Svetla Gadzhanova1, Jenni Ilomäki, Elizabeth E Roughead. 1. Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.
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.
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.
Authors: Robert S Bresalier; Robert S Sandler; Hui Quan; James A Bolognese; Bettina Oxenius; Kevin Horgan; Christopher Lines; Robert Riddell; Dion Morton; Angel Lanas; Marvin A Konstam; John A Baron Journal: N Engl J Med Date: 2005-02-15 Impact factor: 91.245
Authors: Stephen P Motsko; Karen L Rascati; Anthony J Busti; James P Wilson; Jamie C Barner; Kenneth A Lawson; Jason Worchel Journal: Drug Saf Date: 2006 Impact factor: 5.606
Authors: F E Silverstein; G Faich; J L Goldstein; L S Simon; T Pincus; A Whelton; R Makuch; G Eisen; N M Agrawal; W F Stenson; A M Burr; W W Zhao; J D Kent; J B Lefkowith; K M Verburg; G S Geis Journal: JAMA Date: 2000-09-13 Impact factor: 56.272
Authors: Tessa K Morgan; Margaret Williamson; Marie Pirotta; Kay Stewart; Stephen P Myers; Joanne Barnes Journal: Med J Aust Date: 2012-01-16 Impact factor: 7.738
Authors: Emil Loldrup Fosbøl; Gunnar H Gislason; Søren Jacobsen; Steen Z Abildstrom; Morten Lock Hansen; Tina Ken Schramm; Fredrik Folke; Rikke Sørensen; Jeppe N Rasmussen; Lars Køber; Mette Madsen; Christian Torp-Pedersen Journal: Pharmacoepidemiol Drug Saf Date: 2008-08 Impact factor: 2.890