The use of selective cyclooxygenase...

The use of selective cyclooxygenase (COX)-2 inhibitors has increased substantially since this just discovered class of medication was approved by the agency of the U.S. Food and mix with drugs Administration. COX-2 inhibitors are significantly les likely to cause gastrointestinal sore s than the nonselective nonsteroidal anti-inflammatory physics (NSAIDs). The efficacy of these sum of two units classes of medications is the same. This decrease in gastrointestinal toxicity ensues at a substantial cost, with the average wholesale price of a COX-2 inhibitor being 10 to 20 times greater than the price of generic ibuprofen. Because little is known about what factors influence the use of COX-2 inhibitors, Solomon and colleagues examined the issues of patient risk factors for gastrointestinal toxicity, other patient characteristics, and physician prescribing choices on the decision to prescribe a COX-2 inhibitor.

Several characteristics may be used to identify patients who are at increased risk of NSAID-induced gastrointestinal toxicity. These characteristics include older age, a history of peptic imposthume disease, previous gastrointestinal hemorrhage, and use of oral glucocorticoids or warfarin. pair professional medical organizations have attract favor toed that physicians use these risk factors to determine which patients are at risk for NSAID-induced gastrointestinal toxicity and should receive co-therapy with a gastro-protective agent (i.e., proton cross-examine inhibitor, misoprostol) or a COX-2 inhibitor.

The studious mood was a retrospective evaluation of Medicare beneficiaries registered in a statewide pharmacy benefits program. Patients were included in the investigation if they filled a prescription for an NSAID or a COX-2 inhibitor during the index consideration year and if they continued to use the health care rule The data collected on NSAID users were limited to common randomly selected person for each COX-2 inhibitor user. Data were argueed for the participants using diagnosis and action codes for inpatient and outpatient services. Known risk factors for NSAID-induced gastrointestinal toxicity were identified and recorded. In addition, other demographic patient data were collected

Physician choice for prescribing COX-2 inhibitors was identified by means of determining which physicians had prescribed a COX-2 inhibitor for at least 10 patients and including them in the close attention The physician preference was calculated using these data. Predictors of COX-2 inhibitor use were identified using multivariable logistic regression models

The consideration included 28,190 patients, of which undivided half filled a prescription for a COX-2 inhibitor. Of patients with no risk factors for NSAID-induced toxicity, 17 percent received a prescription for a COX-2 inhibitor, while 23 percent received a prescription for an NSAID. Of patients who had common risk factor, 48 percent received NSAIDs, on the other hand only 7 percent were given a gastroprotective medication. In addition, 14 percent of the patients with sum of two units or more risk factors received NSAID prescriptions. Among the patients with brace or more risk factors, the use of COX-2 inhibitors was significantly higher than the use of NSAIDs. When calculating the risk example for COX-2 inhibitor use, the risk factors for NSAID-induced gastrointestinal toxicity were poor predictors. When adding patient characteristics and physician prescribing prioritys the model had an thoroughly good ability to discriminate between the couple groups.

The authors judge that known risk factors for NSAID-induced gastrointestinal toxicity are poor predictors of which patient will be given a prescription for a COX-2 inhibitor. In this inquiry the COX-2 inhibitors were overused and underused. Other idiosyncratic physician factors in the prescribing practices of the COX-2 inhibitor medications may be current that shape the use of this class of medication.

KARL E MILLER, MD

Solomon DH et al. Determinants of selective cyclooxy-genase-2 inhibitor prescribing: are patients or physician characteristics more important? Am J M December 15 2003;115:715-20

EDITOR'S NOTE: The COX-2 inhibitors are marketed as being safer and equally effective alternatives to NSAIDs. The emphasis should be forward the term safer, because plane COX-2 inhibitors have potential adverse powers Newer medications can be overused for a variety of reasons. In this cogitation Solomon and colleagues demonstrated that the use of the COX-2 inhibitors was not necessarily based onward the risk of NSAID-induced gastrointestinal toxicity. When using a novel class of medications, physicians should be aware of the agent's indications and of which patients would best benefit from a modern drug.-K.E.M.

COPYRIGHT 2004 American Academy of Family Physicians

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