PAR8 AVERAGE DAILY DOSE AND COSTS OF REIMBURSED COX-2 INHIBITORS FOR PATIENTS WITH RHEUMATOID ARTHRITIS IN NORWAY

Objective.To examine the incidence of gastrointestinal (GI) events in patients with rheumatoid arthritis (RA) after the removal of rofecoxib from the market.Methods.Residents of British Columbia with a diagnosis of RA who were chronic users of cyclooxygenase 2 (COX-2) inhibitors or nonselective nonsteroidal antiinflammatory drugs (nsNSAID) as of September 30, 2004, were included. We studied the risk of GI events using incidence rates and adjusted HR from Cox proportional hazards regression using time-dependent covariates.Results.The cohort comprised 4266 patients with a mean age of 60 years and over 72% women, of which 2034 (48%) were classified as COX-2 inhibitor users and 2232 (52%) as chronic nsNSAID users as of September 30, 2004. The 2 groups were well balanced on baseline covariates except for comorbid conditions. In the year following rofecoxib withdrawal, 174 patients (5.5%) experienced 1 or more GI events, defined as a GI-related physician visit or hospitalization. There was no statistically significant increase in the risk of a GI event between those classified as a COX-2 inhibitor or nsNSAID user at the time of withdrawal (HR 1.03, 95% CI 0.69–1.54). Considering the drug exposure at the time of the event, there was no increased risk of GI events associated with the use of either COX-2 inhibitors or nsNSAID, or with the use of oral corticosteroids, low-dose aspirin, or clopidogrel, after adjustment for potential confounders.Conclusion.In this cohort, withdrawal of rofecoxib did not result in a significant increase in GI events among patients with RA.

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COX-2 inhibitors in rheumatoid arthritis

Current Rheumatology Reports ◽

10.1007/s11926-001-0055-9 ◽

2001 ◽

Vol 3 (1) ◽

pp. 86-91 ◽

Cited By ~ 17

Author(s):

John S. Sundy

Keyword(s):

Rheumatoid Arthritis ◽

Cox 2 ◽

Cox 2 Inhibitors

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Interactions among Low Dose of Methotrexate and Drugs Used in the Treatment of Rheumatoid Arthritis

Advances in Pharmacological Sciences ◽

10.1155/2013/313858 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Marinella Patanè ◽

Miriam Ciriaco ◽

Serafina Chimirri ◽

Francesco Ursini ◽

Saverio Naty ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Low Dose ◽

Reference Lists ◽

Good Control ◽

Limiting Factor ◽

Antirheumatic Drugs ◽

Cox 2 ◽

Cox 2 Inhibitors ◽

Necrosis Factor ◽

Disease Modifying Antirheumatic Drug

Methotrexate (MTX) is a nonbiological disease-modifying antirheumatic drug that has shown both a good control of clinical disease and a good safety. Usually drug-drug interactions (DDIs) represent the most limiting factor during the clinical management of any disease, in particular when several drugs are coadministered to treat the same disease. In this paper, we report the interactions among MTX and the other drugs commonly used in the management of rheumatoid arthritis. Using Medline, PubMed, Embase, Cochrane libraries, and Reference lists, we searched for the articles published until June 30, 2012, and we reported the most common DDIs between MTX and antirheumatic drugs. In particular, clinically relevant DDIs have been described during the treatment with MTX and NSAIDs, for example, diclofenac, indomethacin, or COX-2 inhibitors, and between MTX and prednisone or immunosuppressant drugs (e.g., leflunomide and cyclosporine). Finally, an increase in the risk of infections has been recorded during the combination treatment with MTX plus antitumor necrosis factor-αagents. In conclusion, during the treatment with MTX, DDIs play an important role in both the development of ADRs and therapeutic failure.

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