외래 노인환자의 위장관계 및 심혈관계 위험도에 따른 NSAIDs 처방 적절성 평가

Abstract

Background : Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used for treating arthritis and other musculoskeletal disorders in a variety of clinical conditions. Long term use of NSAIDs causes mucosal injury including peptic ulcer, hemorrhage and perforation, and also cardiovascular disease. Therefore, the anti-inflammatory effect of NSAIDs needs to be balanced with the gastrointestinal and cardiovascular adverse effects. Methods : We retrospectively analyzed the medical records of outpatients more than 65 years old, who received NSAIDs from January to June 2015. Based on the American College of Gastroenterology (ACG) guideline (2009), we evaluated the use of NSAIDs according to the degree of gastrointestinal (GI) and cardiovascular (CV) risk in the patients. By degree of these risk factors, the patients were classified into 6 groups. Results : A total of 1,691 patients over 65 years received NSAIDs for more than 30 days. Mean duration of prescriptions was 62.8 (±30.7) days. Celecoxib was the most frequently prescribed drug, followed by zaltoprofen, aceclofenac and nabumetone. The group of CV low/GI low risk (4.6%, recommend non-selective NSAIDs) was appropriate in 29.5% patients, and group of CV low/GI moderate risk (65.8%, recommend NSAIDs and PPI/misoprostol or COX-2 inhibitor alone) was appropriate in 87.9% patients. Group of CV low/GI high risk (22.8%, recommend COX-2 inhibitor and PPI) was appropriate in 55.4% cases. However, the group of CV high/GI moderate risk (5.6%, recommend Naproxen and PPI) was appropriate only in 2.2% patients. On the other hand, both group of CV high/GI low risk (0.1%, recommend Naproxen and PPI) and group of CV high/GI high risk (1.1%, recommend using alternative therapy) were highly inappropriate. Conclusion : The use of NSAIDs was appropriate for geriatric patients in the CV low/GI moderate risk group, but was inappropriate for the CV high risk group. In order for the appropriate use of NSAIDs in geriatric patients, we need to establish guideline for NSAIDs treatment of geriatric patients and extend the DUR system. Also, the intervention of pharmacists for geriatric patients is required, with close cooperation extended to the medical team.