Schnitzer Thomas J, Kong Sheldon X, Mitchell Jeffrey H, Mavros Panagiotis, Watson Douglas J, Pellissier James M, Straus Walter L
Northwestern Center for Clinical Research, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA.
Clin Ther. 2003 Dec;25(12):3162-72. doi: 10.1016/s0149-2918(03)90100-7.
This study assessed prescribing patterns for rofecoxib and celecoxib in the treatment of osteoarthritis (OA) and rheumatoid arthritis (RA), as well as differences in prescribing patterns across physician specialties.
This was an observational, retrospective, cohort study of a large, US pharmacy claims database. Eligible patients were initiating therapy with rofecoxib or celecoxib and had succeeds, equals 90 days' supply of medication, as well as > or =1 medical claim specific to OA or RA between June 1, 2000, and May 31, 2001. Analyses were stratified according to diagnosis, prescribing physician specialty, and patient demographics. The main outcome measure was mean daily usage (ie, mean daily dose [milligrams]; mean number of pills per day; and mean daily consumption [denoted as DACON], calculated as daily dose divided by most frequently prescribed strength). This was primarily a descriptive study. Tests of statistical significance were not performed because the large sample size would have rendered small differences significant.
A total of 58,574 patients with OA (81.8% [n=47,935]) or RA (18.2% [n=10,639]) received 220,627 prescriptions for rofecoxib or celecoxib (47.7% [n=27, 924] and 52.3% [n=30, 650] of patients, respectively) during the study period. Overall, the most frequently prescribed strengths were rofecoxib 25 mg and celecoxib 200 mg. In both OA and RA, the most frequently prescribed mean daily dose of rofecoxib was 25 mg. In OA, the most frequently prescribed mean daily dose of celecoxib was 200 mg; in RA, it was 400 mg. Both pills per day and DACON were higher for celecoxib than rofecoxib. The DACON for rofecoxib was unrelated to physician specialty. Rheumatologists prescribed celecoxib at 20% to 40% higher mean daily doses than did primary care physicians, orthopedic specialists, or other specialists. Regardless of physician specialty, the DACON appeared higher for patients with RA than OA, for men than women, and for younger (aged <65 years) than older patients.
In this analysis, relative to the most frequently prescribed strength, celecoxib-treated patients with OA and RA had higher DACONs than rofecoxib-treated OA and RA patients across all subgroups. These observations may have economic implications in terms of direct effects on cost and the need for formularies to consider overall use patterns in addition to pill costs. However, these conclusions are limited by lack of clinical information (other than an OA or RA diagnosis), inability to ascertain actual use, and potential for selection bias.
本研究评估了罗非昔布和塞来昔布治疗骨关节炎（OA）和类风湿关节炎（RA）的处方模式，以及不同内科专业之间处方模式的差异。
这是一项对美国大型药房索赔数据库进行的观察性、回顾性队列研究。符合条件的患者开始使用罗非昔布或塞来昔布进行治疗，且已成功获得相当于90天供应量的药物，同时在2000年6月1日至2001年5月31日期间有≥1份特定于OA或RA的医疗索赔。分析根据诊断、开处方的内科专业和患者人口统计学特征进行分层。主要结局指标是平均每日用量（即平均每日剂量[毫克]；每日平均药片数；以及平均每日消耗量[表示为DACON]，计算方法为每日剂量除以最常处方的剂量强度）。这主要是一项描述性研究。未进行统计学显著性检验，因为样本量较大，小差异也会具有显著性。
在研究期间，共有58,574例OA患者（81.8%[n = 47,935]）或RA患者（18.2%[n = 10,639]）接受了220,627份罗非昔布或塞来昔布的处方（分别占患者的47.7%[n = 27,924]和52.3%[n = 30,650]）。总体而言，最常处方剂量强度是罗非昔布25毫克和塞来昔布200毫克。在OA和RA患者中，罗非昔布最常处方的平均每日剂量都是25毫克。在OA患者中，塞来昔布最常处方的平均每日剂量是200毫克；在RA患者中，是400毫克。塞来昔布的每日药片数和DACON均高于罗非昔布。罗非昔布的DACON与内科专业无关。与初级保健医生、骨科专家或其他专家相比，风湿病学家开出的塞来昔布平均每日剂量要高20%至x0%。无论内科专业如何，RA患者的DACON似乎高于OA患者，男性高于女性，年龄较小（<65岁）的患者高于年龄较大的患者。
在本分析中，相对于最常处方的剂量强度而言，在所有亚组中，接受塞来昔布治疗的OA和RA患者的DACON高于接受罗非昔布治疗的OA和RA患者。这些观察结果可能对成本有直接影响，并且在制定处方集时除了药片成本外还需要考虑总体使用模式，从而具有经济意义。然而，这些结论受到缺乏临床信息（除OA或RA诊断外）、无法确定实际使用情况以及存在选择偏倚可能性的限制。
