Assessment of coxib utilization by rheumatologists for nonsteroidal antiinflammatory drug gastroprotection prior to the coxib market withdrawals

被引:6
作者
Greenberg, Jeffrey D.
Bingham, Clifton O., III
Abramson, Steven B.
Reed, George
Kshimoto, Mitsumasa
Hinkle, Kim
Kremer, Joel
机构
[1] NYU, Hosp Joint Dis, New York, NY 10003 USA
[2] Johns Hopkins Med Inst, Baltimore, MD 21205 USA
[3] Univ Massachusetts, Worcester, MA 01605 USA
[4] Ctr Rheumatol, Albany, NY USA
来源
ARTHRITIS & RHEUMATISM-ARTHRITIS CARE & RESEARCH | 2006年 / 55卷 / 04期
关键词
gastroprotection; coxibs; nonsteroidal antiinflammatory drug;
D O I
10.1002/art.22095
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective. To examine cyclooxygenase 2 inhibitor (coxib) utilization by rheumatologists for patients receiving nonsteroidal antiinflammatory drugs (NSAIDs) prior to the coxib market withdrawals. Methods. A prospective study of patients with rheumatoid arthritis enrolled in the Consortium of Rheumatology Researchers of North America registry was performed. Results. Of 1,833 patients receiving prescription NSAIDs, 1,380 (75.3%) received gastroprotection, defined as either coxib monotherapy and/or gastroprotective agent (GPA) cotherapy, and 1,207 (65.8%) received coxibs. The distribution of gastroprotective strategies included 860 (46.9%) patients who were prescribed coxib monotherapy, 347 (18.9%) prescribed dual coxib plus GPA cotherapy, 173 (9.4%) prescribed a nonselective NSAID (NS-NSAID) plus GPA cotherapyl and 453 (24.7%) prescribed an NS-NSAID without GPA cotherapy. For patients with 0, 1, and 2:2 identifiable gastrointestinal (GI) risk factors, coxib prescribing rates as a proportion of NSAID agents were 64.1%, 66.4%, and 68.6%, respectively; among dual aspirin/NSAID users, coxib prescribing rates were 66.2%, 78.3%, and 68.5% of NSAID prescriptions, respectively. Conclusion. The majority of NSAID users were prescribed a gastroprotective strategy, primarily attributable to coxib utilization. Coxib utilization rates were consistently high across all levels of GI risk, including patients without identifiable risk factors. These data indicate that rheumatologists broadly adopted the coxib class of NSAIDs in a nonselective manner with respect to underlying GI risk and concomitant aspirin use. As novel therapeutic classes are introduced, early evaluation of prescribing patterns using arthritis registries can determine the appropriateness of prescribing patterns and may improve patient outcomes.
引用
收藏
页码:543 / 550
页数:8
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