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140 HIGH INTENSITY PROTON PUMP INHIBITOR (PPI) THERAPY IS NOT SUPERIOR TO STANDARD INTENSITY PPI THERAPY FOR PREVENTION OF GASTROINTESTINAL COMPLICATIONS IN NSAID USERS LE Targownik, CM Metge, S Leung, DG Chateau BACKGROUND: Proton pump inhibitors (PPIs) have been shown to decrease the risk of gastrointestinal complications in NSAID users when given at standard doses, though the risk is not eliminated. It is unknown whether higher intensity of PPI therapy would provide a greater reduction in the risk of NSAID-related gastrointestinal complications.
Department of Internal Medicine and Pharmacy, University of Manitoba, Winnipeg, Manitoba
METHODS: We used the Manitoba Health Population Health Research Data Repository to perform a population based matched case-control analysis. We identified all subjects who were using NSAIDs at the time of admission to hospital for an upper gastrointestinal complication, and matched them to ten age- and sex-matched NSAID using controls who had not had a history of a GI complication on the date of interest. The main predictor of interest was PPI intensity, with high-intensity dosing defined as subjects using more than 1.5 times the standard dose of PPI per day immediately prior to the index date. We adjusted for multiple covariates, including history of previous GI events, comorbid illnesses and prior hospitalizations, use of corticosteroids, warfarin, and clopidogrel, and socioeconomic status.
RESULTS: We identified 1730 NSAID users admitted with upper gastrointestinal complications, who were matched to 17300 NSAID using controls. PPIs were actively used by 9.2% cases at the time of the event vs 2.9% of controls (P<0.001). 15.0% of PPI use among cases was at high intensity, compared with 18.9% of controls (p<0.001). Cases were significantly more likely to have severe comorbid illness or a history of gastrointestinal complications, and were more likely to use other medications associated with an increased risk of GI complications. After adjusting for multiple confounders, high-intensity PPI use was associated with a non-significantly decreased likelihood of developing a GI complication when compared with standard dose PPI users (OR 0.77, 95% CI 0.43-1.40).
CONCLUSIONS: High-intensity PPI therapy is not superior to standard doses of PPIs in prevention of NSAID-related GI complications. Further study is required to determine if there remains a role for high-intensity PPI use in preventing NSAID-related GI complications in patients at elevated baseline risk for these events.