Commentary: improving the use of gastroprotective agents among high-risk NSAID users – authors’ reply


We agree with Dr Howden that proper co-prescription of gastroprotective agents (GPA) remains a persistent problem in managing high-risk patients on nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin (ASA).[1]

Our results show that many patients did not receive GPA prophylaxis before the onset of bleeding during the last decade. However, our time trend analysis indicates that more GPA has been co-prescribed between 2006 and 2009 when compared with 2000–2005.[2] An increase in GPA co-prescription was also reported in Western countries.[3, 4] It appears that the global situation on GPA co-prescription is improving, although the progress remains far from satisfactory.

In the last few years, drugs have been developed that combine a NSAID with an H2 receptor antagonist or proton pump inhibitor (PPI) in one tablet. For example, the FDA has approved DUEXIS (ibuprofen 800 mg/famotidine 26.6 mg) and VIMOVO (naproxen 500 mg/esomeprazole 20 mg). Although the use of these drugs may improve patients’ compliance and raise physicians’ awareness of gastrointestinal risk, the true benefits of these combination tablets, in terms of improved clinical outcome and cost-effectiveness, remain largely uninvestigated.[5]

We are far from being successful. Continuing education on adherence to safe prescribing practices and the importance of gastroprotection remains crucial to decreasing hospitalisations due to NSAID- and ASA-associated ulcer bleeding.


The authors’ declarations of personal and financial interests are unchanged from those in the original article.2