NONSTEROIDAL ANTIINFLAMMATORY DRUGS AND ULCER COMPLICATIONS - A RISK FACTOR-ANALYSIS FOR CLINICAL DECISION-MAKING

Background: Use of non-steroidal anti-inflammatory drugs (NSAIDs) is r ecognized as an important cause of peptic ulcer complications. The aim of this nested case-control study was to identify risk factors for NS AID-related ulcer complications. Methods: Cases were consecutive NSAID users admitted with an ulcer complication (n = 118), and controls wer e a random sample of all NSAID users without ulcer complication identi fied by a pharmacoepidemiologic database (n = 540). Results: Ninety-fo ur of 118 cases were interviewed, and 324 of 540 controls answered the questionnaire. Analysis showed no difference between included and non -included subjects. Risk factors for patients at start of NSAID therap y were high age: 60-75 years (odds ratio (OR), 3.5 (95% confidence int erval (Cl), 1.8-7.1); >75 years (OR, 8.9 (4.3-18.3)); male sex (OR 1.7 (1.0-3.0)); ulcer history (OR 2.5 (1.2-5.1)); steroid treatment (OR 2 .0 (0.8-4.6)); smoking (OR 1.6 (0.9-2.7)); and alcohol use (OR 1.8 (0. 9-3.6)). Risk factors for patients receiving NSAID therapy were high a ge, male sex, ulcer history, smoking, and, furthermore, dyspepsia (OR 2.0 (1.0-4.2)), especially NSAID-related dyspepsia (OR 8.7 (4.0-18.9)) . Risk was lower for patients treated more than 3 months. Conclusion: Risk measured from this design can be shown to correlate strongly with the rate difference, a measure that is more clinically relevant than conventional relative risk estimates. Strong risk factors for NSAID-re lated ulcer complication are high age, male sex, ulcer history, and dy spepsia related to the NSAID therapy. Avoiding NSAID therapy in these high-risk patients, whenever possible, might prevent many adverse even ts.