Skip to main content

Advertisement

SpringerLink
Log in

Are traditional NSAIDs prescribed appropriately among French elderly with osteoarthritis? Results from the CADEUS cohort

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Aim

To describe the inappropriate use of traditional non-steroidal anti-inflammatory drugs (tNSAIDs) in elderly subjects in the CADEUS cohort using the Beers 2003 criteria modified by recommendations from the French Medicines Agency.

Methods

Of the 23,217 subjects in the CADEUS cohort, 1,851 were ≥65 years old, had bee diagnosed with osteoarthritis (OA), and had been dispensed a tNSAID at least once in the 6 months before the index date. Data were obtained from the French national reimbursement database and from patient and prescriber questionnaires. The Beers criteria for inappropriate use were modified to include all tNSAIDs, and long-term high-dose use was defined as having been dispensed at least five dispensations for tNSAID over a 6-month period with a gap of <45 days between each dispensation and when the gap was >45 days, medicine availability >50% [i.e., defined daily dose (DDD) delivered/theoretical DDD] for the gap.

Results

The most frequently dispensed tNSAIDs were piroxicam (25%), diclofenac (24%), ibuprofen (18%), ketoprofen (18%), and naproxen (10%). Of the study population, 1.5% were dispensed indomethacin; 15%, two tNSAIDs; 15%, a tNSAIDs with a platelet aggregation inhibitor; 4.6%, a tNSAID with low-dose aspirin; 0.2%, a tNSAID with vitamin K antagonists. The analysis revealed that 18% of the study population were high-dose and long-term users of tNSAIDs and that 70% of these were dispensed a proton pump inhibitor.

Conclusions

The most common inappropriate tNSAID dispensation was the co-prescription of two different tNSAIDs within 1 month or of a platelet aggregation inhibitor. The real-life consequences of our results need to be ascertained, and it would be interesting to update the Beers criteria.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Moore N, Diris H, Martin K, Viale R, Fourrier A, Moride Y, Begaud B (2004) NSAID use profiles derived from reimbursement data in France. Therapie 59(5):541–546

    Article  PubMed  Google Scholar 

  2. Depont F, Fourrier A, Merliere Y, Droz C, Amouretti M, Begaud B, Benichou J, Moride Y, Blin P, Moore N (2007) The CADEUS study: methods and logistics. Pharmacoepidemiol Drug Saf 16(5):571–580

    Article  PubMed  CAS  Google Scholar 

  3. Depont F, Fourrier A, Merliere Y, Droz C, Amouretti M, Begaud B, Benichou J, Moride Y, Velo GP, Sturkenboom M, Blin P, Moore N (2007) Channelling of COX-2 inhibitors to patients at higher gastrointestinal risk but not at lower cardiovascular risk: the Cox2 inhibitors and tNSAIDs description of users (CADEUS) study. Pharmacoepidemiol Drug Saf 16(8):891–900

    Article  PubMed  CAS  Google Scholar 

  4. Vane JR (1971) Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs. Nat New Biol 231(25):232–235

    PubMed  CAS  Google Scholar 

  5. Silverstein FE, Faich G, Goldstein JL, Simon LS, Pincus T, Whelton A, Makuch R, Eisen G, Agrawal NM, Stenson WF, Burr AM, Zhao WW, Kent JD, Lefkowith JB, Verburg KM, Geis GS (2000) Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: A randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA 284(10):1247–1255

    Article  PubMed  CAS  Google Scholar 

  6. Bombardier C, Laine L, Reicin A, Shapiro D, Burgos-Vargas R, Davis B, Day R, Ferraz MB, Hawkey CJ, Hochberg MC, Kvien TK, Schnitzer TJ (2000) Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N Engl J Med 343 (21):1520–1528

    Google Scholar 

  7. Hermann M (2009) Cardiovascular risk associated with nonsteroidal anti-inflammatory drugs. Curr Rheumatol Rep 11(1):31–35

    Article  PubMed  CAS  Google Scholar 

  8. Beers MH (1997) Explicit criteria for determining potentially inappropriate medication use by the elderly. An update. Arch Intern Med 157(14):1531–1536

    Article  PubMed  CAS  Google Scholar 

  9. Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC (1991) Explicit criteria for determining inappropriate medication use in nursing home residents. UCLA Division of Geriatric Medicine. Arch Intern Med 151(9):1825–1832

    Article  PubMed  CAS  Google Scholar 

  10. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH (2003) Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 163(22):2716–2724

    Article  PubMed  Google Scholar 

  11. Afssaps (2006) Rappel des règles de bon usage des AINS. Afssaps, France

  12. Afssaps (2006) Evaluation des nouvelles données de tolérance cardiovasculaire : Le rapport bénéfice/risque des AINS reste favorable mais les précautions d’emploi doivent être renforcées. In: Afssaps, France

  13. Moore N (2003) Place of OTC analgesics and NSAIDs in osteoarthritis. Inflammopharmacology 11(4):355–362

    Article  PubMed  CAS  Google Scholar 

  14. Moore N, Verschuren X, Montout C, Callens J, Kong SX, Begaud B (2000) Excess costs related to non-steroidal anti-inflammatory drug utilization in general practice. Therapie 55(1):133–136

    PubMed  CAS  Google Scholar 

  15. Becker JC, Domschke W, Pohle T (2004) Current approaches to prevent NSAID-induced gastropathy–COX selectivity and beyond. Br J Clin Pharmacol 58(6):587–600

    Article  PubMed  CAS  Google Scholar 

  16. Gallagher PF, Barry PJ, Ryan C, Hartigan I, O'Mahony D (2008) Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers' Criteria. Age Ageing 37(1):96–101

    Article  PubMed  Google Scholar 

  17. O'Mahony D, Gallagher PF (2008) Inappropriate prescribing in the older population: need for new criteria. Age Ageing 37(2):138–141

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Philip Robinson, who is an employee of the Département de Pharmacologie, Université de Bordeaux , Bordeaux, France, for help with the manuscript preparation. We would also like to thank all those who participated in the CADEUS study, and the patients and the prescribers who provided the data.

The CADEUS study was supported by Pfizer Inc. and Merck and Co. The funding source had no involvement in study design, collection, analysis, or interpretation of data, writing of the report, or in the decision to submit the paper for publication. The present analysis of CADEUS data was entirely funded by the Départment de Pharmacologie, INSERM U657, Université de Bordeaux .

Competing interests

The authors declare that they have no conflict of interest.

Authors’ contributions

SEG, AFR, CDP, RL, MR conceived the study and participated in its design. SEG, RL carried out acquisition, statistical analysis, and interpretation of data. SEG drafted the manuscript. SEG, CDP, RL, PB, BB, MR, NM and AFR participated in the critical revision of the manuscript for important intellectual content. All authors have given final approval of the version to be published.

Author information

Authors and Affiliations

  1. INSERM CIC-P 0005 Pharmaco-Epidémiologie, Service de Pharmacologie, Université Bordeaux Segalen–CHU de Bordeaux, Bâtiment le Tondu–Case 41, 146, Rue Léo Saignat, 33076, Bordeaux Cedex, France

    Sinem Ezgi Gulmez, Régis Lassalle & Patrick Blin

  2. INSERM CIC-P 0005 Pharmaco-Epidémiologie, INSERM Unité U657, IFR 99, Service de Pharmacologie, Université Bordeaux Segalen, Bâtiment le Tondu–Case 41, 146, Rue Léo Saignat, 33076, Bordeaux Cedex, France

    Cécile Droz-Perroteau

  3. INSERM CIC-P 0005 Pharmaco-Epidémiologie, INSERM Unité U657, IFR 99, Service de Pharmacologie, Université Bordeaux Segalen–CHU de Bordeaux, Bâtiment le Tondu–Case 41, 146, Rue Léo Saignat, 33076, Bordeaux Cedex, France

    Bernard Bégaud, Nicholas Moore & Annie Fourrier-Réglat

  4. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 4820 Boul. Saint-Laurent, Montreal, QC, Canada

    Michel Rossignol

Authors
  1. Sinem Ezgi Gulmez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cécile Droz-Perroteau
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Régis Lassalle
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patrick Blin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernard Bégaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michel Rossignol
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nicholas Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Annie Fourrier-Réglat
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

On behalf of the CADEUS study group

Corresponding author

Correspondence to Annie Fourrier-Réglat.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gulmez, S.E., Droz-Perroteau, C., Lassalle, R. et al. Are traditional NSAIDs prescribed appropriately among French elderly with osteoarthritis? Results from the CADEUS cohort. Eur J Clin Pharmacol 67, 833–838 (2011). https://doi.org/10.1007/s00228-011-1015-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-011-1015-6

Keywords

Search

Navigation