Mosis Georgio, Stijnen Theo, Castellsague Jordi, Dieleman Jeanne P, van der Lei Johan, Stricker Bruno H C, Sturkenboom Miriam C J M
Erasmus University Medical Center, Rotterdam, The Netherlands.
Arthritis Rheum. 2006 Aug 15;55(4):537-42. doi: 10.1002/art.22096.
To assess use and channeling of cyclooxygenase 2 selective inhibitors (coxibs) over time and to estimate the percentage of coxib users with cardiovascular contraindications.
The study population comprised all coxib and nonselective nonsteroidal antiinflammatory drug (NSAID) users in the Integrated Primary Care Information project between January 2000 and December 2004. The prevalence of risk factors for NSAID-related upper gastrointestinal ulcer complications, cardiovascular disease, and cerebrovascular disease at the start of treatment was compared between users of coxibs and users of nonselective NSAIDs.
The study population included 72,841 nonselective NSAID users and 10,739 coxib users. The prevalence of risk factors for NSAID-related gastrointestinal complications was higher in coxib users than nonselective NSAID users (odds ratio [OR] 1.18, 95% confidence interval [95% CI] 1.10-1.26). Similarly, the prevalence of prior cardiovascular disease was higher in coxib users than in nonselective NSAID users (OR 1.35, 95% CI 1.28-1.43). Channeling of coxibs to patients with NSAID-related gastrointestinal risk factors declined after 2001 but increased again in 2004, whereas the channeling of coxibs to patients with cardiovascular disease remained constant. Less than 15% of all coxib users had history of ischemic coronary or cerebrovascular disease. Among coxib users with increased risk for NSAID-related gastrointestinal disorders, 27% had history of ischemic coronary or cerebrovascular disease.
This study demonstrates that coxibs were preferentially prescribed to patients with risk factors for NSAID-related gastrointestinal disorders and/or cardiovascular diseases. Only one-quarter of coxib users with increased risk for NSAID-related gastrointestinal complications had cardiovascular conditions compatible with recent European safety contraindications for coxibs.
评估环氧化酶2选择性抑制剂（coxibs）随时间的使用情况及用药途径，并估计有心血管疾病禁忌证的coxib使用者的比例。
研究人群包括2000年1月至2004年12月综合初级保健信息项目中的所有coxib使用者和非选择性非甾体抗炎药（NSAID）使用者。比较coxib使用者和非选择性NSAID使用者在治疗开始时非甾体抗炎药相关上消化道溃疡并发症、心血管疾病和脑血管疾病危险因素的患病率。
研究人群包括72841名非选择性NSAID使用者和10739名coxib使用者。coxib使用者中非甾体抗炎药相关胃肠道并发症危险因素的患病率高于非选择性NSAID使用者（优势比[OR]1.18，95%置信区间[95%CI]1.10 - 1.26）。同样，coxib使用者既往心血管疾病的患病率高于非选择性NSAID使用者（OR 1.35，95%CI 1.28 - 1.43）。2001年后，coxibs用于有非甾体抗炎药相关胃肠道危险因素患者的用药途径减少，但在2004年再次增加，而coxibs用于心血管疾病患者的用药途径保持不变。所有coxib使用者中，缺血性冠状动脉或脑血管疾病病史者不到15%。在有非甾体抗炎药相关胃肠道疾病风险增加的coxib使用者中，27%有缺血性冠状动脉或脑血管疾病病史。
本研究表明，coxibs优先开给有非甾体抗炎药相关胃肠道疾病和/或心血管疾病危险因素的患者。在有非甾体抗炎药相关胃肠道并发症风险增加的coxib使用者中，只有四分之一的人有符合近期欧洲coxibs安全禁忌证的心血管疾病。
