Background

Controversies exist about excessive use of gastric acid-suppressing agents or lack of adequate indications, especially when co-prescribed with analgesics for gastroprotection. We aimed to analyze nationwide trend of gastric acid-suppressing agents and analgesics.

Methods

We obtained nationwide consumption data of analgesics (NSAIDs, opioids, others) and gastric acid-suppressing agents (proton pump inhibitors [PPI] and histamine-2 receptor antagonists [H2RAs]) between years of 2014-2018 from IQVIA Turkey. Drug utilization was measured by DDD (defined daily dose)/1000 inhabitants/day (DID) unit. Drug sales data were further used to test correlation of PPIs and H2RAs to analgesics.

Results

During study period, analgesic utilization increased from 65.7 to 67.4 DID. NSAIDs constituted 82.7-84.9% of all analgesic utilization. The consumption of NSAIDs increased by 3.1%, and the most commonly consumed analgesic was diclofenac (18.5±1.5 DID), constituting 25.4-29.0% of all analgesics. PPI utilization was found to regularly raise from 52.1 DID in 2014 to 72.0 DID in 2018 with an overall increment of 38.2%. Use of H2RAs was found to increase from 11.4 DID in 2014 to 14.0 DID in 2018. The physician visit-adjusted utilization of both antirheumatic NSAIDs and non-antirheumatic analgesics showed significantly moderate-strong positive correlations with PPIs (r:0.63, 0.48-0.76 and r:0.63, 0.47-0.75, respectively) and H2RAs (r:0.61, 0.44-0.73 and r:0.57, 0.41-0.71, respectively).

Conclusion

The utilization trend exhibited a dramatic increase of the gastric acid-suppressing agents -more pronounced for PPIs, with a modest increase in analgesics. Excessive utilization of PPIs does not seem to imply a tendency towards only NSAID-related gastroprotection.

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