Introduction of newer selective cyclo-oxygenase-2 inhibitors and rates of hospitalization with bleeding and perforated peptic ulcer

Background Limited data exist on the impact of the introduction of newer selective cyclo-oxygenase-2 inhibitors into clinical practice in 1999 on overall non-steroidal anti-inflammatory drug use and hospitalization rates of complicated peptic ulcer disease at the population level. Aim To examine these issues, we conducted a population-based study in western Denmark, within a population of 1.2 million. Methods All patients with perforated (n = 1488) or bleeding peptic ulcer (n = 6017) between 1996 and 2004 were identified in hospital discharge registries. We computed standardized annual hospitalization rates and hospitalization rate ratios using Poisson regression. Data on annual number of prescriptions for non-steroidal anti-inflammatory drugs were obtained through population-based prescription databases. Results Introduction of newer selective cyclo-oxygenase-2 inhibitors was followed by a 44% increase in the annual number of prescriptions for non-steroidal anti-inflammatory drugs - almost entirely due to increased use of newer selective cyclo-oxygenase-2 inhibitors. Annual standardized hospitalization rates for bleeding peptic ulcer remained stable. Standardized hospitalization rates for perforated peptic ulcer decreased from 17 per 100 000 person-years in 1996 to 12 per 100 000 person-years in 2004 (HRR 0.71; 95% CI: 0.57-0.88). Conclusion Introduction of newer selective cyclo-oxygenase-2 inhibitors was followed by substantial increase in overall non-steroidal anti-inflammatory drug use and coincided with stable and decreasing hospitalization rates for bleeding and perforated peptic ulcer, respectively.