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Drug switching patterns among patients with rheumatoid arthritis and osteoarthritis using COX‐2 specific inhibitors and non‐specific NSAIDs
Author(s) -
Zhao Sean Z.,
Wentworth Chuck,
Burke Thomas A.,
Makuch Robert W.
Publication year - 2004
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.909
Subject(s) - rofecoxib , celecoxib , medicine , naproxen , diclofenac , ibuprofen , rheumatoid arthritis , osteoarthritis , cyclooxygenase , proportional hazards model , confidence interval , pharmacology , valdecoxib , confounding , odds ratio , pathology , biochemistry , chemistry , alternative medicine , enzyme
Purpose To compare RA and OA patients' time‐to‐switch after newly initiating treatment with three most commonly used non‐specific (NS)‐NSAIDs and two COX‐2 inhibitors, celecoxib and rofecoxib. Methods Managed care enrollees newly prescribed celecoxib, rofecoxib, ibuprofen, naproxen or diclofenac were identified. Time to switch to a different NS‐NSAID or COX‐2 specific inhibitor was determined using time‐to‐event analysis and Cox proportional hazards models were used to estimate the odds ratio (OR) after controlling for potential confounders. Results The time to 25% of the cohort switching was longer for rofecoxib and celecoxib (159 and 205 days respectively) compared to the three NS‐NSAIDs (49–78 days). Patients were at the highest risk of switching within the first 100 days of therapy. After adjusting for potential confounding factors, the OR for switching to another NS‐NSAID or COX‐2 specific inhibitor ranged from 1.74 to 2.35 for the three NS‐NSAIDs compared to celecoxib (all comparisons, p < 0.01). Similar findings were obtained when comparing rofecoxib to each of the three NS‐NSAIDS (all comparisons, p < 0.01). When COX‐2 inhibitors combined were compared to NS‐NSAIDS combined, the OR for switching was 1.53 (95% confidence interval=1.42–1.65; p < 0.01) after adjusting for potential confounders. Conclusions Patients on the COX‐2 specific inhibitors (celecoxib and rofecoxib) were significantly less likely to switch their therapy than patients on NS‐NSAIDS (ibuprofen, naproxen and diclofenac). These results suggest that COX‐2 specific inhibitors may be a more effective treatment option when compared with NS‐NSAIDs in usual clinical practice. Copyright © 2003 John Wiley & Sons, Ltd.