A panel rated the appropriateness of NSAIDs, COX-2 inhibitors, and PPIs across 304 clinical scenarios, recommending NSAID alone for low-risk patients <65 years and adding a PPI or using a COX-2 inhibitor for those with prior GI events or on aspirin.
This consensus panel provides appropriateness ratings for NSAID, COX-2 inhibitor, and PPI use based on patient age, gastrointestinal risk, and concurrent aspirin use.
AIM: To rationalize decision making around the use of different non-steroidal anti-inflammatory drug (NSAID) treatment strategies in patients with varying degrees of gastrointestinal and cardiovascular risk. METHODS: The panel comprised nine physicians (three rheumatologists, two internists, two gastroenterologists and two cardiologists) from geographically diverse areas practising in community-based settings (n = 4) and academic institutions (n = 5). A literature review was performed by the authors on the risks, benefits and costs of NSAIDs, cyclo-oxygenase-2-specific inhibitors and proton pump inhibitor co-therapy. The RAND/UCLA Appropriateness Method was used to rate 304 clinical scenarios as 'appropriate', 'uncertain' or 'inappropriate'. RESULTS: In patients with no previous gastrointestinal event and not concurrently on aspirin (low risk), the panel rated the use of an NSAID alone as 'appropriate' for those aged 65 years and at low risk, an NSAID or cyclo-oxygenase-2-specific inhibitor alone was rated as 'uncertain'. For patients with a previous gastrointestinal event or who concurrently received aspirin, an NSAID alone was rated as 'inappropriate', and either a cyclo-oxygenase-2-specific inhibitor or an NSAID +proton pump inhibitor was rated as 'appropriate'. Finally, for patients with a previous gastrointestinal event and on aspirin, an NSAID or cyclo-oxygenase-2-specific inhibitor in conjunction with a proton pump inhibitor was rated as 'appropriate'. CONCLUSIONS: Clinicians and managed care entities need to balance the risks, benefits and costs of NSAIDs, cyclo-oxygenase-2-specific inhibitors and the prophylactic use of proton pump inhibitors. The guidelines given here can assist this process.
Dubois et al. (Thu,) conducted a review in Patients requiring chronic anti-inflammatory therapy. NSAIDs, COX-2 inhibitors, and proton pump inhibitors was evaluated on Appropriateness rating of clinical scenarios. A panel rated the appropriateness of NSAIDs, COX-2 inhibitors, and PPIs across 304 clinical scenarios, recommending NSAID alone for low-risk patients <65 years and adding a PPI or using a COX-2 inhibitor for those with prior GI events or on aspirin.