Purpose

This study aimed to assess the safety risks associated with using nonsteroidal anti-inflammatory drugs (NSAIDs) in elderly patients (≥65 years) compared to younger patients (<65 years) with osteoarthritis (OA) and/or chronic low back pain (CLBP).

Methods

A retrospective analysis was conducted on anonymized claims data of patients prescribed NSAIDs for OA and/or CLBP from 2009-2018 using hospital-based administrative database―Medical Data Vision (MDV). The key outcome was incidence of developing gastrointestinal (GI), renal and acute myocardial infarction (AMI) that are well-known events associated with NSAID use.

Results

Of 288,715 patients included, 23.7%, 60.5% and 15.8% had OA, CLBP or both, respectively. Elderly patients used non-oral NSAIDs more frequently than oral NSAIDs (57.8% and 38.7%, respectively), whereas younger patients showed comparable use (50.7% and 52.8%, respectively). Incidence of events per 10,000 person-years (95% CI) was higher in the elderly than in younger patients: GI, 29.68(27.67-31.68) vs. 16.61(14.60-18.63); renal, 124.77(120.56-128.99) vs. 39.88(36.72-43.03); and AMI, 27.41(25.48-29.35) vs. 10.90(9.27-12.53), respectively. After adjusting for covariates, increase in risk for these events was seen in patients >70 years old compared to younger patients (18-30 years); and was remarkable in patients >80 years old with 2-fold, 10-fold and 7-fold higher risk for developing GI, renal and AMI events, respectively.

Conclusion

Risk for developing NSAID-associated events was higher in the elderly; particularly, renal and AMI events that remarkably increased in >80-year-old patients. To reduce them, NSAIDs should be prescribed at the lowest effective dose for the shortest duration possible.