Factor-associated in pattern of non-steroidal anti-inflammatory drug-induced cutaneous adverse drug reactions in the elderly

Abstract

© 2018, Medical Association of Thailand. All rights reserved. Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed medications in elderly, which can frequently cause cutaneous adverse drug reactions (ADRs). Objective: The present study aimed to investigate demographic data of elderly patients who had cutaneous reactions from NSAIDs and determine the risk factors that induce serious reactions. Materials and Methods: A retrospective analysis involving elderly patients aged 60 years or over with cutaneous ADRs suspected from NSAIDs attending the ADR Center, Siriraj Hospital, Mahidol University, Thailand, over a 4-year period. Demographic data, concurrent medications, clinical course of cutaneous ADRs and causative NSAIDs were analyzed. Results: A total of 101 patients were included. Cutaneous ADRs from NSAIDs occurred more commonly in females (65.3%). Angioedema alone was the most common cutaneous ADRs (29.7%) followed by urticaria with and without angioedema (26.7%). Forty-one patients (40.6%) were categorized as serious ADRs. Systemic reactions were significantly associated with non-selective COX inhibitors as compared to preferential and selective COX-2 inhibitors (p = 0.046). A history of severe cutaneous ADRs is significantly associated with severity of cutaneous ADRs to NSAIDs in elderly (p<0.001). Conclusion: Preferential and selective COX-2 inhibitors may be a good option for elderly due to lower risk of cutaneous ADRs. Early signs and symptoms of severe reactions should be addressed in this group of patients.