title: Channelling of COX-2 inhibitors to patients at higher gastrointestinal risk but not at lower cardiovascular risk: the Cox2 inhibitors and tNSAIDs description of users (CADEUS) study.
abstract: OBJECTIVE
  To describe the characteristics of users of cyclo-oxygenase (COX)-2 inhibitors and traditional nonselective non-steroidal anti-inflammatory drugs (tNSAIDs) in France.
  
  
  METHODS
  Between 1 August 2003 and 31 July 2004, patients who received at least one dispensing of celecoxib, rofecoxib or tNSAIDs were randomly sampled with a 1:1:2 target ratio within the French National Healthcare Insurance database. Patients and prescribers were asked to fill a questionnaire on socio-demographic characteristics, NSAID indication and use and previous medical history. For each respondent, healthcare resources used in the 6 months before inclusion were extracted from the database. Multivariate logistic regression was used to study the determinants of a first COX-2 inhibitor dispensing.
  
  
  RESULTS
  Of the 45 217 patients included, 13 065 COX-2 inhibitors and 13 553 tNSAID users had prescriber data. Ninety seven per cent of COX-2 inhibitor prescriptions were for 'rheumatological' indications, whereas 37% of tNSAIDs use was for benign diseases (n = 2643) or analgesia (n = 2318). Among patients with rheumatological indications (n = 4730) and a first COX-2 inhibitor (n = 2427) or tNSAID (n = 2303) dispensing, multivariate analysis of factors associated with COX-2 inhibitors dispensing showed that, compared to new tNSAID users, new COX-2 inhibitor users were older, more often female, on sick leave or unemployed. COX-2 use was also associated with previous gastrointestinal history and previous gastroprotective agent dispensing, but not with previous cardiovascular (CV) history.
  
  
  CONCLUSIONS
  The choice of NSAID depended largely on indication and on previous gastrointestinal history, in line with the recommendations of the French health authorities. Possible knowledge of CV risk associated with COX-2 inhibitors did not influence prescribing.
authors.affiliation: INSERM U657, Bordeaux, France.
authors.forename: F
authors.initials: F
authors.lastname: Depont
authors.forename: A
authors.initials: A
authors.lastname: Fourrier
authors.forename: Y
authors.initials: Y
authors.lastname: Merlière
authors.forename: C
authors.initials: C
authors.lastname: Droz
authors.forename: M
authors.initials: M
authors.lastname: Amouretti
authors.forename: B
authors.initials: B
authors.lastname: Bégaud
authors.forename: J
authors.initials: J
authors.lastname: Bénichou
authors.forename: Y
authors.initials: Y
authors.lastname: Moride
authors.forename: G P
authors.initials: GP
authors.lastname: Velo
authors.forename: M
authors.initials: M
authors.lastname: Sturkenboom
authors.forename: P
authors.initials: P
authors.lastname: Blin
authors.forename: N
authors.initials: N
authors.lastname: Moore
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D002318:Cardiovascular Diseases; D000068579:Celecoxib; D015331:Cohort Studies; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use*; D005260:Female; D005602:France; D005767:Gastrointestinal Diseases; D006306:Health Surveys; D006801:Humans; D007783:Lactones / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017891:Pharmacoepidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011720:Pyrazoles / Q000627:therapeutic use; D012307:Risk Factors; D012737:Sex Factors; D013449:Sulfonamides / Q000627:therapeutic use; D013450:Sulfones / 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