What therapies have replaced rofecoxib in Ireland?
OBJECTIVE
To examine prescription patterns of nonsteroidal anti-inflammatory drugs (NSAIDs) or analgesics in patients prescribed chronic rofecoxib treatment prior to withdrawal from the Irish market, and to determine the impact on proton pump inhibitor (PPI) co-prescription.


METHODS
Using a national prescribing database, adults (> or =16 years) prescribed rofecoxib for > or =3 months, but not analgesics, from January to September 2004 were identified. A longitudinal prescribing history was used to determine switching patterns to other cyclooxygenase (COX)-2 inhibitors, NSAIDs or analgesics during 3 and 12 months after withdrawal. Concomitant PPI prescription was examined. Logistic regression was used to determine the likelihood of switching to a COX-2 inhibitor vs. nonselective NSAID and factors influencing concomitant PPI prescription.


RESULTS
After rofecoxib withdrawal, 30.2% (1558) and 17.9% (922) of the 5155 study subjects received no further NSAID prescription during 3 and 12 months, respectively. During the 12-month period, approximately one-third of NSAID prescriptions were for <3 months; 40.7% (2096) received sequential prescriptions for different NSAIDs. Co-prescription of analgesics occurred in 49.3% (2539) of subjects. Neither age nor gender influenced the type of NSAID prescribed in the 12 months post rofecoxib withdrawal. PPI prescription increased by 5.5% during the study, associated with use of nonselective NSAIDs, prior use of PPIs and increasing age.


CONCLUSIONS
The majority of those receiving chronic rofecoxib therapy were prescribed either no further NSAID or short-term NSAID therapy only during the 12 months post withdrawal, which suggests the subsequent controversy may have encouraged prescribers to adhere more closely to published guidelines.
Teeling
Mary
M
Department of Pharmacology and Therapeutics, Trinity College/St James's Hospital, Dublin, Ireland. teelingm@tcd.ie
O'Connor
Humphrey
H
Feely
John
J
Bennett
Kathleen
K
D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D011307:Drug Prescriptions; D004363:Drug Utilization / Q000639:trends*; D005260:Female; D006801:Humans; D007494:Ireland; D007783:Lactones / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D013450:Sulfones / Q000008:administration & dosage / Q000009:adverse effects*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D007783:Lactones; D054328:Proton Pump Inhibitors; D013450:Sulfones; C116926:rofecoxib