NSAIDs associated with increased mortality from GI complications. (nonsteroidal anti-inflammatory drugs; gastrointestinal)
(Geriatrics)

WASHINGTON, DC - More than 16,000 persons with rheumatic disease die of gastrointestinal complications each year, almost as many as who die of leukemia, according to the first prospective study of nonsteroida anti-inflammatory drug (NSAID)-related GI pathology to use a survival analysis of long-term data.
Some 3,883 rheumatoid arthritis patients from eight centers in North America were followed for a total of 19,691 patient years. Researchers identified 417 hospitalizations among 303 patients (average age, 57). Considering only the first hospitalization for each patient, the annual incidence rate for hospitalization was 1.31%. The relative risk on
NSAID therapy was 6.89 and on prednisone alone was 6.42. The combination of the two more than doubled the risk, reported Gurkipal Singh, MD,a clinical assistant professor of medicine at Stanford University.

Using this incidence rate, Dr. Singh estimated that at least 16,500 rheumatic disease patients die of GI complications each year, almost as many as the 18,000 who die of leukemia. "Severe GI events are not infrequent, and physicians must figure out which patients are at greatest risk," he said.

A lifetable analysis showed that the hazard rate for NSAID toxicity was constant over a 10-year period. The risk did not decrease with time on drugs. Nearly 81% of all patients who had a serious GI complication did not have any prior warning symptoms. Risk factors identified by a hazard model included age, disease duration, disability index, pain
score, and time on prednisone.

Stanford researchers have developed a simple risk factor calculator that permits treating physicians to estimate the risk for serious NSAID-related GI complications in any patient for the next year. The self-assessment questionnaire, filled out in 2 minutes in the physician's waiting room, can help select appropriate, safe medications, said Dr. Singh.

"High-risk patients should not take NSAIDs or take only the safest ones along with misoprostol," he said. He identified some lower-risk NSAIDs as etodolac (Lodine), nabumetone (Relafen), salsalate, and sulindac.

Author not available, NSAIDs associated with increased mortality from GI complications. (nonsteroidal anti-inflammatory drugs; gastrointestinal). Vol. 53, Geriatrics, 01-01-1998, pp 67(1).

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