Comparison of conventional NSAIDs and cyclooxygenase-2 inhibitors in outpatients

To compare outpatients treated with conventional nonsteroidal antiinflammatory drugs (NSAIDs) versus cyclooxygenase-2 (COX2) inhibitors in June 2002 in the Ain district of France.

A cross-sectional study was done in the 14,216 patients older than 19 years of age who were identified in the universal health insurance database as having received therapy with conventional NSAIDs or COX2 inhibitors. A logistic regression model was built to identify factors associated with the type of antiinflammatory agent.

COX2 inhibitor therapy was noted in 17% of patients. Factors significantly associated with COX2 inhibitor therapy were older age and concomitant use of symptomatic slow-acting drugs for osteoarthritis, disease-modifying antirheumatic drugs, anticoagulants, antiplatelet agents, diuretics, angiotensin-converting enzyme inhibitors, and angiotensin II receptor antagonists. Patients taking COX2 inhibitor therapy were significantly less likely to be taking concomitant gastroprotective therapy, compared to patients on conventional NSAIDs.

The powerful advertisement campaigns that surrounded the introduction of COX2 inhibitors rapidly affected practice patterns regarding the prescription of antiinflammatory drugs. The study reported here showed a significantly greater likelihood of receiving COX2 inhibitors in older patients taking multiple medications, a population known to be at increased risk for drug-induced cardiovascular events. Evidence obtained after the present study established that COX2 inhibitors carry a risk of cardiovascular side effects. Rofecoxib has been removed from the market, and new recommendations have been issued regarding other COX2 inhibitors.