Proton pump inhibitors (PPIs), which are used for treatment of gastroesophageal reflux disease (GERD) and for prevention of upper gastrointestinal adverse effects caused by NSAIDs and aspirin, are one of the most commonly prescribed classes of drugs in the US. All PPIs are similarly effective and generally well tolerated,1,2 but their long-term use has been associated with a number of safety concerns.3,4 Recommendations addressing these concerns have recently been published.5,6
FRACTURES — The labels of all prescription PPIs include a warning about an increased risk of fractures with long-term use.7
Mechanism – Reduced gastric acidity might interfere with calcium absorption.
Clinical Studies – A meta-analysis of 18 trials involving a total of 244,109 fracture cases found...
The FDA has approved the interleukin (IL)-6 inhibitor sarilumab (Kevzara – Sanofi) for second-line treatment of adults with moderately to severely active rheumatoid arthritis (RA). It is the second IL-6 inhibitor to be approved for this indication; tocilizumab (Actemra) was approved earlier.1
STANDARD TREATMENT — For initial treatment of RA, most expert clinicians prescribe a disease-modifying antirheumatic drug (DMARD) and add a nonsteroidal anti-inflammatory drug (NSAID) or a corticosteroid to ...
