RESEARCH - Assessment of coxib utilization by rheumatologists for NSAID gastroprotection prior to the coxib market withdrawals

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Arthritis Rheum. 2006 Aug 15;55(4):543-50.

Assessment of coxib utilization by rheumatologists for nonsteroidal

antiinflammatory drug gastroprotection prior to the coxib market

withdrawals.

Greenberg JD, Bingham CO 3rd, Abramson SB, G, Kishimoto M, Hinkle K,

Kremer J.

New York University Hospital for Joint Diseases, New York 10003, USA.

greenberg@...

OBJECTIVE: To examine cyclooxygenase 2 inhibitor (coxib) utilization by

rheumatologists for patients receiving nonsteroidal antiinflammatory drugs

(NSAIDs) prior to the coxib market withdrawals. METHODS: A prospective study

of patients with rheumatoid arthritis enrolled in the Consortium of

Rheumatology Researchers of North America registry was performed. RESULTS:

Of 1,833 patients receiving prescription NSAIDs, 1,380 (75.3%) received

gastroprotection, defined as either coxib monotherapy and/or

gastroprotective agent (GPA) cotherapy, and 1,207 (65.8%) received coxibs.

The distribution of gastroprotective strategies included 860 (46.9%)

patients who were prescribed coxib monotherapy, 347 (18.9%) prescribed dual

coxib plus GPA cotherapy, 173 (9.4%) prescribed a nonselective NSAID

(NS-NSAID) plus GPA cotherapy, and 453 (24.7%) prescribed an NS-NSAID

without GPA cotherapy. For patients with 0, 1, and > or =2 identifiable

gastrointestinal (GI) risk factors, coxib prescribing rates as a proportion

of NSAID agents were 64.1%, 66.4%, and 68.6%, respectively; among dual

aspirin/NSAID users, coxib prescribing rates were 66.2%, 78.3%, and 68.5% of

NSAID prescriptions, respectively. CONCLUSION: The majority of NSAID users

were prescribed a gastroprotective strategy, primarily attributable to coxib

utilization. ib utilization rates were consistently high across all

levels of GI risk, including patients without identifiable risk factors.

These data indicate that rheumatologists broadly adopted the coxib class of

NSAIDs in a nonselective manner with respect to underlying GI risk and

concomitant aspirin use. As novel therapeutic classes are introduced, early

evaluation of prescribing patterns using arthritis registries can determine

the appropriateness of prescribing patterns and may improve patient

outcomes.

PMID: 16874798

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6874798

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