Farrar J, Rivero E, Silman A, Hochberg M, Pandhi S, Banerjee S, Kahler K, Hunter S, Candrilli S, Castellsague J. Usage patterns of diclofenac and other selected systemic NSAIDs in the United States: results from a retrospective cohort of new users. Poster presented at the IASP World Congress on Pain 2016; September 27, 2016. Yokohama, Japan.

Aim of Investigation  Recent recommendations regarding the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and cost-related issues (prior authorization for branded celecoxib [CEL]) may have affected the patterns of prescribing NSAIDs in the United States (US) population. Due to the widespread availability of these drugs, determining their usage in clinical practice is important in understanding the perceived benefit–risk profile of different NSAIDs. The present analysis was designed to describe characteristics of new users (NUs) of the most commonly prescribed systemic NSAIDs (diclofenac [DCF], meloxicam (MEL), ibuprofen [IBU], naproxen [NPX], and CEL) from a large healthcare claims database in the US.

Methods This retrospective drug utilization study focused on a cohort of NUs of selected systemic NSAIDs from the Truven Marketscan® Commercial and Medicare Supplemental Databases. Patients aged ≥18 years who filled a prescription for any of the selected systemic NSAIDs from October 1, 2012 to September 30, 2013 and had no recorded prescriptions for any systemic NSAID during 12 months before the first observed prescription of the study period (index date) were classified as NUs. NSAID users were characterized at baseline in terms of age, history of comorbidities in the previous 3 years, other medications in the previous year, and diagnoses recorded around the index date that could be deemed as a potential indication. These variables were described across NSAIDs. Similar to other studies on claims databases, data on over-the-counter (OTC) use of IBU and NPX were not available.

Results  The number of NUs was 154,164 for DCF, 366,038 for MEL, 827,830 for IBU, 441,326 for NPX, and 64,088 for CEL. NUs (mean age in years [standard deviation]) of IBU (42 [15]) appeared to be younger than NUs of DCF (48 [14]), MEL (52 [15]), NPX (45 [15]) and CEL (59 [14]). Median values for age were similar to the mean values. The prevalence of cardiovascular system (CV) and digestive system comorbidities in DCF users was 43% and 26%, respectively, which was similar to other NSAID users, except CEL users who had a relatively higher burden (64% and 41%, respectively) of these conditions. CV comedications were the most frequent medications used among NUs of CEL (62%), MEL (49%), and DCF (42%) compared with those of IBU (29%) and NPX (36%). Opioid analgesics, including combination products, were most commonly used among IBU (55%) and NPX (41%) NUs. The frequency of diagnoses of musculoskeletal system disorders (including joint disorders, spinal disorders, and soft tissue disorders) was higher in all age groups among NUs of DCF (76%), MEL (79%), and CEL (77%) than that among NUs of NPX (64%) and IBU (36%). In IBU and NPX NUs, injury and bone fracture were the most frequent diagnoses in the younger population (18-44 years).

Conclusion Variability exists in characteristics of patients receiving different systemic NSAIDs. Users of DCF, MEL, CEL, and NPX tend to be older than users of IBU. This is expected with the increase in chronic inflammatory and painful disorders with age. Use of concomitant medications is relevant in characterizing the risk profile of NSAID users and was consistent with the prevalence of associated chronic comorbidities. A higher frequency of injury and bone fracture in IBU and NPX users is consistent with these common causes for pain in the younger population. Overall, these data suggest that the observed differences in characteristics of users of commonly prescribed NSAIDs are in line with the understanding of the medical indications for their use in clinical practice.

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