title: Prescription of nonselective NSAIDs, coxibs and gastroprotective agents in the era of rofecoxib withdrawal - a 617,400-patient study.
abstract: BACKGROUND
  Gastroprotective strategies are recommended for nonsteroidal anti-inflammatory drug (NSAID) users at risk of upper gastrointestinal (UGI) complications.
  
  
  OBJECTIVE
  To compare the use of gastroprotective strategies in NSAID users in three countries, and the subsequent impact of rofecoxib withdrawal.
  
  
  METHODS
  We conducted a population-based cohort study in three general practice (GP) databases: (i) United Kingdom's (UK) GP Research Database (1998-2008); (ii) Italy's (IT) Health Search/CSD Longitudinal Patient Database (2000-2007); and (iii) the Dutch (NL) Integrated Primary Care Information database (1996-2006). Study cohorts comprised incident NSAID users ≥50 years. Preventive strategies included: (i) co-prescription of gastroprotective agents; or (ii) cyclooxygenase-2-selective inhibitor use. Under-use was defined as no gastroprotection in patients with ≥1 UGI risk factor (history of UGI event, age ≥65 years, concomitant use of anticoagulants, antiplatelets or glucocorticoids). Interrupted time-series analysis was performed to assess the impact of rofecoxib withdrawal on preventive strategies.
  
  
  RESULTS
  The study populations consisted of 384 649 UK, 177 747 IT and 55 004 NL NSAID users. In UK, under-use of preventive strategies fell from 91% to 71% [linear trend (lt) P = 0.001], in NL from 92% to 58% (lt P < 0.001) and in IT from 90% to 76% (lt P = 0.38) in high-risk NSAID users. In 2000 and 2006, under-use was significantly lower in NL compared with UK and IT (P < 0.001) in high-risk users. After rofecoxib's withdrawal, under-use increased significantly in UK and NL.
  
  
  CONCLUSIONS
  The prescription of gastropreventive strategies followed a similar pattern across countries. Despite a temporary negative effect of rofecoxib withdrawal on under-use, improvement of gastroprotection with nonsteroidal anti-inflammatory drugs was observed.
authors.affiliation: Department of Medical Informatics, Erasmus University Medical Centre, Rotterdam, the Netherlands. v.valkhoff@erasmusmc.nl
authors.forename: V E
authors.initials: VE
authors.lastname: Valkhoff
authors.forename: E M
authors.initials: EM
authors.lastname: van Soest
authors.forename: G M C
authors.initials: GM
authors.lastname: Masclee
authors.forename: S
authors.initials: S
authors.lastname: de Bie
authors.forename: G
authors.initials: G
authors.lastname: Mazzaglia
authors.forename: M
authors.initials: M
authors.lastname: Molokhia
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: M C J M
authors.initials: MC
authors.lastname: Sturkenboom
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000009:adverse effects*; D015331:Cohort Studies; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D016208:Databases, Factual; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D007558:Italy; D007783:Lactones / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012307:Risk Factors; D056737:Safety-Based Drug Withdrawals; D013450:Sulfones / Q000009:adverse effects*; D006113:United Kingdom
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D005765:Gastrointestinal Agents; D007783:Lactones; D013450:Sulfones; C116926:rofecoxib