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Prescribing COX-2-selective NSAIDs over traditional NSAIDs is influenced by physician specialty and patient risk factors

Nonsteroidal antiinflammatory drugs (NSAIDs) are often used long-term by patients suffering from inflammatory illnesses such as rheumatoid arthritis. However, the safety of long-term NSAID use remains a concern, especially for patients at greater risk for toxicity, such as the elderly. More physicians are using the newer, potentially safer cyclooxygenase 2 (COX-2)-selective NSAIDs (coxibs) to treat inflammatory diseases. Patients treated by specialists and those who have a history of gastrointestinal (GI) problems, which may be worsened with traditional NSAIDs, are more likely to receive coxibs, according to a study supported in part by the Agency for Healthcare Research and Quality (HS10389).

Researchers from the Centers for Education and Research on Therapeutics (CERTs) at the University of Alabama at Birmingham linked medical record, pharmacy, and administrative data for 452 patients from a regional managed care organization who had three or more consecutive NSAID prescriptions from June 1998 to April 2001. They examined the association between patient and provider characteristics and coxib initiation and discontinuation. Patients seeing rheumatologists and internists were two or three times as likely to receive a coxib as patients seeing family or general practitioners. However, generalists were more likely than specialists to selectively use coxibs among their patients with a history of GI disease.

Patients with a history of osteoarthritis, GI disease, and congestive heart failure were more likely than other patients to receive a coxib. Coxibs were 40 percent less likely to be discontinued than were traditional NSAIDs, suggesting that they may be better tolerated. Compared with coxibs, traditional NSAIDs were significantly more likely to be discontinued because of a GI problem such as bleeding or a history of GI disease. In contrast, coxibs were more likely to be discontinued when the patient had a history of hypertension.

See "The effects of physician specialty and patient comorbidities on the use and discontinuation of coxibs," by Fausto G. Patino, M.D., Dr.P.H., Jeroan Allison, M.D., M.Sc., Jason Olivieri, M.P.H., and others, in the June 15, 2003, Arthritis & Rheumatism 49(3), pp. 293-299.

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