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Pharmacoepidemiology and rheumatic diseases: 2001-2002.
Daniel H Solomon1, Jerry Avorn
1Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA. dhsolomon@partners.org
Current Opinion in Rheumatology
|February 25, 2003
Summary
Pharmacoepidemiology research in rheumatology highlights cardiovascular risks with COX-2 inhibitors and benefits of early disease-modifying antirheumatic drug initiation. Ongoing studies monitor biologic therapies and glucocorticoid-related osteoporosis risks.
Area of Science:
- Pharmacoepidemiology
- Rheumatology
- Drug Safety
Background:
- Pharmacoepidemiology is crucial in rheumatology due to increased medication options and data availability.
- Recent focus on cardiovascular risks of selective COX-2 inhibitors and potential protective effects of naproxen.
- Growing evidence supports early initiation of disease-modifying antirheumatic drugs (DMARDs) for rheumatoid arthritis.
Purpose of the Study:
- To review recent pharmacoepidemiological findings in rheumatology.
- To assess the safety and efficacy of various rheumatologic medications.
- To inform clinical practice regarding medication use in rheumatic diseases.
Main Methods:
- Review of pooled analyses and observational studies.
- Analysis of prescribing databases and clinical trial extensions.
- Synthesis of published data on drug-induced adverse events and therapeutic benefits.
Main Results:
- Potential increased risk of acute myocardial infarction with selective COX-2 inhibitors; naproxen may have a protective effect.
- Continued long-term benefits of TNF-alpha antagonists, with noted risks of tuberculosis and CNS demyelination.
- Quantification of osteoporosis risk with glucocorticoids; reduced concern for upper gastrointestinal events with biphosphonates.
Conclusions:
- Pharmacoepidemiology provides critical insights into medication safety and efficacy in rheumatology.
- Careful monitoring for adverse events is essential with advanced therapies like biologics and COX-2 inhibitors.
- Evidence supports optimizing treatment strategies, including early DMARD use, for improved patient outcomes.