Effect of cardiovascular comorbidities and concomitant aspirin use on selection of cyclooxygenase inhibitor among rheumatologists
Effect of cardiovascular comorbidities and concomitant aspirin use on selection of cyclooxygenase inhibitor among rheumatologists
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DOI：
10.1002/art.20905
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发表时间：
2005-02-15
期刊：
影响因子：
--
通讯作者：
Kremer, J
中科院分区：
文献类型：
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作者：
Greenberg, JD;Bingham, CI;Kremer, J
Objective.评估心血管合并症和阿司匹林处方对风湿病医生环氧化酶（考克斯）-2抑制剂（coxib）处方模式的影响。在北美风湿病研究者联盟登记处的类风湿性关节炎和骨关节炎患者中进行了一项前瞻性队列研究。从2002年3月至2003年9月的医生和患者问卷中前瞻性地获得药物和合并症数据。研究了多变量校正后的昔布使用与特定心血管变量（包括阿司匹林使用）之间的相关性。共纳入3，522例关节炎患者。在我们的研究中，考克斯抑制剂，包括昔布类、非选择性非甾体类抗炎药（NSAID）和美洛昔康，在骨关节炎患者中的使用比例（68.4%）高于类风湿关节炎患者（47.1%）（P < 0.001）。大多数阿司匹林使用者（51.5%）和相似比例的非使用者（49.8%）处方了考克斯抑制剂。在多变量分析中，使用昔布与非选择性NSAID的独立预测因素包括骨关节炎（比值比[OR] 2.52，95%置信区间[95% CI] 1.81-3.52）和糖尿病（OR 1.63，95% CI 1.06-2.51）的诊断。相反，阿司匹林的使用独立预测选择非选择性NSAID而不是昔布（OR 0.73，95%CI 0.55-0.98）。心肌梗死和卒中病史均不能预测昔布的使用。同样，心血管变量也不能预测罗非昔布与塞来昔布的使用。我们的数据表明，考克斯抑制剂coprescription阿司匹林用户是频繁的。尽管人们对昔布类药物存在心血管问题，但我们的数据表明，阿司匹林的使用（而不是心血管合并症）可以预测非选择性非甾体抗炎药而不是昔布类药物的选择。
Objective. To evaluate the effects of cardiovascular comorbidities and aspirin coprescription on cyclooxygenase (COX)-2 inhibitor (coxib) prescribing patterns among rheumatologists.Methods. A prospective cohort study was carried out with rheumatoid arthritis and osteoarthritis patients in the Consortium of Rheumatology Researchers of North America registry. Medication and comorbidity data were obtained prospectively from physician and patient questionnaires between March 2002 and September 2003. Multivariate adjusted associations between coxib use and specific cardiovascular variables, including aspirin use, were examined.Results. A total of 3,522 arthritis patients were included. COX inhibitors, including coxibs, nonselective nonsteroidal antiinflammatory drugs (NSAIDs), and meloxicam, were prescribed to a larger proportion of osteoarthritis patients (68.4%) than rheumatoid arthritis patients (47.1%) in our study (P < 0.001). COX inhibitors were prescribed to the majority of aspirin users (51.5%) and a similar proportion of nonusers (49.8%). In multivariate analyses, independent predictors of coxib use versus nonselective NSAID use included diagnoses of osteoarthritis (odds ratio [OR] 2.52, 95% confidence interval [95% CI] 1.81-3.52) and diabetes (OR 1.63, 95% CI 1.06-2.51). Conversely, aspirin use independently predicted selection of a nonselective NSAID rather than a coxib (OR 0.73, 95% CI 0.55-0.98). Neither a history of myocardial infarction nor stroke predicted utilization of a coxib. Similarly, cardiovascular variables did not predict the use of rofecoxib versus celecoxib.Conclusion. Our data indicate that COX inhibitor coprescription among aspirin users is frequent. Despite cardiovascular concerns regarding the coxibs, our data suggest that aspirin use, but not cardiovascular comorbidities, predicted the selection of nonselective NSAIDs over coxibs.