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Gastroprotective agents may benefit elderly NSAID users
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Elderly patients on an NSAID regimen appeared to benefit from co-prescriptions of gastroprotective agents to prevent GI events related to treatment in a recent study.
Researchers performed a systematic review of 23 observational studies of elderly patients (aged 65 years and older) in which data was included on co-prescriptions of NSAIDs and gastroprotective medications, and/or the efficacy of gastroprotective medication among NSAID users. All studies were collected from Embase and MEDLINE. Five studies provided data on co-prescription rates and treatment efficacy, 14 included co-prescription rates only and three only included efficacy data.
Co-prescription of NSAIDs and gastroprotective agents was reported in a median of 23.6% of patients across 19 studies (range, 10.2% to 69.4%). Eight of 11 studies indicated an association between age and co-prescription rate. Other factors significantly associated with co-prescription included a history of upper GI issues (seven of seven studies), female sex (four of seven studies) and concurrent use of corticosteroids (seven of seven studies), anticoagulants (four of six studies) and aspirin (two of three studies). Risk of bias was considered low among the co-prescription studies.
All eight efficacy studies on gastroprotective medications were beneficial. Investigators, however, were unable to synthesize adjusted results from these studies, and significant heterogeneity (I2=97%) was observed among five studies with evaluable unadjusted results.
Cost-effectiveness was assessed in two studies, yielding contradictory results. No studies provided information on the adverse effects caused by the gastroprotective agents, but increasing age was significantly associated with increased risk for GI events, while PPI use was found to be protective across four studies.
“The observational evidence for the effectiveness of co-prescription of gastroprotective agents with NSAIDs to prevent GI events in elderly patients is in concordance with the evidence from randomized controlled trials in high-risk patients,” the researchers concluded. “However, the evidence is insufficient to quantify this effect in a meta-analysis, and we cannot extrapolate to determine at what age NSAID treatment should be accompanied by gastroprotective agents and what the effect would be if a higher percentage of elderly patients received gastroprotection.”
Disclosure: The researchers report no relevant financial disclosures.
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