NSAIDs utilization for musculoskeletal indications in elderly patients with cerebro/cardiovascular disease

Fini Massimo, Bonassi Stefano

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To describe NSAID utilization for musculoskeletal conditions in a large cohort of Italian elderly with cerebro/cardiovascular disease, a population in which NSAIDs should be generally avoided due to the prothrombotic potential.

METHODS: Administrative data from five Italian geographic areas were analyzed. Patients aged ≥ 65 with a cerebro/cardiovascular event recorded between 2008 and 2011 (cohort entry) were selected. Prescription NSAIDs reimbursed for musculoskeletal conditions and dispensed during 1 year follow-up were retrieved to describe (i) prevalence of use, (ii) average amount of defined daily doses of NSAIDs claimed by users per day of follow-up, and (iii) distribution of the received daily dose (RDD) among patients with ≥ 2 dispensings. Among new users, i.e., patients without NSAID dispensings during 2 years before cohort entry, the first dispensed NSAID molecule was observed.

RESULTS: Overall, 511,989 patients were selected. Across the five geographic areas, prevalence of use ranged from 48 to 21% and average consumption ranged between 30 and 67 DDD/1000 users/day. Around 10% of patients in the overall cohort had a RDD > 1. Nimesulide (9.6%) and diclofenac (7.5%) had the highest prevalence of use. The most consumed NSAIDs were nimesulide and coxibs with 10.6 and 7.5 DDD/1000 users/day, respectively. Among new users recruited in 2011, 30% had diclofenac or a coxibs as the first prescription.

CONCLUSIONS: NSAID use was common in the study cohort, particularly in central-southern areas. In contrast with current recommendations, coxibs and diclofenac were among the most prescribed active principles, even in new users. Interventions to promote appropriateness of use are warranted.

Original languageEnglish
Pages (from-to)637-643
Number of pages7
JournalEuropean Journal of Clinical Pharmacology
Volume74
Issue number5
DOIs
Publication statusPublished - May 2018

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Non-Steroidal Anti-Inflammatory Agents
Cardiovascular Diseases
nimesulide
Diclofenac
Cyclooxygenase 2 Inhibitors
Dichlorodiphenyldichloroethane
Prescriptions
Cohort Studies
Population

Keywords

  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents, Non-Steroidal/therapeutic use
  • Cardiovascular Diseases/drug therapy
  • Drug Utilization/statistics & numerical data
  • Female
  • Humans
  • Musculoskeletal Diseases/drug therapy

Cite this

NSAIDs utilization for musculoskeletal indications in elderly patients with cerebro/cardiovascular disease. / Fini Massimo; Bonassi Stefano.

In: European Journal of Clinical Pharmacology, Vol. 74, No. 5, 05.2018, p. 637-643.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVES: To describe NSAID utilization for musculoskeletal conditions in a large cohort of Italian elderly with cerebro/cardiovascular disease, a population in which NSAIDs should be generally avoided due to the prothrombotic potential.METHODS: Administrative data from five Italian geographic areas were analyzed. Patients aged ≥ 65 with a cerebro/cardiovascular event recorded between 2008 and 2011 (cohort entry) were selected. Prescription NSAIDs reimbursed for musculoskeletal conditions and dispensed during 1 year follow-up were retrieved to describe (i) prevalence of use, (ii) average amount of defined daily doses of NSAIDs claimed by users per day of follow-up, and (iii) distribution of the received daily dose (RDD) among patients with ≥ 2 dispensings. Among new users, i.e., patients without NSAID dispensings during 2 years before cohort entry, the first dispensed NSAID molecule was observed.RESULTS: Overall, 511,989 patients were selected. Across the five geographic areas, prevalence of use ranged from 48 to 21{\%} and average consumption ranged between 30 and 67 DDD/1000 users/day. Around 10{\%} of patients in the overall cohort had a RDD > 1. Nimesulide (9.6{\%}) and diclofenac (7.5{\%}) had the highest prevalence of use. The most consumed NSAIDs were nimesulide and coxibs with 10.6 and 7.5 DDD/1000 users/day, respectively. Among new users recruited in 2011, 30{\%} had diclofenac or a coxibs as the first prescription.CONCLUSIONS: NSAID use was common in the study cohort, particularly in central-southern areas. In contrast with current recommendations, coxibs and diclofenac were among the most prescribed active principles, even in new users. Interventions to promote appropriateness of use are warranted.",
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author = "Giuseppe Roberto and Claudia Bartolini and Federico Rea and Graziano Onder and Cristiana Vitale and Gianluca Trifir{\`o} and Ursula Kirchmayer and Alessandro Chinellato and Ersilia Lucenteforte and Giovanni Corrao and Alessandro Mugelli and Francesco Lapi and Rosa Gini and {Fini Massimo} and {Bonassi Stefano}",
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TY - JOUR

