Systematic review with network meta‐analysis: comparative effectiveness and safety of strategies for preventing <scp>NSAID</scp>‐associated gastrointestinal toxicity

Yuan, Jinqiu; Tsoi, Kelvin K.F.; Yang, Man; Wang, J. Y.; Threapleton, Diane; Yang, Zu‐Yao; Zhu, Bing; Chen, Mao; Tang, Jin; Chan, Francis K.L.

doi:10.1111/apt.13642

Cited by 69 publications

(56 citation statements)

References 41 publications

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“…In these patients, the combination of a PPI and a COX-2 inhibitor reduces the risk of upper GI bleeding compared to that of COX-2 inhibitor alone [28, 236]. A very recent network meta-analysis indeed found that this drug combination represents the best strategy to prevent ulcer complications [241]. …”

Section: Resultsmentioning

confidence: 99%

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Scarpignato

Gatta

Zullo³

et al. 2016

BMC Med

359

288

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BackgroundThe introduction of proton pump inhibitors (PPIs) into clinical practice has revolutionized the management of acid-related diseases. Studies in primary care and emergency settings suggest that PPIs are frequently prescribed for inappropriate indications or for indications where their use offers little benefit. Inappropriate PPI use is a matter of great concern, especially in the elderly, who are often affected by multiple comorbidities and are taking multiple medications, and are thus at an increased risk of long-term PPI-related adverse outcomes as well as drug-to-drug interactions. Herein, we aim to review the current literature on PPI use and develop a position paper addressing the benefits and potential harms of acid suppression with the purpose of providing evidence-based guidelines on the appropriate use of these medications.MethodsThe topics, identified by a Scientific Committee, were assigned to experts selected by three Italian Scientific Societies, who independently performed a systematic search of the relevant literature using Medline/PubMed, Embase, and the Cochrane databases. Search outputs were distilled, paying more attention to systematic reviews and meta-analyses (where available) representing the best evidence. The draft prepared on each topic was circulated amongst all the members of the Scientific Committee. Each expert then provided her/his input to the writing, suggesting changes and the inclusion of new material and/or additional relevant references. The global recommendations were then thoroughly discussed in a specific meeting, refined with regard to both content and wording, and approved to obtain a summary of current evidence.ResultsTwenty-five years after their introduction into clinical practice, PPIs remain the mainstay of the treatment of acid-related diseases, where their use in gastroesophageal reflux disease, eosinophilic esophagitis, Helicobacter pylori infection, peptic ulcer disease and bleeding as well as, and Zollinger–Ellison syndrome is appropriate. Prevention of gastroduodenal mucosal lesions (and symptoms) in patients taking non-steroidal anti-inflammatory drugs (NSAIDs) or antiplatelet therapies and carrying gastrointestinal risk factors also represents an appropriate indication. On the contrary, steroid use does not need any gastroprotection, unless combined with NSAID therapy. In dyspeptic patients with persisting symptoms, despite successful H. pylori eradication, short-term PPI treatment could be attempted. Finally, addition of PPIs to pancreatic enzyme replacement therapy in patients with refractory steatorrhea may be worthwhile.ConclusionsOverall, PPIs are irreplaceable drugs in the management of acid-related diseases. However, PPI treatment, as any kind of drug therapy, is not without risk of adverse effects. The overall benefits of therapy and improvement in quality of life significantly outweigh potential harms in most patients, but those without clear clinical indication are only exposed to the risks of PPI prescription. Adhering with evidence-based ...

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Section: Resultsmentioning

confidence: 99%

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Scarpignato

Gatta

Zullo³

et al. 2016

BMC Med

359

288

View full text Add to dashboard Cite

show abstract

“…Inhibition of COX-1 in the gastrointestinal tract leads to a reduction of prostaglandin secretion and its cytoprotective effects Peptic ulcer disease and non-steroidal anti-inflammatory drugs proton pump inhibitors were associated with the lowest absolute event probability for ulcer complications (0.07; 95% confidence interval 0.02-0.18). 13 This strategy may be the most effective way to reduce the risk of ulcer complications, followed by the use of a selective COX-2 inhibitor alone and a non-selective NSAID combined with a proton pump inhibitor. Importantly all three strategies were well tolerated by patients.…”

Section: Ulcers and Nsaidsmentioning

confidence: 99%

Peptic ulcer disease and non-steroidal anti-inflammatory drugs

Drini¹

2017

Aust Prescr

178

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“…Given that osteoarthritis patients are likely to consume NSAIDs and possess higher prevalence of UGIB risk in NSAIDs prescription, regardless of patients’ age[30]. Selective COX-2 inhibitors or concurrent prescription of proton pump inhibitors or misoprostol may be a good option for osteoarthritis patients with high risk of UGIB[28,34,35,39,40]. …”

Section: Discussionmentioning

confidence: 99%

Prevalence of upper gastrointestinal bleeding risk factors among the general population and osteoarthritis patients

Kim

Yun

Chang

et al. 2016

WJG

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AIMTo assess the prevalence of possible risk factors of upper gastrointestinal bleeding (UGIB) and their age-group specific trend among the general population and osteoarthritis patients.METHODSWe utilized data from the National Health Insurance Service that included claims data and results of the national health check-up program. Comorbid conditions (peptic ulcer, diabetes, liver disease, chronic renal failure, and gastroesophageal reflux disease), concomitant drugs (aspirin, clopidogrel, cilostazol, non-steroidal anti-inflammatory drugs, steroid, anticoagulants, and SSRI), personal habits (smoking, and alcohol consumption) were considered as possible UGIB risk factors. We randomly imputed the prevalence of infection in the data considering the age-specific prevalence of Helicobacter pylori (H. pylori) infection in Korea. The prevalence of various UGIB risk factors and the age-group specific trend of the prevalence were identified. Prevalence was compared between osteoarthritis patients and others.RESULTSA total of 801926 subjects (93855 osteoarthritis patients) aged 20 and above were included. The prevalence of individual and concurrent multiple risk factors became higher as the age increased. The prevalence of each comorbid condition and concomitant drug were higher in osteoarthritis patients. Thirty-five point zero two percent of the overall population and 68.50% of osteoarthritis patients had at least one or more risk factors of UGIB. The prevalence of individual and concurrent multiple risk factors in younger age groups were also substantial. Furthermore, when personal habits (smoking, and alcohol consumption) and H. pylori infection were included, the prevalence of concurrent multiple risk factors increased greatly even in younger age groups.CONCLUSIONPrevalence of UGIB risk factors was high in elderly population, but was also considerable in younger population. Patient with osteoarthritis was at higher UGIB risk than those without osteoarthritis. Physicians should consider individualized risk assessment regardless of age when prescribing drugs or performing procedures that may increase the risk of UGIB, and take necessary measures to reduce modifiable risk factors such as H. pylori eradication or lifestyle counseling.

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Systematic review with network meta‐analysis: comparative effectiveness and safety of strategies for preventing NSAID‐associated gastrointestinal toxicity

Abstract: The combination of selective COX-2 inhibitors plus PPIs provides the best gastrointestinal protection, followed by selective COX-2 inhibitors, and thirdly by nonselective NSAIDs plus PPIs.

Cited by 69 publications

References 41 publications

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Peptic ulcer disease and non-steroidal anti-inflammatory drugs

Prevalence of upper gastrointestinal bleeding risk factors among the general population and osteoarthritis patients

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