Non-steroidal anti-inflammatory drugs (
NSAIDs) are among the most commonly prescribed agents for rheumatic disorders such as
osteoarthritis (OA),
rheumatoid arthritis (RA) and
ankylosing spondylitis (AS). Despite the known association between
NSAID use and gastropathy, however, only around one-third of patients at risk of
NSAID-induced gastrointestinal toxicity receive adequate gastroprotection, and as many as 44% of these patients are non-adherent. We review the co-prescription of
proton pump inhibitors (PPIs) for the prevention of
NSAID-induced gastropathy, with a particular focus on the first fixed-dose
NSAID/PPI formulation:
ketoprofen/
omeprazole modified-release capsules. The
ketoprofen/
omeprazole fixed-dose combination is available in doses of 100 mg/20 mg, 150 mg/20 mg or 200 mg/20 mg as a single
capsule for once-daily administration.
Ketoprofen monotherapy has been shown to be generally equivalent to other
NSAIDs when used in the treatment of OA. In RA,
ketoprofen has demonstrated equivalent efficacy to
diclofenac,
indometacin,
piroxicam,
aceclofenac,
phenylbutazone,
naproxen and
flurbiprofen. Studies comparing
ketoprofen with
ibuprofen and
sulindac in patients with RA have, in general, favoured
ketoprofen. Studies in AS have generally reported similar efficacy between
ketoprofen and
phenylbutazone and
pirprofen. Prophylaxis with
omeprazole is effective for the prevention of
gastroduodenal ulcers, maintenance of remission and alleviation of dyspeptic symptoms in
NSAID recipients.
Omeprazole is well tolerated, and adverse events are generally gastrointestinal in nature. The fixed-dose combination of
ketoprofen and
omeprazole has demonstrated bioequivalence to the respective monotherapies. The incidence of digestive symptoms and the need for
dose reduction was reported to be lower with the combination than with its components.
Ketoprofen/
omeprazole modified-release capsules are the first fixed-dose
NSAID/PPI formulation to be approved. This formulation ensures compliance with the gastroprotective prophylaxis, as whenever the
NSAID is taken, the PPI is co-administered. Additionally, the once-daily formulation has the potential to improve adherence to anti-inflammatory
therapy.