The COX-2 inhibitor market withdrawals and prescribing patterns by rheumatologists in patients with gastrointestinal and cardiovascular risk

Jeffrey D. Greenberg, Mark C. Fisher, Joel Kremer, Hong Chang, Elliot D. Rosenstein, Mitsumasa Kishimoto, Susan Lee, Yusuf Yazici, Arthur Kavanaugh, Steven B. Abramson

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Objective: To examine effects of the COX-2 inhibitor market withdrawals on NSAID utilization among patients at increased risk of gastrointestinal (GI) and cardiovascular (CV) toxicities. Methods: A prospective cohort study was conducted using patients enrolled in the Consortium of Rheumatology Researchers of North America (CORRONA) Registry. The study population included rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients prescribed NSAIDs by rheumatologists from 1/1/2003 to 12/31/2005. Three cohorts were defined based on calendar year. The primary outcome assessed whether or not an NSAID gastroprotective strategy was prescribed. Secondary outcomes included rates of COX-2 inhibitor utilization and gastroprotective co-therapy utilization, stratified by the presence of cardiac and GI risk factors. Results: NSAID gastroprotection utilization decreased from 65.1% in 2003 to 47.7% (p<0.001) in 2005. COX-2 inhibitor use decreased from 55.1% to 29.2% (p<0.001), whereas nonselective NSAIDs (nsNSAIDs) use increased from 50.2% to 73.9% (p=<0.01). Among patients with two or more risk factors for NSAID related GI bleeding, gastroprotection decreased from 74.4% in 2003 to 60.9% (p<0.01). For patients with two or more CV risk factors from 2003 to 2005, COX-2 inhibitor utilization decreased significantly, whereas nsNSAID utilization increased significantly. Conclusions: The COX-2 inhibitor withdrawals resulted in a rapid decline in NSAID gastroprotection prescribed by participating U.S. rheumatologists despite the availability of other gastroprotective options. Channeling toward nsNSAID use was widespread, including among patients at increased CV risk. Longer term follow-up is required to determine the clinical significance of these changes in NSAID prescribing, particularly for NSAID-related GI and CV-related toxicities.

Original languageEnglish (US)
Pages (from-to)395-401
Number of pages7
JournalClinical and Experimental Rheumatology
Volume27
Issue number3
StatePublished - May 1 2009

Fingerprint

Product Recalls and Withdrawals
Cyclooxygenase 2 Inhibitors
Non-Steroidal Anti-Inflammatory Agents
Psoriatic Arthritis
Rheumatology
North America
Registries
Rheumatologists
Rheumatoid Arthritis
Cohort Studies
Research Personnel
Prospective Studies
Hemorrhage
Population

All Science Journal Classification (ASJC) codes

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

Greenberg, Jeffrey D. ; Fisher, Mark C. ; Kremer, Joel ; Chang, Hong ; Rosenstein, Elliot D. ; Kishimoto, Mitsumasa ; Lee, Susan ; Yazici, Yusuf ; Kavanaugh, Arthur ; Abramson, Steven B. / The COX-2 inhibitor market withdrawals and prescribing patterns by rheumatologists in patients with gastrointestinal and cardiovascular risk. In: Clinical and Experimental Rheumatology. 2009 ; Vol. 27, No. 3. pp. 395-401.
@article{dca4845742904fa38d01d196ea90a5e0,
title = "The COX-2 inhibitor market withdrawals and prescribing patterns by rheumatologists in patients with gastrointestinal and cardiovascular risk",
abstract = "Objective: To examine effects of the COX-2 inhibitor market withdrawals on NSAID utilization among patients at increased risk of gastrointestinal (GI) and cardiovascular (CV) toxicities. Methods: A prospective cohort study was conducted using patients enrolled in the Consortium of Rheumatology Researchers of North America (CORRONA) Registry. The study population included rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients prescribed NSAIDs by rheumatologists from 1/1/2003 to 12/31/2005. Three cohorts were defined based on calendar year. The primary outcome assessed whether or not an NSAID gastroprotective strategy was prescribed. Secondary outcomes included rates of COX-2 inhibitor utilization and gastroprotective co-therapy utilization, stratified by the presence of cardiac and GI risk factors. Results: NSAID gastroprotection utilization decreased from 65.1{\%} in 2003 to 47.7{\%} (p<0.001) in 2005. COX-2 inhibitor use decreased from 55.1{\%} to 29.2{\%} (p<0.001), whereas nonselective NSAIDs (nsNSAIDs) use increased from 50.2{\%} to 73.9{\%} (p=<0.01). Among patients with two or more risk factors for NSAID related GI bleeding, gastroprotection decreased from 74.4{\%} in 2003 to 60.9{\%} (p<0.01). For patients with two or more CV risk factors from 2003 to 2005, COX-2 inhibitor utilization decreased significantly, whereas nsNSAID utilization increased significantly. Conclusions: The COX-2 inhibitor withdrawals resulted in a rapid decline in NSAID gastroprotection prescribed by participating U.S. rheumatologists despite the availability of other gastroprotective options. Channeling toward nsNSAID use was widespread, including among patients at increased CV risk. Longer term follow-up is required to determine the clinical significance of these changes in NSAID prescribing, particularly for NSAID-related GI and CV-related toxicities.",
author = "Greenberg, {Jeffrey D.} and Fisher, {Mark C.} and Joel Kremer and Hong Chang and Rosenstein, {Elliot D.} and Mitsumasa Kishimoto and Susan Lee and Yusuf Yazici and Arthur Kavanaugh and Abramson, {Steven B.}",
year = "2009",
month = "5",
day = "1",
language = "English (US)",
volume = "27",
pages = "395--401",
journal = "Clinical and Experimental Rheumatology",
issn = "0392-856X",
publisher = "Clinical and Experimental Rheumatology S.A.S.",
number = "3",

}

Greenberg, JD, Fisher, MC, Kremer, J, Chang, H, Rosenstein, ED, Kishimoto, M, Lee, S, Yazici, Y, Kavanaugh, A & Abramson, SB 2009, 'The COX-2 inhibitor market withdrawals and prescribing patterns by rheumatologists in patients with gastrointestinal and cardiovascular risk', Clinical and Experimental Rheumatology, vol. 27, no. 3, pp. 395-401.

