Key result
Patients aged 75 years or older were significantly more likely to be prescribed COX-2 inhibitors than traditional nonselective NSAIDs (OR 4.22), indicating prescription channeling based on gastrointestinal risk factors.
Why the study?
Are risk factors for upper gastrointestinal bleeding associated with the prescription of COX-2 inhibitors versus traditional nonselective NSAIDs?
Case-Control (n=80,514)
Are risk factors for upper gastrointestinal bleeding associated with the prescription of COX-2 inhibitors versus traditional nonselective NSAIDs?
Odds Ratio: 4.22 (95% CI 3.95–4.51)
At the time of their introduction, COX-2 inhibitors were preferentially prescribed to patients with higher baseline risk for gastrointestinal bleeding, highlighting prescription channeling that could confound observational risk comparisons.
Channeling of COX-2 inhibitors to older, higher-GI-risk patients confounds unadjusted observational comparisons; leaves open true safety differences without adjustment.
This pharmacoepidemiologic study was conducted to determine whether risk factors for upper gastrointestinal bleeding influenced the prescription of cyclo-oxygenase (COX)-2 inhibitors and traditional nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) at the time when COX-2 inhibitors were first included in the formulary of reimbursed medications. A population-based case-control study was conducted in which the prevalence of risk factors and the medical histories of patients prescribed COX-2 inhibitors and traditional nonselective NSAIDs were compared. The study population consisted of a random sample of members of the Quebec drug plan (age 18 years or older) who received at least one dispensation of celecoxib (n = 42,422; cases), rofecoxib (n = 25,674; cases), or traditional nonselective NSAIDs (n = 12,418; controls) during the year 2000. All study data were obtained from the Quebec health care databases. Adjusting for income level, Chronic Disease Score, prior use of low-dose acetylsalicylic acid, acetaminophen, antidepressants, benzodiazepines, prescriber specialty, and time period, the following factors were significantly associated with the prescription of COX-2 inhibitors: age 75 years or older (odds ratio [OR] 4.22, 95% confidence interval [CI] 3.95-4.51), age 55-74 years (OR 3.23, 95% CI 3.06-3.40), female sex (OR 1.52, 95% CI 1.45-1.58), prior diagnosis of gastropathy (OR 1.21, 95% CI 1.08-1.36) and prior dispensation of gastroprotective agents (OR 1.57, 95% CI 1.47-1.67). Patients who received a traditional nonselective NSAID recently were more likely to switch to a coxib, especially first-time users (OR 2.17, 95% CI 1.93-2.43). Associations were significantly greater for celecoxib than rofecoxib for age, chronic NSAID use, and last NSAID use between 1 and 3 months before the index date. At the time of introduction of COX-2 inhibitors into the formulary, prescription channeling could confound risk comparisons across products.
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Moride et al. (2005) conducted a case-control in Prescription of NSAIDs or COX-2 inhibitors (n=80,514). COX-2 inhibitors (celecoxib, rofecoxib) vs. Traditional nonselective NSAIDs was evaluated on Prescription of COX-2 inhibitors associated with age ≥75 years (OR 4.22, 95% CI 3.95-4.51). Patients aged 75 years or older were significantly more likely to be prescribed COX-2 inhibitors than traditional nonselective NSAIDs (OR 4.22), indicating prescription channeling based on gastrointestinal risk factors.
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