Use of celecoxib immediately post marketing in Canada: acute or chronic pain?

The diffusion of innovations theory suggests that early users of innovations influence others. This study was undertaken to apply the diffusion of innovations theory to the prescribing of celecoxib and to determine if prescriber and patient characteristics differed amongst early use of celecoxib for acute pain versus chronic musculoskeletal conditions.

Using Manitobaâs population-based prescription and health care databases, diffusion time from market availability to first prescription for celecoxib was determined for each prescriber. The diffusion of prescribing curves for celecoxib in acute pain versus chronic musculoskeletal conditions were compared. Separately for acute and chronic conditions, the likelihood of being an early or late prescriber or user of celecoxib was determined according to physician factors (specialty and place of training) and patient demographics. This multivariate analysis was completed using polytomous logistic regression, with majority prescribers as the reference.

The use of celecoxib for chronic musculoskeletal conditions demonstrated faster diffusion than for acute pain. The majority of early use of celecoxib was for chronic conditions; however 36% of first prescriptions were for acute pain, including the treatment of back pain and injuries. Early prescribers of celecoxib for acute pain were more likely than majority prescribers to be general practitioners (OR = 2.24, 95%CI: 1.53-3.29) and have hospital affiliations (OR=1.54, 95%CI: 1.04-2.27). Early users of celecoxib for chronic conditions were less likely to be low income (OR=0.56, 95%CI: 0.35-0.91).

Immediately after market release in Canada, celecoxib was commonly prescribed for the treatment of acute pain; these prescriptions were associated with general practitioners and hospital affiliation status.