Pharmacoutilization of anti-inflammatory and gastroprotective drugs in patients with osteoarthritis: comparison between COXIBs and conventional NSAIDs by using administrative records

The aim of the study was to analyze anti-inflammatory and gastroprotective drug utilization in patients with osteoarthritis comparing conventional non-steroidal anti-inflammatory drugs (NSAIDs) versus cyclo-oxygenase 2 (COX 2) inhibitors. A retrospective observational cohort study was conducted and health-assisted subjects from the Local Health Units of Turin and Caserta were enrolled. Data linkage techniques were used to cross demographical, pharmaceutical and nosological databases. All subjects aged ≥18 years who were hospitalized for osteoarthritis from July 1st 2002 to June 30th 2004 were enrolled in the study. Concurrent prescriptions of non-steroidal anti-inflammatory and gastroprotective drugs were considered. Other demographic and clinical characteristics were recorded. A total of 1,002 subjects with a diagnosis of osteoarthritis treated with NSAIDs were enrolled. Of these subjects, 438 patients were treated with non selective NSAIDs (80.8%), 104 with COXIBs (19.2%) and 460 with multiple therapy. There were no significant differences between the demographic and clinical characteristics of the three groups. Gastroprotective drugs were prescribed in 37.0% and 35.6% of subjects treated with NSAIDs and COXIBs, respectively. Gastroprotective drug prescriptions increased from the index date to the follow-up period (from 20.4% to 41.1% of subjects treated with NSAIDs). In high-risk subjects with gastrointestinal events, gastroprotective drug utilization was undersized and increased from the index date to the follow up period (from 19.4% to 40.8% of high-risk subjects). Evidence from this study indicated that non selective NSAIDs and COXIBs are used indiscriminately with respect to patient characteristics and gastroprotection