Prospective study of NSAIDs prescribing in Saudi Arabia: Cardiovascular and gastrointestinal risk in patients with diabetes mellitus

Objectives: The purpose of this study was to investigate the patterns of nonsteroidal anti-inflammatory drug (NSAID) prescriptions in diabetes mellitus (DM) patients and to evaluate their suitability based on patient gastrointestinal/cardiovascular (GI/CV) risk profiles. Materials and methods: We retrospectively identified patients with DM, who were seen at a primary care facility from March 1 to 31, 2016. GI risk factors, CV histories, and current medications were recorded. Data were evaluated for appropriateness of NSAID prescribing by using current understanding and accepted guidelines. Results: A total of 443 evaluable patients were reviewed. NSAIDs were prescribed in 171 patients (38.5%). Ibuprofen (23.5%) was the most frequently prescribed drug, followed by celecoxib (20%) and naproxen (14.1%). Of 171 patients, 76 (44.4%) had a previous history of CV events, while 52 patients without CV history had a moderate to very high 10-year risk of heart disease. Markedly fewer patients with CV history (19.1%) than patients without CV history were prescribed naproxen. Patients at high GI risk (22.9%) were prescribed traditional NSAIDs without a gastroprotective agent. Overall, 22.9% of patients at high GI risk and 65.8% at high CV risk were prescribed NSAIDs that were not in accordance with current guidelines or recommendations of regulatory agencies. Conclusion: Inappropriate prescribing of NSAIDs was found in more than half of the studied DM patients who were at risk for significant GI and CV adverse events. Assessment of GI and CV risks in DM patients is crucial to tailor NSAID selection and optimize patient outcomes.