Study on the use of non-steroidal anti-inflammatory drugs in Québec adults (only available in French)

03-01-2009 | Médicaments: Usage optimal

Cohort study 2004–2008

In September 2004, rofecoxib (VIOXX®), a widely prescribed non-steroidal anti-inflammatory drug (NSAID), was pulled from the Canadian market. Shortly thereafter, in April 2005 and October 2007 respectively, valdecoxib (BEXTRA®) and lumiracoxib (Prexige®), two other selective cyclo-oxygenase-2 inhibitors (coxibs), were also taken off the market. The withdrawal of these products and the publication of numerous studies on the risks associated with NSAIDs have likely caused physicians to be more prudent with NSAID prescriptions.

This study aimed to evaluate NSAID use since the withdrawal of rofecoxib, in September 30, 2004, in patients aged 18 and over who were covered by the public drug insurance plan. The study also sought to determine the factors associated with the prescription of a coxib over a non-selective NSAID during a new treatment period.

A retrospective longitudinal cohort study was carried out using the data banks of the Régie de l’assurance maladie du Québec (RAMQ). The population studied consisted of everyone aged 18 and over who had received their first prescription for an NSAID between October 1, 2004, and September 30, 2007. Subjects’ socio-demographic statistics (age, sex, insurance category, recent diagnoses), risk factors (gastrointestinal, cardiovascular, renal), and treatment details (treatment for 60 or more consecutive days, previous treatment with an analgesic, concomitant treatment with acetylsalicylic acid [ASA]) were analyzed according to treatment group and the year subjects entered the study. Subjects were divided into four treatment groups according to whether they had been prescribed:

  • only a non-selective NSAID;
  • a non-selective NSAID with a proton pump inhibitor (PPI) as a gastroprotector;
  • only a coxib;
  • a coxib with a PPI as a gastroprotector.

A multivariate logistic regression model was constructed to determine the factors associated with the prescription of a coxib over a non-selective NSAID during a new treatment period.

We noted that from 2004 to 2007, the prevalence of NSAID use as a new treatment in insured persons aged 18 and over decreased (from 7.2% to 5.4%). Of the 157,216 new NSAID users in 2006-2007, 73.6% were given a non-selective NSAID, with 15.1% of these users also being given a PPI, and 26.4% (41,427 users) were given a coxib, with 25.8% of these users also receiving a PPI. While the use of coxibs was relatively low in 2004-2005 (19.5%), it increased, with an absolute coxib use increase of 6.9% for the period from 2004-2005 to 2006-2007. The main factors for the prescription of a coxib over a non-selective NSAID during a new treatment period were age (adjusted odds ratio [OR]: 9.1 in subjects aged 75 and over compared with subjects between the ages of 18 and 29) and treatment for 60 or more consecutive days (adjusted OR: 2.9). It should be noted that the majority of these treatments (88.7%) were prescribed by general practitioners.

NSAID use in Québec has changed considerably since rofecoxib was withdrawn from the market. However, NSAID use is still not optimal, particularly in the most at-risk patients. Strategies must be put in place to improve NSAID use in elderly populations and in populations with gastrointestinal risks.

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