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Prescribing of COX-2 Before Withdrawal Was Nonselective

Monitoring prescribing patterns of new drug classes may improve patient outcome

FRIDAY, July 28 (HealthDay News) -- The release of new classes of drugs, such as the COX-2 inhibitors, can alter their prescribing patterns and expand their use into populations that might not need them, according to a report published online July 27 in Arthritis Care & Research.

Jeffrey D. Greenberg, M.D., from New York University Hospital for Joint Diseases in New York City, and colleagues examined the prescribing pattern of COX-2 inhibitors and other gastroprotective agents for 2,690 rheumatoid arthritis patients in mid-2004, up to the point when rofecoxib was pulled from the market.

The investigators found that 1,833 (68.1 percent) were prescribed nonsteroidal anti-inflammatory drugs (NSAIDs), 538 (20 percent) were prescribed aspirin, and 319 (11.9 percent) were prescribed both NSAIDs and aspirin. A majority (75.3 percent) of the NSAID users in this study were also prescribed a gastroprotective strategy. Further, 72 percent of patients without any gastrointestinal risk factors were prescribed gastroprotection, many of them with COX-2 inhibitors.

"Our data indicate that coxib prescribing by rheumatologists prior to the coxib market withdrawals was widespread and not limited to a higher risk patient population," the authors write. "As novel therapeutic classes are introduced, early evaluation of prescribing patterns using arthritis registries can determine the appropriateness of prescribing patterns and may improve patient outcomes."

Some of the study authors have taken consulting fees from, or are employed by, drug companies.

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