title: COX-2 inhibitor and non-selective NSAID use in those at increased risk of NSAID-related adverse events: a retrospective database study.
abstract: BACKGROUND
  Adverse events related to analgesic use represent a challenge for optimizing treatment of pain in older people.
  
  
  OBJECTIVE
  The aim of this study was to determine whether non-selective non-steroidal anti-inflammatory drug (NS-NSAID) and cyclo-oxygenase (COX)-2 inhibitor use is appropriately targeted in those with a prior history of gastrointestinal (GI) events, myocardial infarction (MI) or stroke.
  
  
  METHODS
  A retrospective study of pharmacy claims data from the Australian Government Department of Veterans' Affairs was conducted, involving 288,912 veterans aged 55 years and over. Analgesic utilization from 2007 to 2009 was assessed. Three risk cohorts (veterans with prior hospitalization for GI bleed, MI or stroke) and a low-risk cohort were identified. Poisson regression was applied to test for a linear trend over the study period.
  
  
  RESULTS
  The prevalence of analgesics dispensed in the overall study population was approximately 34 % between 2007 and 2009. COX-2 inhibitors were more widely dispensed than NS-NSAIDs in all those at risk of NSAID-related adverse events. At the end of 2009, the ratio was 5.1 % to 2.5 % in the GI cohort, 3.6 % to 3.2 % in the MI cohort and 3.6 % to 2.6 % in the stroke cohort.
  
  
  CONCLUSIONS
  Although COX-2 inhibitors appeared to be preferred over NS-NSAIDs in those with a prior history of GI events, 2.5 % of patients were still using an NS-NSAID at the end of the study period. Consistent with treatment guidelines, in most of these cases, these drugs were co-dispensed with proton pump inhibitors. COX-2 inhibitors were used at slightly higher rates than NS-NSAIDs in those with a prior history of MI or stroke, which is not consistent with guidelines recommending NS-NSAID use.
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.
authors.forename: Svetla
authors.initials: S
authors.lastname: Gadzhanova
authors.forename: Jenni
authors.initials: J
authors.lastname: Ilomäki
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Roughead
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use*; D015331:Cohort Studies; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D062313:Databases, Pharmaceutical; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000188:drug therapy
chemical_list: D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors