Background: The risk of gastrointestinal (GI) complications in NSAID users over the age of 65 is substantially increased however gastroprotective strategies decrease the risk of GI complications in these patients. Prescribing of gastroprotective agents in non-selective NSAID users with high-risk patients is highly recommended.

Objectives: The aim of the study was to determine the prevalence of GP and prescription patterns of gastric protectors in patients aged 65 years and over, who were prescribed NSAID therapy for any reason.

Methods: The electronic prescription database of the Pension Fund of the Turkish Republic, serves almost 21% of the Turkish population was searched for the period from 1st Jan to 31th Dec 2003. Commercially available oral forms of all NSAIDs and gastroprotective agents that were available on the Turkish market were the target of our investigation. Demographic data of patients were also obtained. NSAID were classified into 3 groups: classical, COX-2 specific (rofecoxib,celecoxib) and COX-2 selective inhibitors (meloxicam,etodolac). Also gastric protectors were classified as proton pump inhibitors (PPI), H2 receptor blockers (H2RB) and misoprostol (M).The first NSAID prescription for each individual aged 65 and over in January 2003 was determined as Index Prescription (IP). Patients who had treated with an NSAID 6 months before IP and treated with a gastroprotective agent 3 months before IP were excluded from the study because of a possibility of drug use related with GI symptoms. As, only one kind of NSAID should be ordered at any one time, coprescription of the different types were excluded.The preference of NSAID usage patterns in IP and whether a gastroprotective agent was ordered in the same prescription were noticed. Analyzes were performed according to gender and two age (65-74,75yrs. and over) groups.

Results: The number of population serviced by the Pension Fund of the Turkey was 2.222.819 in the year of 2003.The total patients who were prescribed a NSAID was 1.520.049 in 2003. The number of patients who covered the study criteria were 25.177 (M:41%, F:59%). In the analysis of IP, proportions of classical NSAID use, selective and specific COX-2 use were 70%, 18% and 12% respectively. Only 10% of the patients were prescribed gastric protectors (Table 1). GP percentages were found similar according to both age groups. GP ratios were found to be 11%, 10% and 9% in specific and selective COX-2 inhibitors and classical NSAID users respectively. The proportions of PPI use, H2RB use and M use in prescriptions prescribed for GP were 46%, 45% and 3% respectively. A further analysis of prescription patterns for gastric protectors showed that PPI prescribed most frequently (54%) within the age group 75 yrs. and over, PPI (46%) and H2RB (45%) were similarly prescribed in age group 65-74.

Table 1

Age groups	Sex	Classical NSAID	COX-2 selective NSAID	COX-2 specific NSAID
		(%)	(%)	(%)
65-74	M	450 (%8)	88 (%8)	55 (%11)
	F	567 (%10)	172 (%11)	125 (%12)
75 yrs. and over	M	227 (%8)	62 (%10)	37 (%11)
	F	414 (%9)	121 (%11)	105 (%12)

GP ratios according to age and sex.

Conclusion: Although serious GI complications associated with NSAID use can significantly be reducible with gastroprotective agents in old patients, unfortunately such a preventive strategy may not be considered in a real clinical setting. Similar gastroprotective agent prescribing ratio with different groups of NSAID demonstrated that clinicians did not differ between these medications according to their effects on COX-2 inhibition.

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