Assessment of coxib utilization by rheumatologists for nonsteroidal antiinflammatory drug gastroprotection prior to the coxib market withdrawals

Authors

  • Jeffrey D. Greenberg,

    Corresponding author
    1. New York University Hospital for Joint Diseases, New York
    • NYU-Hospital for Joint Diseases, 301 East 17th Street, Suite 1410, New York, NY 10003
    Search for more papers by this author
    • Dr. Greenberg is recipient of a Physician Scientist Development award from the Arthritis Foundation/American College of Rheumatology. Dr. Bingham is recipient of an Arthritis Investigator award from the Arthritis Foundation.

  • Clifton O. Bingham III,

    1. Johns Hopkins Medical Institutions, Baltimore, Maryland
    Search for more papers by this author
    • Dr. Greenberg is recipient of a Physician Scientist Development award from the Arthritis Foundation/American College of Rheumatology. Dr. Bingham is recipient of an Arthritis Investigator award from the Arthritis Foundation.

    • Dr. Abramson has received consulting fees (less than $10,000 each per year) from Novartis, Pfizer, Abbott, Amgen, Centocor, and GlaxoSmithKline. Dr. Reed has a contract (greater than $10,000) with CORRONA. Dr. Bingham has received consulting fees (less than $10,000 per year) from Novartis and is a clinical trial investigator for Merck and Pfizer.

  • Steven B. Abramson,

    1. New York University Hospital for Joint Diseases, New York
    Search for more papers by this author
    • Dr. Abramson has received consulting fees (less than $10,000 each per year) from Novartis, Pfizer, Abbott, Amgen, Centocor, and GlaxoSmithKline. Dr. Reed has a contract (greater than $10,000) with CORRONA. Dr. Bingham has received consulting fees (less than $10,000 per year) from Novartis and is a clinical trial investigator for Merck and Pfizer.

  • George Reed,

    1. University of Massachusetts, Worcester
    Search for more papers by this author
    • Dr. Abramson has received consulting fees (less than $10,000 each per year) from Novartis, Pfizer, Abbott, Amgen, Centocor, and GlaxoSmithKline. Dr. Reed has a contract (greater than $10,000) with CORRONA. Dr. Bingham has received consulting fees (less than $10,000 per year) from Novartis and is a clinical trial investigator for Merck and Pfizer.

  • Mitsumasa Kishimoto,

    1. New York University Hospital for Joint Diseases, New York
    Search for more papers by this author
  • Kim Hinkle,

    1. The Center for Rheumatology, Albany, New York
    Search for more papers by this author
  • Joel Kremer

    1. The Center for Rheumatology, Albany, New York
    Search for more papers by this author

Abstract

Objective

To examine cyclooxygenase 2 inhibitor (coxib) utilization by rheumatologists for patients receiving nonsteroidal antiinflammatory drugs (NSAIDs) prior to the coxib market withdrawals.

Methods

A prospective study of patients with rheumatoid arthritis enrolled in the Consortium of Rheumatology Researchers of North America registry was performed.

Results

Of 1,833 patients receiving prescription NSAIDs, 1,380 (75.3%) received gastroprotection, defined as either coxib monotherapy and/or gastroprotective agent (GPA) cotherapy, and 1,207 (65.8%) received coxibs. The distribution of gastroprotective strategies included 860 (46.9%) patients who were prescribed coxib monotherapy, 347 (18.9%) prescribed dual coxib plus GPA cotherapy, 173 (9.4%) prescribed a nonselective NSAID (NS-NSAID) plus GPA cotherapy, and 453 (24.7%) prescribed an NS-NSAID without GPA cotherapy. For patients with 0, 1, and ≥2 identifiable gastrointestinal (GI) risk factors, coxib prescribing rates as a proportion of NSAID agents were 64.1%, 66.4%, and 68.6%, respectively; among dual aspirin/NSAID users, coxib prescribing rates were 66.2%, 78.3%, and 68.5% of NSAID prescriptions, respectively.

Conclusion

The majority of NSAID users were prescribed a gastroprotective strategy, primarily attributable to coxib utilization. Coxib utilization rates were consistently high across all levels of GI risk, including patients without identifiable risk factors. These data indicate that rheumatologists broadly adopted the coxib class of NSAIDs in a nonselective manner with respect to underlying GI risk and concomitant aspirin use. As novel therapeutic classes are introduced, early evaluation of prescribing patterns using arthritis registries can determine the appropriateness of prescribing patterns and may improve patient outcomes.

Ancillary