title: Persistence with non-selective NSAIDs and celecoxib among patients with gastroesophageal reflux disease and osteoarthritis or rheumatoid arthritis.
abstract: OBJECTIVE
  Gastrointestinal (GI) symptoms are common in patients taking nonselective, nonsteroidal anti-inflammatory drugs (nsNSAIDs) and are often a reason for therapy discontinuation. In osteoarthritis (OA) and rheumatoid arthritis (RA) patients requiring pain control, selective COX-2 NSAID use is typically associated with less dyspepsia than is nsNSAID use. Little is known about NSAID tolerance in patients with gastroesophageal reflux disease (GERD). This study assessed nsNSAID and celecoxib prescription patterns, in particular persistence, in OA/RA patients with concomitant diagnosis of GERD.
  
  
  METHODS
  An observational study of GERD patients with a diagnosis of OA/RA using two separate databases, the IMS Lifelink Health Plan Claims Database (PharMetrics) and Market Scan Claims Database (Medstat) was conducted. In each database, parallel and separate analyses were performed in adult patients who had their first GERD diagnosis in 2006 and who were subsequently diagnosed with OA or RA in the same year. From this subset of patients, celecoxib-naïve and nsNSAID-naïve cohorts were identified and patients were selected. Patients with pre-existing GI conditions were excluded from the study. Persistence, measured as time to discontinuation, was evaluated by Kaplan-Meier survival curves and Cox proportional hazards models. Reasons for discontinuations were not available in these databases.
  
  
  RESULTS
  Fewer patients discontinued celecoxib as compared to nsNSAIDs during the 60 days of the first prescription and throughout the entire follow-up period. After adjusting for baseline characteristics, celecoxib patients still had significantly decreased risk of discontinuation as compared to nsNSAID patients (p < 0.0001). Replication of these observations in two separate, large patient databases increases the confidence in this study's conclusion.
  
  
  CONCLUSIONS
  Limitations include those inherent to claims data analyses and retrospective review, e.g. these data do not provide clinical information related to reasons for medication discontinuation.
  
  
  CONCLUSIONS
  In patients with concomitant GERD and OA or RA who require anti-inflammatory treatment, significantly more patients treated with celecoxib were persistent with their treatment than were patients treated with nsNSAIDs.
authors.affiliation: Department of Medicine, Division of Gastroenterology, UT Southwestern Medical School, Dallas, TX 75390-9006, USA. Byron.Cryer@JTSouthwestern.edu
authors.forename: B
authors.initials: B
authors.lastname: Cryer
authors.forename: X
authors.initials: X
authors.lastname: Luo
authors.forename: A R
authors.initials: AR
authors.lastname: Assaf
authors.forename: G
authors.initials: G
authors.lastname: Sands
authors.forename: J
authors.initials: J
authors.lastname: Mardekian
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D000068579:Celecoxib; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use; D019992:Databases as Topic; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D011720:Pyrazoles / Q000627:therapeutic use*; D013449:Sulfonamides / Q000627:therapeutic use*; D016903:Drug Monitoring
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib