Treatment Patterns, Adverse Events Associated with NSAIDs

Las Vegas—A retrospective analysis of a healthcare claims database found that patients who took nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve chronic pain conditions had different clinical characteristics and varying cardiovascular and gastrointestinal conditions depending on the type of NSAID they were prescribed. The results were presented at the AAPM meeting during a poster presentation titled NSAID Treatment Patterns and Adverse Health Outcomes. NSAIDs are used to reduce pain and inflammation. There are 2 common types of NSAIDs, those that block cyclooxygenase (COX)-1 inhibitors and those that block COX-2 inhibitors. COX-1 inhibitors, otherwise known as nonselective NSAIDs, are associated with side effects such as gastrointestinal bleeding, peptic ulcer disease, hypertension, edema, and renal disease. COX-2 inhibitors, or selective NSAIDs, reduce the risk of peptic ulceration but increase the risk of renal and cardiovascular events, according to the authors. In this trial, the authors were interested in gaining a better understanding of the clinical characteristics, treatment patterns, and healthcare utilization of the patients who were prescribed the different types of NSAIDs. They analyzed data from Thomson Reuters MarketScan research databases for 2006 through 2009 that included healthcare claims for >20 million individuals insured through large employers and health plans as well as >2 million Medicare patients. Patients were included if they were ≥18 years of age, had ≥1 NSAID prescription during the index period (January 1, 2007-December 31, 2007), and had continuous pharmaceutical and medical benefit enrollment 1 year before and 2 years after the index date. The study included 255,618 patients with an average age of 53 years; 63% of patients were females. The average age of patients taking COX-2 inhibitors was 61 years compared with 52 years for patients taking COX-1 inhibitors (P<.0001). Patients with osteoarthritis were more likely to take COX-2 inhibitors than COX-1 inhibitors, as were older patients and those with greater morbidity. COX-1 inhibitors were more likely to be prescribed for patients with low back pain. Patients taking COX-2 inhibitors had an average Charlson Comorbidity Index (CCI) score of 1.6 compared with 1.1 for patients taking COX-1 inhibitors (P<.0001). The CCI score was also significantly worse for patients taking gastroprotective therapy (GPT) compared with those not taking GPT (P<.005). Patients took NSAIDs for <1 year on average, although they remained on therapy for a longer period if they also received GPT. The authors cited several limitations. The study can only be utilized for the time period assessed, for insured patients in the United States, and for patients who suffered from pain conditions. More than 60% of patients in the databases were excluded because they were not diagnosed with chronic pain. They also said that patient preference, health plan access, prescriber characteristics, and other unobserved measures could have influenced the results. Finally, the findings could have been impacted by coding errors, misclassifications, or omissions. This study was supported by Eli Lilly and Company.