Risk of upper gastrointestinal adverse events in Malaysian rheumatic patients on long-term non-steroidal antiinflammatory drugs
Journal Title: International Journal of Clinical Rheumatology - Year 2018, Vol 13, Issue 3
Abstract
Background: Non-steroidal anti-inflammatory drug (NSAID)-induced upper gastrointestinal (GI) adverse events are well-described in the Western population but data is lacking in Asian patients. This study aims to describe the incidence and predictive factors for NSAID-induced upper GI complications in a cohort of multi-ethnic patients in Malaysia. Methods and Findings: A retrospective cohort study was conducted in adult patients with rheumatoid arthritis (RA) and/or osteoarthritis (OA) from 2010-2013 in four main rheumatology centres in Malaysia with computerized clinical and pharmaceutical records. Clinical, pharmaceutical and demographic data over a 24-months follow-up period were analysed in subjects who were prescribed long-term NSAID therapy (defined as a minimum duration of four weeks). 634 patients were included in the final analysis with the following characteristics: mean age 53.4 ± 12.5 years, 89.9% female, diagnosis: RA 59.5%, OA 10.2% and RA/OA combination 30.3%. 371 (58.5%) patients received non-selective NSAIDs and 263 (41.5%) patients received COX-2 inhibitors. There were a total of 84 GI adverse events during the period of study, giving an incidence rate of 66.2 per 1000 person-years and a risk of 13.2%. The majority of upper GI adverse events was dyspepsia (92.9%), and only 7.1% with peptic ulcer disease/ upper GI bleeding. Multivariate analysis showed that the only independent predictive factor of upper GI adverse event in this cohort was a history of upper GI disease (O.R. 2.073, 95% C.I. 1.029 – 4.176). COX-2 inhibitor showed a trend towards, but not independently predictive of, GI protection in this analysis (OR 0.643; 95% C.I. 0.397 – 1.043). Conclusion: Malaysian rheumatic patients on long-term NSAID therapy, managed at referral centres, have a 13.2% risk of upper GI adverse events, with dyspepsia being the commonest complication. Patients with a history of upper GI disease were twice as likely to develop further upper GI adverse events with the use of long-term NSAIDs.
Authors and Affiliations
Lydia Say Lee Pok, Fatiha Hana Shabaruddin, Maznah Dahlui, Sargunan Sockalingam, Mohd Shahrir Said, Azmillah Rosman, Ing-Soo Lau, Liza Mohd Isa, Heselynn Hussein, Chin Teck Ng, Sanjiv Mahadeva
Keywords
Related Articles
- EP ID EP604496
- DOI -
- Views 46
- Downloads 0
Nanomedicine in rheumatology: A new field in the diagnosis and therapy of rheumatic diseases
Nanomedicine is a prolific and vastly expanding field of medicine rendering important new avenues to improve diagnosis and treatment of human maladies. However, safety of the nanomaterials and therapeutic agents must be...
Mobile health applications in rheumatology: Could they improve our care and research?
With>165,000 mobile health apps available on iTunes and Google Play mHealth is a rapidly growing field, which generated high expectations for the improvement of our health care. We identify two uses for mHealth in the fi...
Application of treat-to-target principles in patients with early rheumatoid arthritis in routine clinical practice in Central-Eastern Europe
Objective: Understanding the extent to which treat-to-target (T2T) recommendations are applied by rheumatologists in patients with rheumatoid arthritis (RA) may identify gaps or issues in disease management. This study e...
Sickle cell trait in orthopaedic surgery: A real issue or just a bogeyman
Sickle cell disease is a hereditary blood disease characterized by the production of abnormal haemoglobin. HbS precipitates in the red cells under specific circumstances. The sickle cell trait (SCT), long considered an a...
Hyperuricemia as an independent predictor and prognostic factor in the development of lupus nephritis
Background: Lupus nephritis (LN) can increase morbidity and mortality risk in systemic lupus erythematosus (SLE) and 25% of the patients with LN will advance to end-stage renal disease. Objective: To evaluate if hyperuri...