Chen Ying, Bedson John, Hayward Richard A, Jordan Kelvin P
Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, UK.
Fam Pract. 2018 Jul 23;35(4):426-432. doi: 10.1093/fampra/cmx142.
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain, but have potential side effects in patients with cardiovascular disease (CVD).
To determine trends in NSAIDs prescribing between 2002 and 2010 in patients with CVD, and ascertain whether prescribing patterns changed following publication of major national (the Medicines and Healthcare products Regulatory Agency (MHRA) and the National Institute for Health and Clinical Excellence (NICE)) guidance to GPs.
This was an observational database study of adult patients in 11 practices (Staffordshire, England). NSAIDs were categorised into basic, COX-2 and topical. Study duration was divided on a quarterly basis from 2002-quarter-1 to 2010q4. CVD patients were identified using pre-defined Read Codes recorded in the two years prior to each quarter. Quarterly prevalence was determined. Times of significant changes in prescribing trends were determined using Joinpoint Regression, and compared to dates of the five major guidelines (in 2004q4, 2005q1, 2005q3, 2006q4, 2008q1).
In CVD patients, the prescription of basic NSAIDs showed a decreasing trend throughout the study period, from 774 (95% CI, 691-863) per 10000 patients in 2002q1 to 245 (204-291) in 2010q4. COX-2 prescribing increased from 232/10000 (187-286) in 2002q1 to 403/10000 (348-464) in 2004q3. Prescribing then fell sharply to 102/10000 (76-134) in 2005q2 before stabilising around 55/10000. Topical NSAIDs prescribing showed a steady increase, starting at 115/10000 (108-123) in 2002q1 and ending at 270/10000 (258-281) in 2010q4. Similar trends were observed in patients without CVD, particularly a sharp drop in COX-2 prescribing also occurred from 2004q4 when initial MHRA guidance was issued.
Despite guidelines and a trend toward decreased prescribing, the use of potentially harmful NSAIDs continued in CVD patients. The MHRA directives potentially might have affected patients without CVD who may have inappropriately restricted their use of COX-2.
非甾体抗炎药（NSAIDs）常用于治疗疼痛，但对心血管疾病（CVD）患者有潜在副作用。
确定2002年至2010年CVD患者中NSAIDs处方的趋势，并确定在向全科医生发布主要国家指南（药品和保健产品监管局（MHRA）和国家卫生与临床优化研究所（NICE））后处方模式是否发生变化。
这是一项对11家诊所（英国斯塔福德郡）成年患者的观察性数据库研究。NSAIDs分为基础型、COX-2型和外用型。研究期间按季度划分，从2002年第一季度至2010年第四季度。使用每个季度前两年记录的预定义Read编码识别CVD患者。确定季度患病率。使用Joinpoint回归确定处方趋势的显著变化时间，并与五项主要指南发布日期（2004年第四季度、2005年第一季度、2005年第三季度、2006年第四季度、2008年第一季度）进行比较。
在CVD患者中，基础型NSAIDs的处方在整个研究期间呈下降趋势，从2002年第一季度每10000名患者774例（95%CI，691 - 863）降至2010年第四季度的245例（204 - 291）。COX-2处方从2002年第一季度的232/10000（187 - 286）增加到2004年第三季度的403/10000（348 - 464）。然后在2005年第二季度急剧降至102/10000（76 - 134），之后稳定在约55/10000。外用型NSAIDs处方呈稳步上升趋势，从2002年第一季度的115/10000（108 - 123）开始，到2010年第四季度结束时为270/10000（258 - 281）。在无CVD的患者中也观察到类似趋势，特别是从2004年第四季度发布MHRA初始指南后，COX-2处方也急剧下降。
尽管有指南且处方有减少趋势，但CVD患者中仍继续使用潜在有害的NSAIDs。MHRA指令可能影响了无CVD的患者，他们可能不恰当地限制了COX-2的使用。
