Prescription of nonselective NSAIDs, coxibs and gastroprotective agents in the era of rofecoxib withdrawal - a 617 400-patient study

Summary Background Gastroprotective strategies are recommended for nonsteroidal anti‐inflammatory drug (NSAID) users at risk of upper gastrointestinal (UGI) complications. Aim To compare the use of gastroprotective strategies in NSAID users in three countries, and the subsequent impact of rofecoxib withdrawal. Methods We conducted a population‐based cohort study in three general practice (GP) databases: (i) United Kingdom's (UK) GP Research Database (1998–2008); (ii) Italy's (IT) Health Search/CSD Longitudinal Patient Database (2000–2007); and (iii) the Dutch (NL) Integrated Primary Care Information database (1996–2006). Study cohorts comprised incident NSAID users ≥50 years. Preventive strategies included: (i) co‐prescription of gastroprotective agents; or (ii) cyclooxygenase‐2‐selective inhibitor use. Under‐use was defined as no gastroprotection in patients with ≥1 UGI risk factor (history of UGI event, age ≥65 years, concomitant use of anticoagulants, antiplatelets or glucocorticoids). Interrupted time‐series analysis was performed to assess the impact of rofecoxib withdrawal on preventive strategies. Results The study populations consisted of 384 649 UK, 177 747 IT and 55 004 NL NSAID users. In UK, under‐use of preventive strategies fell from 91% to 71% [linear trend (lt) P = 0.001], in NL from 92% to 58% (lt P