ASSESSMENT OF ANALGESIC TREATMENT SWITCH PATTERNS POST-ROFECOXIB WITHDRAWAL

W.G. Goettsch,M.P.P. Sukel , S.E. Borggreve , C. Chen , P. Kramarz , H. Lilliu , R.M.C. Herings Research, PHARMO Institute, Utrecht, Netherlands, Oncology Pain and Inflammation, Pfizer Inc., New York, United States, EUCAN Group, Pfizer Outcomes Research Europe, Walton Oaks, United KingdomObjectives: To study treatment patterns in patients who formerly used COX-2-inhibitors for at least six months, after the world-wide withdrawal of rofecoxib on October 1, 2004.Methods: A retrospective cohort study was performed. Data were obtained from the PHARMO Record Linkage System comprising the complete medication history and hospital discharge records of more than two million inhabitants in the Netherlands.Patients who formerly used COX-2-inhibitors (coxibs) for at least six months before the withdrawal of rofecoxib and had treatment extended beyond October 1, 2004 (the index date) were included. Switching and stopping of analgesic treatment was studied during a follow-up period of nine months after the index date. General characteristics of different subgroups of analgesic treatment were studied.Results: Of 5,542 chronic coxib users in total, 9.2% continued use during a nine month follow-up period after the withdrawal of rofecoxib. Most patients (3,835; 69%) of all chronic coxib users changed analgesic use within 3 months of the withdrawal of rofecoxib and the remaining group of users (1,198; 22%) changed 3 to 9 months after the withdrawal. The 5,033 coxib users who changed treatment during the nine month follow-up period were categorised in six subgroups: 19% switched to another coxib, 16% stopped all analgesic treatment, 15% switched to a non specific (ns-)NSAID, 17% switched to a combination of ns-NSAID and proton-pump inhibitor (PPI), 28% used other analgesics and 6% switched to a ns-NSAID with or without PPI and then back to a coxib within the 9 month follow-up time frame. The mean age of the users in all subgroups ranged from 62 to 64 years. Most switches (approximately 85%) were initiated by general practitioners.Detailed analysis showed that the majority of patients on non-NSAID analgesics (80%) used them already concomitantly with a coxib even before the withdrawal of rofecoxib. The most common types of medications used were opioids (51%) and acetaminophen (41%).Conclusions: In the first three months after the world-wide withdrawal of rofecoxib, approximately 70% of the chronic coxib users switched pain therapies. A large percentage of these patients stopped analgesic therapy all together or used only acetaminophen or opioid therapy. These results point to the potential need to reassess appropriate analgesic therapy during this post-rofecoxib withdrawal period.Citation: Ann Rheum Dis, volume 65, supplement II, year 2006, page 603Session: Health service and outcome research