Nonsteroidal Antiinflammatory Drug Toxicity Monitoring and Safety Practices

Fausto G. Patino, Jason Olivieri, Jeroan J. Allison, Ted R Mikuls, Larry Moreland, Stacey H. Kovac, Lucia Juarez, Sharina Person, Jeffrey Curtis, Kenneth C. Saag

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Objective. Nonsteroidal antiinflammatory drug (NSAID) related gastrointestinal (GI) and renal adverse events are commonly reported. Although published guidelines recommend periodic laboratory monitoring, NSAID safety practices of physicians have not been investigated at a population level. We examined the associations of physician specialty and patient characteristics with NSAID safety practices. Methods. Using administrative data and medical record review from a regional managed care organization, we studied a retrospective cohort of 373 frequent NSAID users (≥ 3 consecutive NSAID prescriptions and ≥ 1 month of continuous NSAID use and followup). NSAID safety measures included: complete blood count (CBC) testing, creatinine testing, use of GI cytoprotective agents, and lack of simultaneous prescriptions for different NSAID (NSAID overlap), Results. The mean duration of cumulative NSAID use was 14.4 ± 7.7 months/patient, patient age was 62.0 ± 11.4 years, and 63% were women. About two-thirds of patients received CBC (238, 63.8%) and creatinine monitoring (263, 70.5%), one-third (120, 32.2%) were prescribed cytoprotective agents, and one-fourth (97, 26%) had at least one NSAID overlap. After multivariable adjustments, concomitant use of disease-modifying antirheumatic drugs (OR 2.5, 95% CI 1.1-5.8), longer NSAID exposure (OR 1.3, 95% CI 1.1-1.4), and a greater number of physician visits/year (OR 1.1, 95% CI 1.0-1.2) were significantly associated with receipt of a CBC. A history of hypertension (OR 2.0, 95% CI 1.2-3.2), longer NSAID exposure (OR 1.3, 95% CI 1.2-1.4), and more physician visits/year (OR 1.1, 95% CI 1.0-1.2) were significantly associated with serum creatinine testing. Rheumatologists, and to a lesser extent internists, trended toward more NSAID toxicity monitoring than family/general practitioners. However, family/general practitioners and internists were more likely to monitor creatinine than rheumatologists among patients with renal risk factors. Conclusion. While rheumatologists and internists trended toward more CBC and creatinine testing, visit frequency, duration of NSAID use, and comorbidities were the factors most consistently associated with safety monitoring.

Original languageEnglish (US)
Pages (from-to)2680-2688
Number of pages9
JournalJournal of Rheumatology
Volume30
Issue number12
StatePublished - Dec 1 2003

Fingerprint

Drug Monitoring
Drug-Related Side Effects and Adverse Reactions
Anti-Inflammatory Agents
Safety
Pharmaceutical Preparations
Blood Cell Count
Creatinine
Physicians
Gastrointestinal Agents
General Practitioners
Kidney
Social Adjustment
Drug Prescriptions
Antirheumatic Agents
Managed Care Programs
Drug Users
Medical Records
Prescriptions
Comorbidity

Keywords

  • Drug safety
  • Drug toxicity monitoring
  • Nonsteroidal antiinflammatory drugs

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

Patino, F. G., Olivieri, J., Allison, J. J., Mikuls, T. R., Moreland, L., Kovac, S. H., ... Saag, K. C. (2003). Nonsteroidal Antiinflammatory Drug Toxicity Monitoring and Safety Practices. Journal of Rheumatology, 30(12), 2680-2688.

Nonsteroidal Antiinflammatory Drug Toxicity Monitoring and Safety Practices. / Patino, Fausto G.; Olivieri, Jason; Allison, Jeroan J.; Mikuls, Ted R; Moreland, Larry; Kovac, Stacey H.; Juarez, Lucia; Person, Sharina; Curtis, Jeffrey; Saag, Kenneth C.

In: Journal of Rheumatology, Vol. 30, No. 12, 01.12.2003, p. 2680-2688.

