Channeling and prevalence of cardiovascular contraindications in users of cyclooxygenase 2 selective nonsteroidal antiinflammatory drugs

Mosis, Georgio; Stijnen, Theo; Castellsagué, Jordi; Dieleman, Jeanne P.; Lei, Johan van der; Stricker, Bruno H.; Sturkenboom, Miriam

doi:10.1002/art.22096

Cited by 13 publications

(14 citation statements)

References 23 publications

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“…This study confirmed that coxibs and diclofenac/misoprostol were more commonly prescribed to patients with an increasing number of risk factors for NSAID‐related UGI complications 28 . Noteworthy, GPAs were more frequently prescribed in combination with coxibs than in combination with nsNSAIDs, which is remarkable since the additional benefit of gastroprotection with the use of coxibs has not been proven 13, 29 .…”

Section: Discussionsupporting

confidence: 58%

Adherence to gastroprotection and the risk of NSAID‐related upper gastrointestinal ulcers and haemorrhage

Soest

Sturkenboom

Dieleman

et al. 2007

Aliment Pharmacol Ther

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Section: Discussionsupporting

confidence: 58%

Adherence to gastroprotection and the risk of NSAID‐related upper gastrointestinal ulcers and haemorrhage

Soest

Sturkenboom

Dieleman

et al. 2007

Aliment Pharmacol Ther

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“…It might be the channeling effects of injection use rather than the actual symptoms changes since current clinical guidelines are still conflicting 4,8,9,33,34 . A similar phenomenon was found in a study of celecoxib compared to other NSAIDs in OA patients 35 . Another potential explanation is that the relation between change in symptoms and actual treatments received may not be a linear.…”

Section: Discussionsupporting

confidence: 84%

Patterns of intra-articular injection use after initiation of treatment in patients with knee osteoarthritis: data from the osteoarthritis initiative

Liu

Dubé

Driban

et al. 2017

Osteoarthritis and Cartilage

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Objective We sought to describe and evaluate longitudinal use of intra-articular injections after treatment initiation among adults with radiographically confirmed knee osteoarthritis (OA). Method Using data from the Osteoarthritis Initiative, we included participants with radiographically confirmed OA (Kellgren-Lawrence grade (K-L) ≥ 2) in ≥ 1 knee at baseline. With 9 years of data, 412 participants newly initiating hyaluronic acid or corticosteroid injections with their index visit were identified. For each type of injection initiated, socio-demographic and clinical characteristics were described by patterns of treatments (one-time use, switched, or continued injections). Multinomial logistic models estimated the extent to which patient-reported symptoms (post-initial injection and changes over time) were associated with patterns of injection use. Results Of those initiating injections, ~19% switched, ~21% continued injection type, and ~60% did not report any additional injections. For participants initiating corticosteroid injections, greater symptoms post-initial injection were associated with lower odds of continued use compared to one-time users (adjusted odds ratio (aOR) for WOMAC pain: 0.91; 95%, confidence interval (CI): 0.83 to 0.99; aORstiffness: 0.77; CI: 0.63 to 0.94; aORphysical function: 0.97; CI: 0.94 to 1.00). Symptom changes over time (e.g. worsened or improved) were not associated with patterns of injections use. Conclusion After treatment initiation, the proportion of patients switching injection use and one-time users was substantial. Symptoms post-initial injection appear to be associated with patterns of injection use. The extent to which these patterns are an indication of lack of impact on patient-reported symptoms should be explored.

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“…However, few large-scale studies have focused specifically on the influence of CV risk on the prescription of NSAIDs by GPs, which was the aim of the present study. One prior study did investigate this in the primary care population as we did, but it only reported on the years 2000 to 2004, before evidence emerged of the CV risk of NSAIDs [35]. Other studies which have reported on CV risk and the use of NSAIDs both before and after rofecoxib withdrawal in 2004 [36,37] were not population-based.…”

Section: Discussionmentioning

confidence: 96%

Ischaemic cardiovascular risk and prescription of non-steroidal anti-inflammatory drugs for musculoskeletal complaints

Koffeman¹,

Valkhoff²,

Jong³

et al. 2014

Scandinavian Journal of Primary Health Care

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Objective. To determine the influence of ischaemic cardiovascular (CV) risk on prescription of non-steroidal anti-inflammatory drugs (NSAIDs) by general practitioners (GPs) in patients with musculoskeletal complaints. Design. Cohort study. Setting. A healthcare database containing the electronic GP medical records of over one million patients throughout the Netherlands. Patients. A total of 474 201 adults consulting their GP with a new musculoskeletal complaint between 2000 and 2010. Patients were considered at high CV risk if they had a history of myocardial infarction, angina pectoris, stroke, transient ischaemic attack, or peripheral arterial disease, and at low CV risk if they had no CV risk factors. Main outcome measures. Frequency of prescription of non-selective (ns)NSAIDs and selective cyclooxygenase-2 inhibitors (coxibs). Results. Overall, 24.4% of patients were prescribed an nsNSAID and 1.4% a coxib. Of the 41,483 patients with a high CV risk, 19.9% received an nsNSAID and 2.2% a coxib. These patients were more likely to be prescribed a coxib than patients with a low CV risk (OR 1.9, 95% CI 1.8–2.0). Prescription of nsNSAIDs decreased over time in all risk groups and was lower in patients with a high CV risk than in patients with a low CV risk (OR 0.8, 95% CI 0.7–0.8). Conclusion. Overall, patients with a high CV risk were less likely to be prescribed an NSAID for musculoskeletal complaints than patients with a low CV risk. Nevertheless, one in five high CV risk patients received an NSAID, indicating that there is still room for improvement.

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Channeling and prevalence of cardiovascular contraindications in users of cyclooxygenase 2 selective nonsteroidal antiinflammatory drugs

Cited by 13 publications

References 23 publications

Adherence to gastroprotection and the risk of NSAID‐related upper gastrointestinal ulcers and haemorrhage

Adherence to gastroprotection and the risk of NSAID‐related upper gastrointestinal ulcers and haemorrhage

Patterns of intra-articular injection use after initiation of treatment in patients with knee osteoarthritis: data from the osteoarthritis initiative

Ischaemic cardiovascular risk and prescription of non-steroidal anti-inflammatory drugs for musculoskeletal complaints

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