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Glucocorticoids and the Risk of Peptic Ulcer Bleeding: Case–Control Analysis Based on Swiss Claims Data
- Source :
- Drug Safety. 41:725-730
- Publication Year :
- 2018
- Publisher :
- Springer Science and Business Media LLC, 2018.
-
Abstract
- Controversy exists as to whether glucocorticoids (GC) are ulcerogenic per se and may thus cause peptic ulcer bleeding (PUB) independent of concomitantly prescribed nonsteroidal anti-inflammatory drugs (NSAIDs). To investigate the association between GC use and PUB with or without co-medication with NSAIDs. We conducted a case–control study using administrative claims data from the Swiss health insurance company Helsana. We identified 1191 cases with incident PUB between 2012 and 2016 and matched up to 10 PUB-free controls to each case on age, sex, region and number of years insured with Helsana. We compared prior GC exposure between cases and controls using multivariate conditional logistic regression analyses controlling for several potential confounders. Patients with or without concomitant NSAID exposure were analysed separately. Patients with prior exposure to both GC and NSAIDs were five times more likely to experience PUB than patients who neither used GC nor NSAIDs (adjusted odds ratio [adj. OR] 4.80, 95% CI 3.55–6.71). Although the risk of PUB among patients who used NSAIDs without GC was increased threefold (adj. OR 3.20, 95% CI 2.59–3.95), we observed only a moderately increased risk among patients who used GC alone without NSAIDs (adj. OR 1.63, 95% CI 1.20–2.42). The use of NSAIDs with or without GC was associated with a markedly higher risk of PUB compared with GC monotherapy. Use of GC alone was associated with a moderately increased risk of PUB, which might be causal or attributed to confounding by indication.
- Subjects :
- Adult
Male
medicine.medical_specialty
Toxicology
03 medical and health sciences
0302 clinical medicine
Pharmacotherapy
Risk Factors
Claims data
Internal medicine
medicine
Humans
Pharmacology (medical)
030212 general & internal medicine
Glucocorticoids
Aged
Aged, 80 and over
Insurance Claim Reporting
Pharmacology
business.industry
Anti-Inflammatory Agents, Non-Steroidal
Confounding
Case-control study
Odds ratio
Middle Aged
Peptic Ulcer Hemorrhage
Case-Control Studies
Concomitant
Case control analysis
Drug Therapy, Combination
Female
030211 gastroenterology & hepatology
Peptic ulcer bleeding
business
Switzerland
Subjects
Details
- ISSN :
- 11791942 and 01145916
- Volume :
- 41
- Database :
- OpenAIRE
- Journal :
- Drug Safety
- Accession number :
- edsair.doi.dedup.....919344848648b3758bd73ee332219a2e