In 2005, approximately 15 per cent of the Danish population bought NSAID on prescription (approximately 830,000 persons). This figure covers persons undergoing both long-term and short-term treatment, for example persons with chronic arthritis diseases or persons with an isolated need, for instance in connection with sports injuries. An adverse reaction from NSAID can be gastrointestinal problems, for example in the form of stomach ulcers. The Institute for Rational Pharmacotherapy (IRF) and Medicin.dk (Medicinal Product Catalogue) therefore recommends doctors to consider preventive treatment for NSAID users with increased risk of developing ulcer.
The Danish Medicines Agency has drawn up a report on the consumption of NSAID in 2005. The report has two purposes:
- describe persons with a higher NSAID consumption
- assess to what extent users with increased risk of developing stomach ulcers are given medicine to prevent this.
Main findings of the report
Most NSAID users bought very small quantities in 2005. Around 95,000 persons (11 per cent of the users) bought quantities equivalent of more than one average daily dose per day in around six months (>180 DDD/year). In the report, this group is referred to as ‘persons with a higher consumption’, which does not necessarily mean that their consumption is too large.
Half of the persons with a higher consumption in 2005 were between 50 and 70 years old. 61 per cent were women.
Among those with a higher consumption, ibuprofen was the most frequently used NSAID, but diclofenac and etodolac were also used to a large extent. Among persons with a higher NSAID consumption, Etodolac was used to a greater extent than among persons with a lower NSAID consumption.
Some of the persons with a higher consumption also had a higher consumption of NSAID in the previous two years.
We have defined a group with increased risk of developing stomach ulcers based on the group of persons with a higher consumption of NSAID, not including the consumption of coxibs. To be included in the risk group, the persons needed to have at least one of the following risk factors: age > 75 years, purchase of glucocorticoids (> 90 DDD in 2005), purchase of acetylsalicylic acid on prescription at least twice in 2005 or previous medical treatment of stomach ulcer (triple therapy). 33 per cent of the persons in the risk group bought preventive ulcer medicine in the form of proton pump inhibitors (PPI) (26 per cent) or misoprostol (9 per cent) in 2005. The percentage increases to 36 if it includes persons who bought H 2 antagonists on prescription. The proportion of people undergoing preventive treatment varies according to the risk factors involved. There is a higher proportion undergoing preventive treatment among those who had previously purchased triple therapy and subsequently among those who were simultaneously being treated with glucocorticoids.
By including persons who bought preventive medicine at the end of 2004 and by narrowing the risk group only to include persons with an even higher consumption, the proportion of people in preventive treatment further increases to 39 per cent.
The findings for the proportion in preventive treatment should be considered in the light of several factors. For persons with an increased risk, it is possible that the general practitioner to begin with chose merely to pay extra attention to gastrointestinal discomfort instead of prescribing preventive medicine right away. Moreover, it is possible that some persons solely buy H 2 antagonists over the counter, which it is not possible for us to monitor.
Consumption of NSAID in 2005
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