Adoption of celecoxib and rofecoxib: a nationwide database study.
OBJECTIVE
Cyclooxygenase 2-selective non-steroidal anti-inflammatory drugs (NSAIDs, coxibs) are recommended primarily for patients at high risk of gastrointestinal bleeding, most of them being elderly. Our objective was to describe and analyse patient- and physician-related factors affecting the adoption of celecoxib and rofecoxib 2 years after their launch in Finland.


METHODS
Retrospective analysis of the nationwide Prescription Register. Physicians who had issued at least 200 reimbursed prescriptions in 2002 (n = 12 033, 80% of working-age Finnish physicians) were involved in the analysis.


CONCLUSIONS
Excluding patients with rheumatoid arthritis (RA), almost one-fifth (18%) of NSAIDs prescriptions were for coxibs. In patients with RA the share was 25%. The share of coxib prescriptions of all NSAIDs increased with age of the patient. Over one half (58%) of coxib prescriptions were issued for patients under 65 years of age. Specialists in physical and rehabilitation medicine were the fastest adopters of coxibs: one-third of their NSAID prescriptions in 2002 were for coxibs. Primary care physicians were the most conservative both in adopting and favouring coxibs.


CONCLUSIONS
Coxibs have gained the status of standard prescription NSAIDs within a few years. Their use should be restricted to patients who could benefit most from the use. Routine prescribing of expensive new drugs increases the drug bill without additional health gain.
Helin-Salmivaara
A
A
Centre for Pharmacotherapy Development, Helsinki, Finland. arja.helin-salmivaara@rohto.fi
Huupponen
R
R
Virtanen
A
A
Klaukka
T
T
D000367:Age Factors; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000068579:Celecoxib; D002648:Child; D016208:Databases, Factual / Q000706:statistics & numerical data / Q000639:trends*; D017723:Drug Utilization Review / Q000379:methods; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data / Q000639:trends; D007783:Lactones / Q000627:therapeutic use*; D008511:Medicine / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends; D011358:Product Surveillance, Postmarketing / Q000191:economics / Q000379:methods; D011720:Pyrazoles / Q000627:therapeutic use*; D012189:Retrospective Studies; D012737:Sex Factors; D013038:Specialization; D013449:Sulfonamides / Q000627:therapeutic use*; D013450:Sulfones / Q000627:therapeutic use*; D013997:Time Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007783:Lactones; D011720:Pyrazoles; D013449:Sulfonamides; D013450:Sulfones; C116926:rofecoxib; D000068579:Celecoxib