Division of Clinical Epidemiology, McGill University Health Centre, 687 Pine Avenue West, V Building, Montreal, Québec H3A 1A1.
J Rheumatol. 2011 Feb;38(2):195-202. doi: 10.3899/jrheum.100332. Epub 2010 Nov 15.
Use of traditional nonsteroidal antiinflammatory drugs (tNSAID) increased after rofecoxib withdrawal. tNSAID use is associated with increased gastrointestinal (GI) toxicity and cardiovascular (CV) risk similar to celecoxib. The objective of our study was to describe changes in celecoxib and tNSAID use regarding GI and CV risk and congestive heart failure (CHF) and renal risk that occurred in Quebec, Canada, between April 2005-March 2007 (the post-period) compared to April 2002-March 2004 (the pre-period).
Data were obtained from the provincial health insurance agency. All NSAID users ≥ 50 years of age were considered.
Celecoxib use decreased by 23% (coxib 61%) while that of tNSAID doubled. In both periods, celecoxib users were older and included more women, and they suffered more frequently from arthritis. Users of celecoxib were more likely to have higher level of GI risk: post-period odds ratios compared to low GI risk, very high 1.79 (95% CI 1.63, 1.97), high 1.76 (95% CI 1.71, 1.81), and moderate 1.30 (95% CI 1.27, 1.33); similar results were observed in the pre-period. Celecoxib users had higher CV risk levels in the pre-period: OR compared to low CV risk, very high 1.13 (95% CI 1.08, 1.19), high 1.24 (95% CI 1.20, 1.29), and moderate 1.16 (95% CI 1.14, 1.19); and in the post-period, very high 0.85 (95% CI 0.81, 0.89), high 1.13 (95% CI 1.10, 1.16), and moderate 1.15 (95% CI 1.12, 1.17). CHF and renal risk factors did not play an important role in the choice of NSAID in either period.
Current NSAID use differs from that prior to 2004. Coxib utilization decreased substantially and patients at high CV risk seem less likely to receive celecoxib, while those at high GI risk seem more likely to receive it.
罗非昔布撤市后，传统非甾体抗炎药（tNSAID）的使用有所增加。tNSAID 的使用与增加的胃肠道（GI）毒性和心血管（CV）风险相关，与塞来昔布相似。我们研究的目的是描述魁北克省 2005 年 4 月至 2007 年 3 月（后时期）与 2002 年 4 月至 2004 年 3 月（前时期）相比，GI 和 CV 风险以及充血性心力衰竭（CHF）和肾脏风险方面塞来昔布和 tNSAID 使用率的变化。
数据来自省级医疗保险机构。所有≥50 岁的 NSAID 使用者均被考虑。
coxib 的使用减少了 23%（coxib 减少了 61%），而 tNSAID 的使用增加了一倍。在前、后两个时期，塞来昔布使用者年龄更大，且包括更多的女性，并且更频繁地患有关节炎。塞来昔布使用者发生胃肠道风险更高：后时期与低胃肠道风险相比，极高风险为 1.79（95%CI 1.63，1.97），高风险为 1.76（95%CI 1.71，1.81），中度风险为 1.30（95%CI 1.27，1.33）；在前时期也观察到类似的结果。塞来昔布使用者在前时期具有更高的 CV 风险水平：与低 CV 风险相比，极高风险为 1.13（95%CI 1.08，1.19），高风险为 1.24（95%CI 1.20，1.29），中度风险为 1.16（95%CI 1.14，1.19）；在后时期，极高风险为 0.85（95%CI 0.81，0.89），高风险为 1.13（95%CI 1.10，1.16），中度风险为 1.15（95%CI 1.12，1.17）。在两个时期，心力衰竭和肾脏危险因素在 NSAID 的选择中都没有发挥重要作用。
目前 NSAID 的使用与 2004 年之前不同。coxib 的使用大幅减少，高 CV 风险的患者似乎不太可能接受塞来昔布，而高 GI 风险的患者似乎更有可能接受塞来昔布。
