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What therapies have replaced rofecoxib in Ireland?
Author(s) -
Teeling Mary,
O'Connor Humphrey,
Feely John,
Bennett Kathleen
Publication year - 2007
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2007.02918.x
Subject(s) - rofecoxib , medicine , concomitant , medical prescription , proton pump inhibitor , pharmacoepidemiology , analgesic , nonsteroidal , cyclooxygenase , anesthesia , pharmacology , biochemistry , chemistry , enzyme
What is already known about this subject • Prior to the worldwide withdrawal of rofecoxib in 2004, due to cardiovascular toxicity with its use, selective COX‐2 inhibitors had been shown to be preferentially prescribed to ‘at‐risk’ patients in Ireland, including older females or those receiving antiulcer medications or multiple concomitant medications. What this study adds • During the 12 months post rofecoxib withdrawal the majority of those previously receiving chronic rofecoxib therapy were prescribed either no further nonsteroidal anti inflammatory drug (NSAID) therapy or short‐term NSAID therapy only. • Prescriptions for analgesic agents were initiated in half of the study group. • These results suggest that the withdrawal of rofecoxib and the subsequent controversy may have led prescribers to question their use of NSAIDs in the first place and to adhere more closely to published guidelines on their use. Aims To examine prescription patterns of nonsteroidal anti‐inflammatory drugs (NSAIDs) or analgesics in patients prescribed chronic rofecoxib treatment prior to withdrawal from the Irish market, and to determine the impact on proton pump inhibitor (PPI) co‐prescription. Methods Using a national prescribing database, adults (≥16 years) prescribed rofecoxib for ≥3 months, but not analgesics, from January to September 2004 were identified. A longitudinal prescribing history was used to determine switching patterns to other cyclooxygenase (COX)‐2 inhibitors, NSAIDs or analgesics during 3 and 12 months after withdrawal. Concomitant PPI prescription was examined. Logistic regression was used to determine the likelihood of switching to a COX‐2 inhibitor vs. nonselective NSAID and factors influencing concomitant PPI prescription. Results After rofecoxib withdrawal, 30.2% (1558) and 17.9% (922) of the 5155 study subjects received no further NSAID prescription during 3 and 12 months, respectively. During the 12‐month period, approximately one‐third of NSAID prescriptions were for <3 months; 40.7% (2096) received sequential prescriptions for different NSAIDs. Co‐prescription of analgesics occurred in 49.3% (2539) of subjects. Neither age nor gender influenced the type of NSAID prescribed in the 12 months post rofecoxib withdrawal. PPI prescription increased by 5.5% during the study, associated with use of nonselective NSAIDs, prior use of PPIs and increasing age. Conclusions The majority of those receiving chronic rofecoxib therapy were prescribed either no further NSAID or short‐term NSAID therapy only during the 12 months post withdrawal, which suggests the subsequent controversy may have encouraged prescribers to adhere more closely to published guidelines.