Gastrointestinal-Related Complications in a Long-Term Care Population Taking NSAIDs Versus COX-2 Inhibitor Therapy

OBJECTIVES: To determine the following in a long-term care population taking traditional nonsteroidal anti-inflammatory drug (NSAID) or cyclo-oxygenase-2 (COX-2) inhibitor therapy: (1) incidence of gastrointestinal (GI) adverse events and GI-related hospitalizations, (2) prevalence of GI-protective medication use, and (3) prevalence of GI risk factors as defined by Indiana Medicaid prior-authorization criteria. DESIGN: Longitudinal cross-sectional study. SETTING: Long-term care facilities in Indiana. PATIENTS: Residents in long-term care and assisted-living facilities were included if they were receiving either traditional NSAID or COX-2 inhibitor therapy. MAIN OUTCOME MEASURES: The number of residents experiencing GI intolerance or complications or GI-related hospitalizations associated with NSAID or COX-2 inhibitor use. RESULTS: Over this 14-month evaluation period, 1,198 long-term care and assisted living residents were identified as receiving NSAID or COX-2 inhibitor therapy. Celecoxib was the most frequently prescribed medication used in this population. Age >70 years and concomitant aspirin use were the most frequently noted risk factors for GI disease. Significantly fewer GI complications were observed in COX-2 recipients (4.0%) compared with NSAID users (8.4%) (P = 0.002). GI-related hospitalizations occurred significantly less with COX-2 use (2.0%) compared with traditional NSAID use (4.5%) (P = 0.014). A relatively low incidence of GI-related events also was associated with ibuprofen use. CONCLUSION: Individuals residing in assisted living or long-term care settings had lower rates of GI complications and hospitalizations related to COX-2 inhibitors compared with traditional NSAIDs.