title: Prescription channeling of COX-2 inhibitors and traditional nonselective nonsteroidal anti-inflammatory drugs: a population-based case-control study.
abstract: This pharmacoepidemiologic study was conducted to determine whether risk factors for upper gastrointestinal bleeding influenced the prescription of cyclo-oxygenase (COX)-2 inhibitors and traditional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) at the time when COX-2 inhibitors were first included in the formulary of reimbursed medications. A population-based case-control study was conducted in which the prevalence of risk factors and the medical histories of patients prescribed COX-2 inhibitors and traditional nonselective NSAIDs were compared. The study population consisted of a random sample of members of the Quebec drug plan (age 18 years or older) who received at least one dispensation of celecoxib (n = 42,422; cases), rofecoxib (n = 25,674; cases), or traditional nonselective NSAIDs (n = 12,418; controls) during the year 2000. All study data were obtained from the Quebec health care databases. Adjusting for income level, Chronic Disease Score, prior use of low-dose acetylsalicylic acid, acetaminophen, antidepressants, benzodiazepines, prescriber specialty, and time period, the following factors were significantly associated with the prescription of COX-2 inhibitors: age 75 years or older (odds ratio [OR] 4.22, 95% confidence interval [CI] 3.95-4.51), age 55-74 years (OR 3.23, 95% CI 3.06-3.40), female sex (OR 1.52, 95% CI 1.45-1.58), prior diagnosis of gastropathy (OR 1.21, 95% CI 1.08-1.36) and prior dispensation of gastroprotective agents (OR 1.57, 95% CI 1.47-1.67). Patients who received a traditional nonselective NSAID recently were more likely to switch to a coxib, especially first-time users (OR 2.17, 95% CI 1.93-2.43). Associations were significantly greater for celecoxib than rofecoxib for age, chronic NSAID use, and last NSAID use between 1 and 3 months before the index date. At the time of introduction of COX-2 inhibitors into the formulary, prescription channeling could confound risk comparisons across products.
authors.affiliation: Faculty of Pharmacy, Université de Montréal, Montreal, Canada. yola.moride@umontreal.ca
authors.forename: Yola
authors.initials: Y
authors.lastname: Moride
authors.forename: Thierry
authors.initials: T
authors.lastname: Ducruet
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Boivin
authors.forename: Nicholas
authors.initials: N
authors.lastname: Moore
authors.forename: Sylvie
authors.initials: S
authors.lastname: Perreault
authors.forename: Sean
authors.initials: S
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D016022:Case-Control Studies; D000068579:Celecoxib; D015986:Confounding Factors, Epidemiologic; D000075202:Contraindications; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization; D005260:Female; D005569:Formularies as Topic; D005756:Gastritis / Q000453:epidemiology; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D019458:Insurance Coverage; D007356:Insurance, Pharmaceutical Services; D007783:Lactones / Q000009:adverse effects / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008511:Medicine; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011720:Pyrazoles / Q000009:adverse effects / Q000627:therapeutic use; D011792:Quebec / Q000453:epidemiology; D012307:Risk Factors; D012494:Sampling Studies; D012737:Sex Factors; D013038:Specialization; D013449:Sulfonamides / Q000009:adverse effects / Q000627:therapeutic use; D013450:Sulfones / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D007783:Lactones; D011720:Pyrazoles; D013449:Sulfonamides; D013450:Sulfones; C116926:rofecoxib; D000068579:Celecoxib
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