Research output: Contribution to journalArticle

Patino, FG, Olivieri, J, Allison, JJ, Mikuls, TR, Moreland, L, Kovac, SH, Juarez, L, Person, S, Curtis, J & Saag, KC 2003, 'Nonsteroidal Antiinflammatory Drug Toxicity Monitoring and Safety Practices', Journal of Rheumatology, vol. 30, no. 12, pp. 2680-2688.
Patino FG, Olivieri J, Allison JJ, Mikuls TR, Moreland L, Kovac SH et al. Nonsteroidal Antiinflammatory Drug Toxicity Monitoring and Safety Practices. Journal of Rheumatology. 2003 Dec 1;30(12):2680-2688.
Patino, Fausto G. ; Olivieri, Jason ; Allison, Jeroan J. ; Mikuls, Ted R ; Moreland, Larry ; Kovac, Stacey H. ; Juarez, Lucia ; Person, Sharina ; Curtis, Jeffrey ; Saag, Kenneth C. / Nonsteroidal Antiinflammatory Drug Toxicity Monitoring and Safety Practices. In: Journal of Rheumatology. 2003 ; Vol. 30, No. 12. pp. 2680-2688.
@article{6f612e5da9c547c1b0068400773df3bb,
title = "Nonsteroidal Antiinflammatory Drug Toxicity Monitoring and Safety Practices",
abstract = "Objective. Nonsteroidal antiinflammatory drug (NSAID) related gastrointestinal (GI) and renal adverse events are commonly reported. Although published guidelines recommend periodic laboratory monitoring, NSAID safety practices of physicians have not been investigated at a population level. We examined the associations of physician specialty and patient characteristics with NSAID safety practices. Methods. Using administrative data and medical record review from a regional managed care organization, we studied a retrospective cohort of 373 frequent NSAID users (≥ 3 consecutive NSAID prescriptions and ≥ 1 month of continuous NSAID use and followup). NSAID safety measures included: complete blood count (CBC) testing, creatinine testing, use of GI cytoprotective agents, and lack of simultaneous prescriptions for different NSAID (NSAID overlap), Results. The mean duration of cumulative NSAID use was 14.4 ± 7.7 months/patient, patient age was 62.0 ± 11.4 years, and 63{\%} were women. About two-thirds of patients received CBC (238, 63.8{\%}) and creatinine monitoring (263, 70.5{\%}), one-third (120, 32.2{\%}) were prescribed cytoprotective agents, and one-fourth (97, 26{\%}) had at least one NSAID overlap. After multivariable adjustments, concomitant use of disease-modifying antirheumatic drugs (OR 2.5, 95{\%} CI 1.1-5.8), longer NSAID exposure (OR 1.3, 95{\%} CI 1.1-1.4), and a greater number of physician visits/year (OR 1.1, 95{\%} CI 1.0-1.2) were significantly associated with receipt of a CBC. A history of hypertension (OR 2.0, 95{\%} CI 1.2-3.2), longer NSAID exposure (OR 1.3, 95{\%} CI 1.2-1.4), and more physician visits/year (OR 1.1, 95{\%} CI 1.0-1.2) were significantly associated with serum creatinine testing. Rheumatologists, and to a lesser extent internists, trended toward more NSAID toxicity monitoring than family/general practitioners. However, family/general practitioners and internists were more likely to monitor creatinine than rheumatologists among patients with renal risk factors. Conclusion. While rheumatologists and internists trended toward more CBC and creatinine testing, visit frequency, duration of NSAID use, and comorbidities were the factors most consistently associated with safety monitoring.",
keywords = "Drug safety, Drug toxicity monitoring, Nonsteroidal antiinflammatory drugs",
author = "Patino, {Fausto G.} and Jason Olivieri and Allison, {Jeroan J.} and Mikuls, {Ted R} and Larry Moreland and Kovac, {Stacey H.} and Lucia Juarez and Sharina Person and Jeffrey Curtis and Saag, {Kenneth C.}",
year = "2003",
month = "12",
day = "1",
language = "English (US)",
volume = "30",
pages = "2680--2688",
journal = "Journal of Rheumatology",
issn = "0315-162X",
publisher = "Journal of Rheumatology",
number = "12",

}

TY - JOUR

T1 - Nonsteroidal Antiinflammatory Drug Toxicity Monitoring and Safety Practices

AU - Patino, Fausto G.

AU - Olivieri, Jason

AU - Allison, Jeroan J.

AU - Mikuls, Ted R

AU - Moreland, Larry

AU - Kovac, Stacey H.

AU - Juarez, Lucia

AU - Person, Sharina

AU - Curtis, Jeffrey

AU - Saag, Kenneth C.