The COX-2 inhibitor market withdrawals and prescribing patterns by rheumatologists in patients with gastrointestinal and cardiovascular risk. / Greenberg, Jeffrey D.; Fisher, Mark C.; Kremer, Joel; Chang, Hong; Rosenstein, Elliot D.; Kishimoto, Mitsumasa; Lee, Susan; Yazici, Yusuf; Kavanaugh, Arthur; Abramson, Steven B.

In: Clinical and Experimental Rheumatology, Vol. 27, No. 3, 01.05.2009, p. 395-401.

Research output: Contribution to journalArticle

TY - JOUR

T1 - The COX-2 inhibitor market withdrawals and prescribing patterns by rheumatologists in patients with gastrointestinal and cardiovascular risk

AU - Greenberg, Jeffrey D.

AU - Fisher, Mark C.

AU - Kremer, Joel

AU - Chang, Hong

AU - Rosenstein, Elliot D.

AU - Kishimoto, Mitsumasa

AU - Lee, Susan

AU - Yazici, Yusuf

AU - Kavanaugh, Arthur

AU - Abramson, Steven B.

PY - 2009/5/1

Y1 - 2009/5/1

N2 - Objective: To examine effects of the COX-2 inhibitor market withdrawals on NSAID utilization among patients at increased risk of gastrointestinal (GI) and cardiovascular (CV) toxicities. Methods: A prospective cohort study was conducted using patients enrolled in the Consortium of Rheumatology Researchers of North America (CORRONA) Registry. The study population included rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients prescribed NSAIDs by rheumatologists from 1/1/2003 to 12/31/2005. Three cohorts were defined based on calendar year. The primary outcome assessed whether or not an NSAID gastroprotective strategy was prescribed. Secondary outcomes included rates of COX-2 inhibitor utilization and gastroprotective co-therapy utilization, stratified by the presence of cardiac and GI risk factors. Results: NSAID gastroprotection utilization decreased from 65.1% in 2003 to 47.7% (p<0.001) in 2005. COX-2 inhibitor use decreased from 55.1% to 29.2% (p<0.001), whereas nonselective NSAIDs (nsNSAIDs) use increased from 50.2% to 73.9% (p=<0.01). Among patients with two or more risk factors for NSAID related GI bleeding, gastroprotection decreased from 74.4% in 2003 to 60.9% (p<0.01). For patients with two or more CV risk factors from 2003 to 2005, COX-2 inhibitor utilization decreased significantly, whereas nsNSAID utilization increased significantly. Conclusions: The COX-2 inhibitor withdrawals resulted in a rapid decline in NSAID gastroprotection prescribed by participating U.S. rheumatologists despite the availability of other gastroprotective options. Channeling toward nsNSAID use was widespread, including among patients at increased CV risk. Longer term follow-up is required to determine the clinical significance of these changes in NSAID prescribing, particularly for NSAID-related GI and CV-related toxicities.

AB - Objective: To examine effects of the COX-2 inhibitor market withdrawals on NSAID utilization among patients at increased risk of gastrointestinal (GI) and cardiovascular (CV) toxicities. Methods: A prospective cohort study was conducted using patients enrolled in the Consortium of Rheumatology Researchers of North America (CORRONA) Registry. The study population included rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients prescribed NSAIDs by rheumatologists from 1/1/2003 to 12/31/2005. Three cohorts were defined based on calendar year. The primary outcome assessed whether or not an NSAID gastroprotective strategy was prescribed. Secondary outcomes included rates of COX-2 inhibitor utilization and gastroprotective co-therapy utilization, stratified by the presence of cardiac and GI risk factors. Results: NSAID gastroprotection utilization decreased from 65.1% in 2003 to 47.7% (p<0.001) in 2005. COX-2 inhibitor use decreased from 55.1% to 29.2% (p<0.001), whereas nonselective NSAIDs (nsNSAIDs) use increased from 50.2% to 73.9% (p=<0.01). Among patients with two or more risk factors for NSAID related GI bleeding, gastroprotection decreased from 74.4% in 2003 to 60.9% (p<0.01). For patients with two or more CV risk factors from 2003 to 2005, COX-2 inhibitor utilization decreased significantly, whereas nsNSAID utilization increased significantly. Conclusions: The COX-2 inhibitor withdrawals resulted in a rapid decline in NSAID gastroprotection prescribed by participating U.S. rheumatologists despite the availability of other gastroprotective options. Channeling toward nsNSAID use was widespread, including among patients at increased CV risk. Longer term follow-up is required to determine the clinical significance of these changes in NSAID prescribing, particularly for NSAID-related GI and CV-related toxicities.

UR - http://www.scopus.com/inward/record.url?scp=67651177870&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67651177870&partnerID=8YFLogxK

M3 - Article

C2 - 19604430

AN - SCOPUS:67651177870

VL - 27

SP - 395

EP - 401

JO - Clinical and Experimental Rheumatology

JF - Clinical and Experimental Rheumatology

SN - 0392-856X

IS - 3

ER -