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Factors associated with celecoxib and rofecoxib utilization
Nigel S B Rawson1, Parivash Nourjah, Stella C Grosser
1Center for Health Care Policy and Evaluation, Eden Prairie, MN Oakville, ON, Canada.
The Annals of Pharmacotherapy
|March 10, 2005
Summary
Patients with greater underlying disease burden were more likely to receive cyclooxygenase-2 (COX-2) selective nonsteroidal anti-inflammatory drugs (NSAIDs). This paradoxically channeled high-risk cardiovascular patients toward potentially dangerous treatments.
Area of Science:
- Pharmacology and Therapeutics
- Clinical Epidemiology
Background:
- Cyclooxygenase-2 (COX-2) selective NSAIDs are marketed for reduced gastrointestinal (GI) complications compared to nonselective NSAIDs.
- However, adverse event data indicate significant GI risks associated with COX-2 selective NSAIDs.
Purpose of the Study:
- To determine if patients prescribed COX-2 selective NSAIDs (celecoxib, rofecoxib) have a higher underlying disease burden than those on nonselective NSAIDs.
- To investigate potential biases in NSAID prescribing patterns.
Main Methods:
- A retrospective cohort study of over 27,000 health plan members aged >34 years.
- Analysis compared users of celecoxib/rofecoxib (cases) with users of nonselective NSAIDs (controls) using logistic regression.
- Inclusion criteria required continuous enrollment for over 364 days prior to NSAID dispensing.
Main Results:
- Factors increasing likelihood of COX-2 selective NSAID use included older age, specialist treatment, polypharmacy, corticosteroid use, and prior GI bleed.
- High nonselective NSAID prescription history decreased COX-2 selective NSAID likelihood.
- Polypharmacy predicted higher prevalence of diabetes mellitus and cardiovascular disease.
Conclusions:
- Patients with a greater underlying disease burden are more likely to receive COX-2 selective NSAIDs.
- This practice paradoxically directs patients at higher cardiovascular risk towards NSAIDs that may increase adverse cardiovascular events.
- Clinical guidelines and prescribing practices warrant re-evaluation for NSAID selection in high-risk populations.