Prescription rates of protective co-therapy for NSAID users at high GI risk and results of attempts to improve adherence to guidelines

P>Background Protective co-therapy is recommended in NSAID users with GI risk factors, but adherence is poor. Aim To assess the proportion of NSAID users receiving co-therapy and strategies to improve adherence. Methods Arthritis patients >= 50 years of age received etoricoxib or diclofenac in a double-blind randomized trial. Reminders that high-risk patients (age >= 65; previous ulcer/haemorrhage; corticosteroid, anticoagulant, aspirin use) should receive co-therapy were given at study initiation. Free PPI was provided. An intervention midway through the study included a written reminder and required written response regarding co-therapy. Results 16 244/23 504 (69%) patients had GI risk factors. Pre-intervention, co-therapy was most common with previous ulcer/haemorrhage [706/1107 (64%)] and 3-4 risk factors [331/519 (64%)]. In the 10 026 patients enrolled pre-intervention and remaining in the study >= 6 months after, co-therapy in high-risk patients increased from 2958/6843 (43%) to 4177/6843 (61%) (difference = 18%; 95% CI 16%,19%). The increase was greater outside the US (22%; 19%,24%) than in the US (15%; 13%,17%). Conclusions Less than 50% of NSAID users with GI risk factors are given protective co-therapy - even if prescribers are given reminders and cost is not an issue. Direct communication requiring written response significantly increased adherence to guidelines, but achieving higher levels of adherence will require additional strategies.