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COX-2 inhibitors have changed prescribing practices for rheumatoid indications
  By Martha Kerr
NEW YORK (Reuters Health) - COX-2 inhibitors accounted for approximately 44% of total NSAID prescriptions for rheumatologic indications in 2003, a figure twice that of 1999, when the first COX-2 inhibitors were approved, University of Pittsburgh investigators told attendees of the 2004 annual scientific meeting of the American College of Rheumatology on Monday.
However, rofecoxib (Vioxx) was recently pulled from the market due to a link to increased cardiovascular events (see Reuters Health report September 30, 2004) and the FDA issuing a warning on serious allergic reactions associated with valdecoxib (Bextra) last week.
"It is hard to predict what prescribing practices will be," Dr. Molly Vogt told Reuters Health. "It appears that there may be a class-wide effect with the COX-2 inhibitors...Unofficially, I know that patients are calling their physicians and wanting to go back on [celecoxib] or one of the non-selective NSAIDs."
In the current study, Dr. Vogt and colleagues reviewed Redbook source data from the Scott-Levine Source Prescription Audit from 1998 through 2003. This included more than 36,000 independent, chain, supermarket, mass merchandisers and deep discount pharmacies. The investigators divided NSAID prescriptions into non-selective agents or COX-2 inhibitors. They also analyzed retail costs for NSAIDs between 2002 and 2003.
Dr. Vogt told Reuters Health that there was a 67.7% overall increase in NSAID prescriptions between 1999 and 2003. In 1999, the year COX-2 agents were first approved, that class of NSAIDs accounted for 22.2% of prescriptions for arthritis. By 2003, the researchers found that COX-2 agents accounted for 44% of all prescriptions.
Between 1998 and 1999, there was a 20% drop in prescriptions for ibuprofen, naproxen and diclofenac. The figure has remained steady since then, the Pittsburgh team found.
Dr. Voigt also reported that the costs of NSAIDs have been rising, with a 1.7% increase in 2003. "Virtually all of that was due to the increased cost in COX-2 inhibitors" which increased 4% during that time period."
Given the recent Vioxx recall and Bextra warning, "it's hard to say what will happen," Dr. Vogt added.

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