T1 - NSAIDs utilization for musculoskeletal indications in elderly patients with cerebro/cardiovascular disease

AU - Roberto, Giuseppe

AU - Bartolini, Claudia

AU - Rea, Federico

AU - Onder, Graziano

AU - Vitale, Cristiana

AU - Trifirò, Gianluca

AU - Kirchmayer, Ursula

AU - Chinellato, Alessandro

AU - Lucenteforte, Ersilia

AU - Corrao, Giovanni

AU - Mugelli, Alessandro

AU - Lapi, Francesco

AU - Gini, Rosa

AU - Fini Massimo

AU - Bonassi Stefano

PY - 2018/5

Y1 - 2018/5

N2 - OBJECTIVES: To describe NSAID utilization for musculoskeletal conditions in a large cohort of Italian elderly with cerebro/cardiovascular disease, a population in which NSAIDs should be generally avoided due to the prothrombotic potential.METHODS: Administrative data from five Italian geographic areas were analyzed. Patients aged ≥ 65 with a cerebro/cardiovascular event recorded between 2008 and 2011 (cohort entry) were selected. Prescription NSAIDs reimbursed for musculoskeletal conditions and dispensed during 1 year follow-up were retrieved to describe (i) prevalence of use, (ii) average amount of defined daily doses of NSAIDs claimed by users per day of follow-up, and (iii) distribution of the received daily dose (RDD) among patients with ≥ 2 dispensings. Among new users, i.e., patients without NSAID dispensings during 2 years before cohort entry, the first dispensed NSAID molecule was observed.RESULTS: Overall, 511,989 patients were selected. Across the five geographic areas, prevalence of use ranged from 48 to 21% and average consumption ranged between 30 and 67 DDD/1000 users/day. Around 10% of patients in the overall cohort had a RDD > 1. Nimesulide (9.6%) and diclofenac (7.5%) had the highest prevalence of use. The most consumed NSAIDs were nimesulide and coxibs with 10.6 and 7.5 DDD/1000 users/day, respectively. Among new users recruited in 2011, 30% had diclofenac or a coxibs as the first prescription.CONCLUSIONS: NSAID use was common in the study cohort, particularly in central-southern areas. In contrast with current recommendations, coxibs and diclofenac were among the most prescribed active principles, even in new users. Interventions to promote appropriateness of use are warranted.

AB - OBJECTIVES: To describe NSAID utilization for musculoskeletal conditions in a large cohort of Italian elderly with cerebro/cardiovascular disease, a population in which NSAIDs should be generally avoided due to the prothrombotic potential.METHODS: Administrative data from five Italian geographic areas were analyzed. Patients aged ≥ 65 with a cerebro/cardiovascular event recorded between 2008 and 2011 (cohort entry) were selected. Prescription NSAIDs reimbursed for musculoskeletal conditions and dispensed during 1 year follow-up were retrieved to describe (i) prevalence of use, (ii) average amount of defined daily doses of NSAIDs claimed by users per day of follow-up, and (iii) distribution of the received daily dose (RDD) among patients with ≥ 2 dispensings. Among new users, i.e., patients without NSAID dispensings during 2 years before cohort entry, the first dispensed NSAID molecule was observed.RESULTS: Overall, 511,989 patients were selected. Across the five geographic areas, prevalence of use ranged from 48 to 21% and average consumption ranged between 30 and 67 DDD/1000 users/day. Around 10% of patients in the overall cohort had a RDD > 1. Nimesulide (9.6%) and diclofenac (7.5%) had the highest prevalence of use. The most consumed NSAIDs were nimesulide and coxibs with 10.6 and 7.5 DDD/1000 users/day, respectively. Among new users recruited in 2011, 30% had diclofenac or a coxibs as the first prescription.CONCLUSIONS: NSAID use was common in the study cohort, particularly in central-southern areas. In contrast with current recommendations, coxibs and diclofenac were among the most prescribed active principles, even in new users. Interventions to promote appropriateness of use are warranted.

KW - Aged

KW - Aged, 80 and over

KW - Anti-Inflammatory Agents, Non-Steroidal/therapeutic use

KW - Cardiovascular Diseases/drug therapy

KW - Drug Utilization/statistics & numerical data

KW - Female

KW - Humans

KW - Musculoskeletal Diseases/drug therapy

U2 - 10.1007/s00228-018-2411-y

DO - 10.1007/s00228-018-2411-y

M3 - Article

C2 - 29383397

VL - 74

SP - 637

EP - 643

JO - European Journal of Clinical Pharmacology

JF - European Journal of Clinical Pharmacology

SN - 0031-6970

IS - 5

ER -