TOWARD AN UNDERSTANDING OF NSAID-RELATED ADVERSE EVENTS - THE CONTRIBUTION OF LONGITUDINAL DATA

The ARAMIS (Arthritis, Rheumatism and Ageing Medical information Syste m) databanks have been used to objectify and quantify drug toxicity. T he relative risk of a gastrointestinal (GI)-provoked hospitalization w as more than five times greater in patients taking non-steroidal anti- inflammatory drugs.(NSAIDs) than in non-NSAID-treated patients, with a n excess hospitalization rate of 1.3% per annum. Additionally, there w as an excess GI-related death rate of around 3% in rheumatoid arthriti s (RA) patients compared with the normal population. Age, previous NSA ID-related GI events, prednisone use, higher doses and greater disabil ity predicted high-risk patients. A toxicity index showed clear differ ences between NSAIDs, with aspirin, salsalate and ibuprofen emerging a s the least toxic, and meclofenamate and indomethacin as the most toxi c. Disease modifying anti-rheumatic drugs (DMARDs) were, surprisingly, found to have similar toxicity scores to the NSAIDs. This supports th e contemporary practice of employing DMARDs earlier and more aggressiv ely in the course of RA.