COX-2 inhibitors and the elderly

November 11, 2002

The cyclooxygenase-2 (COX-2) selective nonsteroidal anti-inflammatory drugs (NSAIDs) celecoxib (Celebrex) and rofecoxib (Vioxx) were first listed on the Ontario Drug Benefit (ODB) formulary as "limited use" products on Apr. 17, 2000.

The "limited use" designation indicated the products would only be covered as a benefit if previous NSAID therapy had failed or was not tolerated by a patient. However, based on their examination of drug claims data, Muhammad Mamdani and colleagues found that most of the patients among the initial users of COX-2 inhibitors did not have a prescription claim for another NSAID in the 4 months preceding their first COX-2 prescription.

The authors state that the listing of the COX-2 inhibitors had a "substantial and immediate impact on expenditures on NSAIDs," and accounted for 48% of prescriptions and 66% of expenditures for NSAIDs in the post-listing period (Apr. 18 to Nov. 30, 2000).

In a related editorial, James Wright describes the appropriate use of these medicines, the safety and efficacy of NSAIDs and the advantages and disadvantages of COX-2 inhibitors.
p. 1125 Initial patterns of use of COX-2 inhibitors by elderly patients in Ontario: findings and implications -- M. Mamdani et al
p. 1131 The double-edged sword of COX-2 selective NSAIDs -- J.M. Wright

Canadian Medical Association Journal

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