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COX-2 Inhibitor and Non-Selective NSAID Use in Those at Increased Risk of NSAID-Related Adverse Events

A Retrospective Database Study

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Abstract

Background

Adverse events related to analgesic use represent a challenge for optimizing treatment of pain in older people.

Objective

The aim of this study was to determine whether non-selective non-steroidal anti-inflammatory drug (NS-NSAID) and cyclo-oxygenase (COX)-2 inhibitor use is appropriately targeted in those with a prior history of gastrointestinal (GI) events, myocardial infarction (MI) or stroke.

Methods

A retrospective study of pharmacy claims data from the Australian Government Department of Veterans’ Affairs was conducted, involving 288,912 veterans aged 55 years and over. Analgesic utilization from 2007 to 2009 was assessed. Three risk cohorts (veterans with prior hospitalization for GI bleed, MI or stroke) and a low-risk cohort were identified. Poisson regression was applied to test for a linear trend over the study period.

Results

The prevalence of analgesics dispensed in the overall study population was approximately 34 % between 2007 and 2009. COX-2 inhibitors were more widely dispensed than NS-NSAIDs in all those at risk of NSAID-related adverse events. At the end of 2009, the ratio was 5.1 % to 2.5 % in the GI cohort, 3.6 % to 3.2 % in the MI cohort and 3.6 % to 2.6 % in the stroke cohort.

Conclusions

Although COX-2 inhibitors appeared to be preferred over NS-NSAIDs in those with a prior history of GI events, 2.5 % of patients were still using an NS-NSAID at the end of the study period. Consistent with treatment guidelines, in most of these cases, these drugs were co-dispensed with proton pump inhibitors. COX-2 inhibitors were used at slightly higher rates than NS-NSAIDs in those with a prior history of MI or stroke, which is not consistent with guidelines recommending NS-NSAID use.

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Acknowledgments

Svetla Gadzhanova and Elizabeth E. Roughead were responsible for study design. Svetla Gadzhanova, Jenni Ilomäki and Elizabeth E. Roughead were responsible for the analyses, interpretation of the results and preparation of the manuscript. This study was funded by NPS Better choices Better health. The authors wish to thank Mark Bartlett from NPS for his comments on the manuscript. We acknowledge the support of the Australian Government Department of Veterans’ Affairs, which provided data for the conduct of these analyses. The authors have no conflicts of interest.

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Authors and Affiliations

  1. Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, Australia

    Svetla Gadzhanova, Jenni Ilomäki & Elizabeth E. Roughead

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  1. Svetla Gadzhanova
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  2. Jenni Ilomäki
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  3. Elizabeth E. Roughead
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Correspondence to Jenni Ilomäki.

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Gadzhanova, S., Ilomäki, J. & Roughead, E.E. COX-2 Inhibitor and Non-Selective NSAID Use in Those at Increased Risk of NSAID-Related Adverse Events. Drugs Aging 30, 23–30 (2013). https://doi.org/10.1007/s40266-012-0037-9

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  • DOI: https://doi.org/10.1007/s40266-012-0037-9

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