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Nonsteroidal antiinflammatory drug discontinuation in patients with osteoarthritis
D Scholes1, A Stergachis, P M Penna
1Department of Pharmacy, School of Pharmacy, University of Washington, Seattle 98195, USA.
Objective:
To determine whether discontinuation patterns differed among nonsteroidal antiinflammatory drugs (NSAID) prescribed to treat osteoarthritis (OA).
Methods:
In a retrospective cohort study of Health Maintenance Organization enrollees, 1405 patients with OA aged 45 and older who received a new prescription for one of 4 NSAID were followed for 12 months. Survival analysis was used to evaluate time to discontinuation, used here as a relative measure of both drug efficacy and tolerability.
Results:
Rates of NSAID discontinuation during the study period were high; only 15 to 20% of those started on a study NSAID were still using the same drug at the end of the 12 month followup period. Using a proportional hazards model to adjust for covariates, the risk of discontinuation did not differ when comparing the agent with the longest duration of use, piroxicam (the referent), to enteric coated aspirin [relative risk (RR) 1.10, 95% confidence interval (CI) 0.93 to 1.30]. Adjusted rates of discontinuation were significantly higher for ibuprofen (RR 1.43, 95% CI 1.22 to 1.69) and for naproxen (RR 1.40, 95% CI 1.19 to 1.65) when compared to piroxicam.
Conclusion:
NSAID discontinuation rates are high among patients with OA and risk of discontinuation differed between NSAID, even after controlling for the effects of such variables as age, disease severity, and concomitant therapy.
Insights
Discontinuation rates for nonsteroidal anti-inflammatory drugs (NSAID) in osteoarthritis (OA) patients are high. Ibuprofen and naproxen showed higher discontinuation risks compared to piroxicam.
Area of Science:
- Rheumatology
- Pharmacology
- Clinical Medicine
Background:
- Osteoarthritis (OA) management often involves nonsteroidal anti-inflammatory drugs (NSAID).
- Understanding NSAID discontinuation patterns is crucial for optimizing OA treatment.
- Variability in drug efficacy and tolerability may influence patient adherence.
Purpose of the Study:
- To compare discontinuation rates among different NSAID prescribed for osteoarthritis.
- To identify if specific NSAID are associated with higher risks of treatment cessation.
Main Methods:
- Retrospective cohort study of 1405 OA patients aged 45+.
- Follow-up period of 12 months after new NSAID prescription.
- Survival analysis used to assess time to discontinuation as a measure of efficacy and tolerability.
Main Results:
- High NSAID discontinuation rates observed; only 15-20% continued the same drug after 12 months.
- No significant difference in discontinuation risk between piroxicam (referent) and enteric-coated aspirin.
- Significantly higher discontinuation risks for ibuprofen (RR 1.43) and naproxen (RR 1.40) compared to piroxicam.
Conclusions:
- NSAID discontinuation rates are substantial in osteoarthritis patients.
- Discontinuation risk varies among NSAID, independent of factors like age and disease severity.
- These findings highlight the need to consider individual NSAID profiles in OA management.