ulcer bleeding: a nationwide population‐based case‐crossover study

Tseng, Chi-Lung; Chen, Yei Tsung; Huang, Chin‐Chou; Luo, Jiing Chyuan; Peng, Yuting; Huang, Der-Chen; Hou, Ming; Lin, Han Chieh; Lee, F.-Y.

doi:10.1111/apt.13298

Cited by 41 publications

(16 citation statements)

References 34 publications

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“…A retrospective review of 92 haematology inpatients post chemotherapy found that 70% of patients with gut‐derived bacteraemia were on PPI therapy compared with 48% without bacteraemia, but confounding factors could not be excluded . A study in healthy volunteers which analysed gut flora pre‐ and post‐PPI therapy demonstrated changes in specific taxa, including Streprococcaceae and Enterococcaceae, which may lead to increased risk of Clostridium difficile infection …”

Section: Literature Reviewmentioning

confidence: 99%

“…7 A study in healthy volunteers which analysed gut flora pre-and post-PPI therapy demonstrated changes in specific taxa, including Streprococcaceae and Enterococcaceae, which may lead to increased risk of Clostridium difficile infection. 40 Retrospective review of prescribing practices in clinical haematology at our institution Over the 14-months of our institutional retrospective review of PPI prescribing, 14 919 prescriptions were prescribed for PPI across all patients, 1123 of which were prescribed to haematology patients. Patients were grouped according to their disease state and the analyses of the appropriateness of PPI prescribing at the initiation and cessation of treatment showed that:…”

Section: Chemotherapy-related Mucositismentioning

confidence: 99%

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Is there a role for proton pump inhibitor prophylaxis in haematology patients?

Leitinger

Hui

Grigg

2019

Internal Medicine Journal

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While proton pump inhibitors (PPI) are widely prescribed as prophylaxis in selected haematology inpatient and outpatients, an informal survey of haematology units around Australia found wide variations in the specific indications for their use. This is consistent with a literature review which showed a paucity of robust evidence to support their use, specifically in chemotherapy‐induced mucositis, thrombocytopenia or administration of high dose glucocorticosteroids in the absence of additional risk factors. Rationalising PPI prescribing is clinically important from both a cost and safety perspective, given the emerging evidence of adverse events associated with prolonged PPI administration. A review of prescribing practices at our institution over a 14‐month period found that approximately 60% of myeloma, lymphoma and autograft patients received PPI prophylaxis during and beyond chemotherapy without an accepted indication. We encourage institutions to review their PPI prescribing practices with the intent of rationalising their use, and to conduct studies aiming to fill the substantial gaps in our knowledge.

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Section: Literature Reviewmentioning

confidence: 99%

Section: Chemotherapy-related Mucositismentioning

confidence: 99%

Is there a role for proton pump inhibitor prophylaxis in haematology patients?

Leitinger

Hui

Grigg

2019

Internal Medicine Journal

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“…No study investigated gastroprotective measures in glucocorticoid users specifically. The rationale for gastroprotective medication is given by the slightly increased risk for gastrointestinal adverse effects by treatment with glucocorticoids (relative risk: 1.1, CI: 0.5-2.1 [33] and odds ratio: 1.73, CI: 1.34-2.23 [34]) and the around threefold to fourfold increased risk when glucocorticoid treatment is combined with use of nonsteroidal anti- inflammatory drugs (NSAIDs) [33,34]. Several treatment regimens have been shown to be gastroprotective.…”

Section: Pharmacotherapymentioning

confidence: 99%

Can adverse effects of glucocorticoid therapy be prevented and treated?

Goes

Strehl

Buttgereit

et al. 2016

Expert Opinion on Pharmacotherapy

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“…Several observational studies have described risk factors for NSAID‐induced upper GI complications expressed as odds ratios (OR) or relative risk (RR). Risk factors for NSAID‐induced upper GI complications include advanced age, history of peptic ulcer and concomitant therapy, including aspirin, other NSAIDs, anticoagulants or corticosteroids and SSRI . These risk factors are all well‐established, as are their relative risk measures.…”

Section: Introductionmentioning

confidence: 99%

A model to predict the risk of aspirin/non‐steroidal anti‐inflammatory drugs‐related upper gastrointestinal bleeding for the individual patient

Petersen

Hansen

Muckadell

et al. 2019

Basic Clin Pharma Tox

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Upper gastrointestinal bleeding is a feared complication of using non‐steroidal anti‐inflammatory drugs (NSAIDs) or aspirin. Studies predicting the incidence rate for individuals with a given set of characteristics are lacking. The aim of this study was to develop a risk model to predict the incidence rate of upper gastrointestinal bleeding (UGIB) in users of aspirin/NSAID based on presence of well‐defined risk factors for the individual patient. Methods The model was developed from data from a case‐control study, sampled from a well‐defined source population, residents of the Funen County 1995‐2006. All cases and controls were characterized in terms of factors known to affect the risk of UGIB. By using census data, we rescaled the control group, so their composition accurately reflected age and sex distribution of the source population. Only persons using NSAIDs or/and aspirin and no PPI were included in the analysis. As reference group, we chose 80‐ to 89‐year‐old women with no ulcer history, using NSAID, but neither aspirin, other platelet inhibitors, vitamin K antagonists, selective serotonin reuptake inhibitors nor corticosteroids. Results We identified 1388 cases among non‐users of PPIs. We found a modelled baseline incidence rate of 10.7 per 1000 person‐years for the reference group. The strongest associations were found for ADP inhibitors (OR 5.80), followed by anticoagulants treatment (OR 2.62) and prior ulcer (OR 2.68). The model performed well in terms of calibration and discriminatory power. Conclusion This study is the first to describe a model, which estimates the incidence rate of UGIB for patients using aspirin/NSAID, based on the specific combination of risk factors. Risk of upper gastrointestinal bleeding for a given patient can be accurately estimated using this model.

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Short‐term use of glucocorticoids and risk of peptic ulcer bleeding: a nationwide population‐based case‐crossover study

Abstract: SUMMARY BackgroundControversy exists regarding glucocorticoids therapy and the risk of peptic ulcer bleeding (PUB).

Cited by 41 publications

References 34 publications

Is there a role for proton pump inhibitor prophylaxis in haematology patients?

Is there a role for proton pump inhibitor prophylaxis in haematology patients?

Can adverse effects of glucocorticoid therapy be prevented and treated?

A model to predict the risk of aspirin/non‐steroidal anti‐inflammatory drugs‐related upper gastrointestinal bleeding for the individual patient

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