Skip to main content
Top
Published in: Drug Safety 7/2006

01-07-2006 | Original Research Article

Increase in Nonfatal Digestive Perforations and Haemorrhages Following Introduction of Selective NSAIDs

A Public Health Concern

Authors: Ms Louise Barnard, Dominic Lavoie, Nancy Lajeunesse

Published in: Drug Safety | Issue 7/2006

Login to get access

Abstract

Background and objective: This article documents the impact of the introduction of selective NSAIDs on overall prescription patterns of NSAIDs and associated gastroprotective agents (GPAs), and on the rate of nonfatal digestive perforations and haemorrhages.
Methods: A retrospective, closed cohort study was conducted using the Quebec Health Insurance Board databases, for a 3-year period overlapping the introduction of selective NSAIDs. All adult subjects who were continuously registered with the Public Prescription Drug Program (PPDP) between 1 January 1999 and 31 December 2001 (n = 2 052 231) were included. Prescriptions for NSAIDs (selective [celecoxib, rofecoxib and meloxicam] and nonselective), concomitant use of GPAs and nonfatal digestive perforations or haemorrhages diagnosed in hospital were compiled. Data were analysed on an annual basis according to age, sex and patient risk of gastrointestinal (GI) complications.
Results: The listing of selective NSAIDs in the PPDP formulary was followed by a 28.2% increase in the prevalence of NSAID use from 19.5% in 1999 to 25% in 2001. The proportion of long-term users also evolved rapidly with a 135% increase over 3 years. From 1999 to 2001, there was a 75.9% increase in the rate of nonfatal digestive perforations and haemorrhages in the presence of NSAIDs.
Conclusion: The introduction of selective NSAIDs stimulated NSAID use and coincided with an increased incidence of nonfatal digestive perforations and haemorrhages in the presence of NSAIDs. Selective NSAIDs should be prescribed with caution to persons at risk for GI complications.
Literature
1.
go back to reference Rahme E, Marentette MA, Kong SX, et al. Use of NSAIDs, COX-2 inhibitors, and acetaminophen and associated coprescriptions of gastroprotective agents in an elderly population. Arthritis Rheum 2002; 47: 595–602PubMedCrossRef Rahme E, Marentette MA, Kong SX, et al. Use of NSAIDs, COX-2 inhibitors, and acetaminophen and associated coprescriptions of gastroprotective agents in an elderly population. Arthritis Rheum 2002; 47: 595–602PubMedCrossRef
2.
go back to reference Fitzgerald GA, Patrono C. The coxibs, selective inhibitors of cyclooxygenase-2. N Engl J Med 2001; 345: 433–42PubMedCrossRef Fitzgerald GA, Patrono C. The coxibs, selective inhibitors of cyclooxygenase-2. N Engl J Med 2001; 345: 433–42PubMedCrossRef
3.
go back to reference Bolten WW. Scientific rationale for specific inhibition of COX-2. J Rheumatol Suppl 1998; 51: 2–7PubMed Bolten WW. Scientific rationale for specific inhibition of COX-2. J Rheumatol Suppl 1998; 51: 2–7PubMed
4.
go back to reference Tannenbaum H, Peloso PM, Russell AS, et al. An evidence-based approach to prescribing NSAIDs in the treatment of osteoarthritis and rheumatoid arthritis: the Second Canadian Consensus Conference. Can J Clin Pharmacol 2000; 7: 4A–16APubMed Tannenbaum H, Peloso PM, Russell AS, et al. An evidence-based approach to prescribing NSAIDs in the treatment of osteoarthritis and rheumatoid arthritis: the Second Canadian Consensus Conference. Can J Clin Pharmacol 2000; 7: 4A–16APubMed
5.
go back to reference Schnitzer TJ. Update of ACR guidelines for osteoarthritis: role of the coxibs. J Pain Symptom Manage 2002; 23: S24–30PubMedCrossRef Schnitzer TJ. Update of ACR guidelines for osteoarthritis: role of the coxibs. J Pain Symptom Manage 2002; 23: S24–30PubMedCrossRef
6.
go back to reference Hunt RH, Barkun AN, Baron D, et al. Recommendations for the appropriate use of anti-inflammatory drugs in the era of the coxibs: defining the role of gastroprotective agents. Can J Gastroenterol 2002; 16: 231–40PubMed Hunt RH, Barkun AN, Baron D, et al. Recommendations for the appropriate use of anti-inflammatory drugs in the era of the coxibs: defining the role of gastroprotective agents. Can J Gastroenterol 2002; 16: 231–40PubMed
7.
go back to reference National Institute for Clinical Excellence. Guidance on the use of cyclo-oxygenase (Cox) II selective inhibitors, celecoxib, rofecoxib, meloxicam and etodolac for osteoarthritis and rheumatoid arthirtis. London, UK: 2001. Report No.: Technology Appraisal Guidance no 27 National Institute for Clinical Excellence. Guidance on the use of cyclo-oxygenase (Cox) II selective inhibitors, celecoxib, rofecoxib, meloxicam and etodolac for osteoarthritis and rheumatoid arthirtis. London, UK: 2001. Report No.: Technology Appraisal Guidance no 27
8.
go back to reference Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA 2000; 284: 1247–55PubMedCrossRef Silverstein FE, Faich G, Goldstein JL, et al. Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: a randomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA 2000; 284: 1247–55PubMedCrossRef
9.
go back to reference Bombardier C, Laine L, Reicin A, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N Engl J Med 2000; 343: 1520–8PubMedCrossRef Bombardier C, Laine L, Reicin A, et al. Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N Engl J Med 2000; 343: 1520–8PubMedCrossRef
10.
go back to reference Schnitzer TJ, Burmester GR, Mysler E, et al. Comparison of lumiracoxib with naproxen and ibuprofen in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), reduction in ulcer complications: randomised controlled trial. Lancet 2004; 364: 665–74PubMedCrossRef Schnitzer TJ, Burmester GR, Mysler E, et al. Comparison of lumiracoxib with naproxen and ibuprofen in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), reduction in ulcer complications: randomised controlled trial. Lancet 2004; 364: 665–74PubMedCrossRef
11.
go back to reference Dai C, Stafford RS, Alexander GC. National trends in cyclooxygenase-2 inhibitor use since market release: nonselective diffusion of a selectively cost-effective innovation. Arch Intern Med 2005; 165: 171–7PubMedCrossRef Dai C, Stafford RS, Alexander GC. National trends in cyclooxygenase-2 inhibitor use since market release: nonselective diffusion of a selectively cost-effective innovation. Arch Intern Med 2005; 165: 171–7PubMedCrossRef
12.
go back to reference Juni P, Rutjes AW, Dieppe PA. Are selective COX 2 inhibitors superior to traditional non steroidal anti-inflammatory drugs? BMJ 2002; 324: 1287–8PubMedCrossRef Juni P, Rutjes AW, Dieppe PA. Are selective COX 2 inhibitors superior to traditional non steroidal anti-inflammatory drugs? BMJ 2002; 324: 1287–8PubMedCrossRef
13.
go back to reference Mamdani M, Juurlink DN, Kopp A, et al. Gastrointestinal bleeding after the introduction of COX 2 inhibitors: ecological study. BMJ 2004; 328: 1415–6PubMedCrossRef Mamdani M, Juurlink DN, Kopp A, et al. Gastrointestinal bleeding after the introduction of COX 2 inhibitors: ecological study. BMJ 2004; 328: 1415–6PubMedCrossRef
14.
go back to reference Girvin B, Rafferty T, Stevenson MR, et al. Uptake of COX-2 selective inhibitors and influence on NSAID prescribing in Northern Ireland. Pharmacoepidemiol Drug Saf 2004; 13: 153–7PubMedCrossRef Girvin B, Rafferty T, Stevenson MR, et al. Uptake of COX-2 selective inhibitors and influence on NSAID prescribing in Northern Ireland. Pharmacoepidemiol Drug Saf 2004; 13: 153–7PubMedCrossRef
15.
go back to reference Comité de revue de l’utilisation des medicaments (CRUM). Etude sur les anti-inflammatoires non stéroïdiens. Québec: CRUM, 2002 Comité de revue de l’utilisation des medicaments (CRUM). Etude sur les anti-inflammatoires non stéroïdiens. Québec: CRUM, 2002
16.
go back to reference Tamblyn R, Lavoie G, Petrella L, et al. The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claims database in Quebec. J Clin Epidemiol 1995; 48: 999–1009PubMedCrossRef Tamblyn R, Lavoie G, Petrella L, et al. The use of prescription claims databases in pharmacoepidemiological research: the accuracy and comprehensiveness of the prescription claims database in Quebec. J Clin Epidemiol 1995; 48: 999–1009PubMedCrossRef
17.
go back to reference Comité de revue de l’utilisation des médicaments (CRUM) en collaboration avec le Conseil consultatif de pharmacologie. Les crit999-1009res d’utilisation optimale concernant les inhibiteurs de la pompe à protons (IPP). Québec: CRUM, 2002 Comité de revue de l’utilisation des médicaments (CRUM) en collaboration avec le Conseil consultatif de pharmacologie. Les crit999-1009res d’utilisation optimale concernant les inhibiteurs de la pompe à protons (IPP). Québec: CRUM, 2002
18.
go back to reference Brzozowski T, Konturek PC, Konturek SJ, et al. Involvement of cyclooxygenase (COX)-2 products in acceleration of ulcer healing by gastrin and hepatocyte growth factor. J Physiol Pharmacol 2000; 51: 751–73PubMed Brzozowski T, Konturek PC, Konturek SJ, et al. Involvement of cyclooxygenase (COX)-2 products in acceleration of ulcer healing by gastrin and hepatocyte growth factor. J Physiol Pharmacol 2000; 51: 751–73PubMed
19.
go back to reference Chan FK, Hung LC, Suen BY, et al. Celecoxib versus diclofenac plus omeprazole in high-risk arthritis patients: results of a randomized double-blind trial. Gastroenterology 2004; 127: 1038–43PubMedCrossRef Chan FK, Hung LC, Suen BY, et al. Celecoxib versus diclofenac plus omeprazole in high-risk arthritis patients: results of a randomized double-blind trial. Gastroenterology 2004; 127: 1038–43PubMedCrossRef
20.
go back to reference Higham J, Kang JY, Majeed A. Recent trends in admissions and mortality due to peptic ulcer in England: increasing frequency of haemorrhage among older subjects. Gut 2002; 50: 460–4PubMedCrossRef Higham J, Kang JY, Majeed A. Recent trends in admissions and mortality due to peptic ulcer in England: increasing frequency of haemorrhage among older subjects. Gut 2002; 50: 460–4PubMedCrossRef
21.
go back to reference Schoenfeld P, Kimmey MB, Scheiman J, et al. Review article: nonsteroidal anti-inflammatory drug-associated gastrointestinal complications: guidelines for prevention and treatment. Aliment Pharmacol Ther 1999; 13: 1273–85PubMedCrossRef Schoenfeld P, Kimmey MB, Scheiman J, et al. Review article: nonsteroidal anti-inflammatory drug-associated gastrointestinal complications: guidelines for prevention and treatment. Aliment Pharmacol Ther 1999; 13: 1273–85PubMedCrossRef
Metadata
Title
Increase in Nonfatal Digestive Perforations and Haemorrhages Following Introduction of Selective NSAIDs
A Public Health Concern
Authors
Ms Louise Barnard
Dominic Lavoie
Nancy Lajeunesse
Publication date
01-07-2006
Publisher
Springer International Publishing
Published in
Drug Safety / Issue 7/2006
Print ISSN: 0114-5916
Electronic ISSN: 1179-1942
DOI
https://doi.org/10.2165/00002018-200629070-00006

Other articles of this Issue 7/2006

Drug Safety 7/2006 Go to the issue

Editorial

Desmopressin