PY - 2003/12/1

Y1 - 2003/12/1

N2 - Objective. Nonsteroidal antiinflammatory drug (NSAID) related gastrointestinal (GI) and renal adverse events are commonly reported. Although published guidelines recommend periodic laboratory monitoring, NSAID safety practices of physicians have not been investigated at a population level. We examined the associations of physician specialty and patient characteristics with NSAID safety practices. Methods. Using administrative data and medical record review from a regional managed care organization, we studied a retrospective cohort of 373 frequent NSAID users (≥ 3 consecutive NSAID prescriptions and ≥ 1 month of continuous NSAID use and followup). NSAID safety measures included: complete blood count (CBC) testing, creatinine testing, use of GI cytoprotective agents, and lack of simultaneous prescriptions for different NSAID (NSAID overlap), Results. The mean duration of cumulative NSAID use was 14.4 ± 7.7 months/patient, patient age was 62.0 ± 11.4 years, and 63% were women. About two-thirds of patients received CBC (238, 63.8%) and creatinine monitoring (263, 70.5%), one-third (120, 32.2%) were prescribed cytoprotective agents, and one-fourth (97, 26%) had at least one NSAID overlap. After multivariable adjustments, concomitant use of disease-modifying antirheumatic drugs (OR 2.5, 95% CI 1.1-5.8), longer NSAID exposure (OR 1.3, 95% CI 1.1-1.4), and a greater number of physician visits/year (OR 1.1, 95% CI 1.0-1.2) were significantly associated with receipt of a CBC. A history of hypertension (OR 2.0, 95% CI 1.2-3.2), longer NSAID exposure (OR 1.3, 95% CI 1.2-1.4), and more physician visits/year (OR 1.1, 95% CI 1.0-1.2) were significantly associated with serum creatinine testing. Rheumatologists, and to a lesser extent internists, trended toward more NSAID toxicity monitoring than family/general practitioners. However, family/general practitioners and internists were more likely to monitor creatinine than rheumatologists among patients with renal risk factors. Conclusion. While rheumatologists and internists trended toward more CBC and creatinine testing, visit frequency, duration of NSAID use, and comorbidities were the factors most consistently associated with safety monitoring.

AB - Objective. Nonsteroidal antiinflammatory drug (NSAID) related gastrointestinal (GI) and renal adverse events are commonly reported. Although published guidelines recommend periodic laboratory monitoring, NSAID safety practices of physicians have not been investigated at a population level. We examined the associations of physician specialty and patient characteristics with NSAID safety practices. Methods. Using administrative data and medical record review from a regional managed care organization, we studied a retrospective cohort of 373 frequent NSAID users (≥ 3 consecutive NSAID prescriptions and ≥ 1 month of continuous NSAID use and followup). NSAID safety measures included: complete blood count (CBC) testing, creatinine testing, use of GI cytoprotective agents, and lack of simultaneous prescriptions for different NSAID (NSAID overlap), Results. The mean duration of cumulative NSAID use was 14.4 ± 7.7 months/patient, patient age was 62.0 ± 11.4 years, and 63% were women. About two-thirds of patients received CBC (238, 63.8%) and creatinine monitoring (263, 70.5%), one-third (120, 32.2%) were prescribed cytoprotective agents, and one-fourth (97, 26%) had at least one NSAID overlap. After multivariable adjustments, concomitant use of disease-modifying antirheumatic drugs (OR 2.5, 95% CI 1.1-5.8), longer NSAID exposure (OR 1.3, 95% CI 1.1-1.4), and a greater number of physician visits/year (OR 1.1, 95% CI 1.0-1.2) were significantly associated with receipt of a CBC. A history of hypertension (OR 2.0, 95% CI 1.2-3.2), longer NSAID exposure (OR 1.3, 95% CI 1.2-1.4), and more physician visits/year (OR 1.1, 95% CI 1.0-1.2) were significantly associated with serum creatinine testing. Rheumatologists, and to a lesser extent internists, trended toward more NSAID toxicity monitoring than family/general practitioners. However, family/general practitioners and internists were more likely to monitor creatinine than rheumatologists among patients with renal risk factors. Conclusion. While rheumatologists and internists trended toward more CBC and creatinine testing, visit frequency, duration of NSAID use, and comorbidities were the factors most consistently associated with safety monitoring.

KW - Drug safety

KW - Drug toxicity monitoring

KW - Nonsteroidal antiinflammatory drugs

UR - http://www.scopus.com/inward/record.url?scp=10744232134&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=10744232134&partnerID=8YFLogxK

M3 - Article

VL - 30

SP - 2680

EP - 2688

JO - Journal of Rheumatology

JF - Journal of Rheumatology

SN - 0315-162X

IS - 12

ER -