title: Drug utilization in patients with OA: a population-based study.
abstract: OBJECTIVE
  Patients with OA use different drugs in their search for relief. We aimed to study the prevalence of use and combinations of different medications for OA in a population-based cohort of OA patients in Catalonia, Spain, while characterizing users of each of the drugs available, with a particular focus on cardiovascular risk factors.
  
  
  METHODS
  Data were obtained from the Sistema d'Informació per al Desenvolupament de l'Investigació en Atenció Primària (SIDIAP) database, which includes electronic medical records and pharmacy invoice data for >5 million people from Catalonia. Study participants were those with a clinical diagnosis of OA in 2006-10. Drugs studied included oral and topical NSAIDs, analgesics (paracetamol, metamizole), opioids (tramadol, fentanyl), cyclooxygenase 2 (COX-2) inhibitors and symptomatic slow-acting drugs in OA. Drug utilization was described using medication possession ratios (MPRs), equivalent to the proportion of days covered with the drug of interest. The annual incidence of new users in the first year after OA diagnosis from 2006 to 2010 was estimated for all studied drugs among newly diagnosed OA patients using Poisson regression.
  
  
  RESULTS
  We identified 238 536 study participants. The most common regimen of treatment consisted of at least three drugs (53.9% of patients). The drugs most frequently used regularly (MPR ≥50%) were chondroitin (21.2%), glucosamine (15.8%) and oral NSAIDs (14.4%). The incidence of the use of opioids, COX-2 inhibitors and chondroitin increased over the 5 year period, whereas all others decreased.
  
  
  CONCLUSIONS
  Drug combinations are common in the treatment of OA patients, who are thus exposed to potential drug interactions, with unknown impacts on their health. The increasing use of opioids and COX-2 inhibitors is noteworthy because of the potential impact on safety and costs.
authors.affiliation: Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Wilson
authors.affiliation: Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
authors.forename: Lidia
authors.initials: L
authors.lastname: Sanchez-Riera
authors.affiliation: Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
authors.forename: Rosa
authors.initials: R
authors.lastname: Morros
authors.affiliation: Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Diez-Perez
authors.affiliation: Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
authors.forename: M Kassim
authors.initials: MK
authors.lastname: Javaid
authors.affiliation: Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Cooper
authors.affiliation: Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
authors.forename: Nigel K
authors.initials: NK
authors.lastname: Arden
authors.affiliation: Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Catal
authors.forename: Daniel
authors.initials: D
authors.lastname: Prieto-Alhambra
mesh_terms: D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D002807:Chondroitin / Q000627:therapeutic use; D015331:Cohort Studies; D052246:Cyclooxygenase 2 Inhibitors / Q000627:therapeutic use; D016208:Databases, Factual / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data*; D008875:Middle Aged; D010003:Osteoarthritis / Q000188:drug therapy* / Q000453:epidemiology*; D010604:Pharmacy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D052246:Cyclooxygenase 2 Inhibitors; D002807:Chondroitin
keywords: Catalonia; drug utilization; electronic health records; osteoarthritis; pharmaceutical therapy; pharmacoepidemiology; population-based cohort