National trends in cyclooxygenase-2 inhibitor use since market release - Nonselective diffusion of a selectively cost-effective innovation
National trends in cyclooxygenase-2 inhibitor use since market release - Nonselective diffusion of a selectively cost-effective innovation
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DOI：
10.1001/archinte.165.2.171
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发表时间：
2005-01-24
影响因子：
--
通讯作者：
Alexander, C
中科院分区：
文献类型：
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作者：
Dai, CL;Stafford, RS;Alexander, C
背景：罗非昔布的停药引起了人们对环氧合酶-2（考克斯-2）抑制剂安全性的关注。在某些患者中，考克斯-2抑制剂可能比非选择性非甾体抗炎药（NSAID）更安全;然而，考克斯-2抑制剂的公共卫生益处取决于其在高于NSAID正常风险的患者中的使用。我们研究的趋势，考克斯-2抑制剂的使用的基础上的风险，不良事件从NSAIDs.Methods：我们分析的数据，从全国门诊医疗服务调查（1999-2002年）和全国医院门诊医疗服务调查（1999 - 2001年），全国代表性的调查，社区和医院为基础的门诊实践。主要的结果测量是患者就诊时开具考克斯-2抑制剂处方的比例，按照NSAID.Results的不良胃肠道（GI）事件风险分层：在开具考克斯-2抑制剂或NSAID处方的就诊中，考克斯-2抑制剂的使用频率从35%（1999年）增加到55%（2000年）和61%（2001年和2002年）。在非甾体抗炎药不良事件风险最低的患者中，接受考克斯-2抑制剂治疗的比例从1999年的12%增加到2002年的35%。总体而言，增加考克斯-2抑制剂的使用中，NSAIDs可以使用的患者占63%以上的增长考克斯-2抑制剂的使用期间examined.Conclusions：显着增加考克斯-2抑制剂的使用已经发生，因为它们的释放，主要是在低风险的患者中的不良事件，从NSAIDs。这些发现表明，将创新疗法限制在最初靶向和最大受益的环境中是一个挑战。
Background: The withdrawal of rofecoxib has highlighted concerns regarding the safety of cyclooxygenase-2 (COX-2) inhibitors. In some patients COX-2 inhibitors may be safer than nonselective nonsteroidal anti-inflammatory drugs (NSAIDs); however, the public health benefit of COX-2 inhibitors depends on their use in patients at higher than normal risk from NSAIDs. We examined trends in COX-2 inhibitor use based on risk for adverse events from NSAIDs.Methods: We analyzed data from the National Ambulatory Medical Care Survey (1999-2002) and National Hospital Ambulatory Medical Care Survey (19992001), nationally representative surveys of community and hospital-based outpatient practices. The main outcome measure was the proportion of patient visits in which COX-2 inhibitors were prescribed, stratified by risk of adverse gastrointestinal (GI) events from NSAIDs.Results: Of the visits in which either a COX-2 inhibitor or NSAID was prescribed., the frequency of COX-2 inhibitor use increased from 35% (1999) to 55% (2000 to 61% (2001 and 2002). Among patients with the lowest risk for adverse events from NSAIDs, the proportion receiving a COX-2 inhibitor increased from 12% in 1999 to 35% in 2002. Overall, increases in COX-2 inhibitor use among patients in whom NSAIDs could be used accounted for more than 63% of the growth in COX-2 inhibitor use during the period examined.Conclusions: Marked increases in COX-2 inhibitor use have occurred since their release, primarily among patients at low risk for adverse events from NSAIDs. These findings demonstrate the challenge of limiting innovative therapies to the settings in which they are initially targeted and maximally beneficial.