Changing Practices Regarding Aspirin, NSAIDs,COX-2s
Changing Practices Regarding Aspirin, NSAIDs,COX-2s
Background: Our understanding of the benefits and risks of aspirin non steroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) selective NSAIDs and gastro-protective agents (GPAs) continues to expand.
Aim: To assess the perceptions and practices of US primary care physicians (PCPs) regarding the use of aspirin, NSAIDs, COX-2 selective NSAIDs and GPA.
Methods: A 34-question survey was administered to 1000 US PCPs via the internet. Questions addressed issues involving aspirin, NSAIDs, COX-2 selective NSAIDs, and GPAs. Around 491 of 1000 PCPs had participated in a similar survey conducted in 2003.
Results: Eighty-five per cent of PCPs reported that >25% of their patients were taking aspirin for preventive reasons. Nineteen per cent performed a risk calculation when deciding whether to start aspirin for cardioprotection. Fifty-four per cent recommended a proton pump inhibitor (PPI) for a patient with a recently healed ulcer who required ongoing aspirin. Thirty-one per cent reported prescribing NSAIDs more often and 52% were more likely to recommend a GPA with an NSAID than in 2003. Although PCPs were less likely to recommend a COX-2 selective NSAID compared to 2003, only 41% felt that rofecoxib increased cardiovascular risk. One-third felt that celecoxib and traditional NSAIDs were associated with increased cardiac risk.
Conclusion: This survey identified several areas of ongoing confusion regarding aspirin, NSAIDs, COX-2 selective NSAIDs and GPAs, which should help direct future educational efforts regarding the benefits, risks and appropriate use of these agents.
Nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin are the most widely used drugs in the world. Prescribed by physicians and purchased by consumers over the counter, it is estimated that millions of people take these drugs on a daily basis. In addition to NSAID use for pain control, aspirin is commonly used for cardioprotection, as well as chemoprophylaxis for a number of malignancies. Serious adverse events, ranging from dyspepsia to upper and lower gastrointestinal (GI) bleeding, perforation and obstruction, have been attributed to NSAID or aspirin use. Cyclooxygenase-2 (COX-2) specific inhibitors (COX-2 selective NSAIDs) provide an alternative to nonselective NSAIDs that confer a reduced risk for serious GI toxicity. However, the withdrawal of two COX-2 selective NSAIDs from the US market and failure to approve two others primarily for reasons of cardiovascular (CV) safety, have negatively impacted the prescription of COX-2 selective NSAIDs and have drawn attention to the use of gastroprotection concomitant with NSAID use.
Primary care physicians (PCPs) are responsible for the largest proportion of NSAID prescriptions. However, incorporation of new information by healthcare providers in this area, which is undergoing rapid data accrual, can be slow and is subject to influence from promotional efforts of the pharmaceutical industry, which not only target prescribers, but aggressively market directly to consumers. The recognition of adverse CV events associated with COX-2 selective NSAIDs has led to confusion regarding the use of these medications in patients with increased GI and/or CV risk. Uncertainty also remains regarding the appropriate use of low dose aspirin and NSAIDs.
There has been a rapid evolution of information addressing the use of aspirin, NSAIDs, COX-2 selective NSAIDs and gastroprotective agents (GPAs). As such, it is important to identify those areas in which PCPs need further education. In 2003, we surveyed 1000 US PCPs to assess their perceptions and prescribing habits as they pertain to these agents. That survey identified multiple areas of misinformation regarding the risk-benefit of NSAIDs and aspirin as well as appropriate utilization of gastroprotective strategies. For example, a majority of PCPs felt that enteric coating reduced the risk of adverse GI events. In addition, at the time of our original survey, PCPs recommended a COX-2 selective NSAID in a patient requiring an NSAID over 40% of the time. There was confusion about the interaction between aspirin and COX-2 selective NSAIDs and the use of gastroprotection in patients at increased risk for GI adverse events who required ongoing treatment with an NSAID or aspirin.
In light of changes in COX-2 selective NSAID availability in the US and new data on indications and the safety of aspirin and NSAIDs, we conducted a follow-up survey to assess current perceptions on the safety and appropriate use of these drugs.
Abstract and Introduction
Abstract
Background: Our understanding of the benefits and risks of aspirin non steroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase-2 (COX-2) selective NSAIDs and gastro-protective agents (GPAs) continues to expand.
Aim: To assess the perceptions and practices of US primary care physicians (PCPs) regarding the use of aspirin, NSAIDs, COX-2 selective NSAIDs and GPA.
Methods: A 34-question survey was administered to 1000 US PCPs via the internet. Questions addressed issues involving aspirin, NSAIDs, COX-2 selective NSAIDs, and GPAs. Around 491 of 1000 PCPs had participated in a similar survey conducted in 2003.
Results: Eighty-five per cent of PCPs reported that >25% of their patients were taking aspirin for preventive reasons. Nineteen per cent performed a risk calculation when deciding whether to start aspirin for cardioprotection. Fifty-four per cent recommended a proton pump inhibitor (PPI) for a patient with a recently healed ulcer who required ongoing aspirin. Thirty-one per cent reported prescribing NSAIDs more often and 52% were more likely to recommend a GPA with an NSAID than in 2003. Although PCPs were less likely to recommend a COX-2 selective NSAID compared to 2003, only 41% felt that rofecoxib increased cardiovascular risk. One-third felt that celecoxib and traditional NSAIDs were associated with increased cardiac risk.
Conclusion: This survey identified several areas of ongoing confusion regarding aspirin, NSAIDs, COX-2 selective NSAIDs and GPAs, which should help direct future educational efforts regarding the benefits, risks and appropriate use of these agents.
Introduction
Nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin are the most widely used drugs in the world. Prescribed by physicians and purchased by consumers over the counter, it is estimated that millions of people take these drugs on a daily basis. In addition to NSAID use for pain control, aspirin is commonly used for cardioprotection, as well as chemoprophylaxis for a number of malignancies. Serious adverse events, ranging from dyspepsia to upper and lower gastrointestinal (GI) bleeding, perforation and obstruction, have been attributed to NSAID or aspirin use. Cyclooxygenase-2 (COX-2) specific inhibitors (COX-2 selective NSAIDs) provide an alternative to nonselective NSAIDs that confer a reduced risk for serious GI toxicity. However, the withdrawal of two COX-2 selective NSAIDs from the US market and failure to approve two others primarily for reasons of cardiovascular (CV) safety, have negatively impacted the prescription of COX-2 selective NSAIDs and have drawn attention to the use of gastroprotection concomitant with NSAID use.
Primary care physicians (PCPs) are responsible for the largest proportion of NSAID prescriptions. However, incorporation of new information by healthcare providers in this area, which is undergoing rapid data accrual, can be slow and is subject to influence from promotional efforts of the pharmaceutical industry, which not only target prescribers, but aggressively market directly to consumers. The recognition of adverse CV events associated with COX-2 selective NSAIDs has led to confusion regarding the use of these medications in patients with increased GI and/or CV risk. Uncertainty also remains regarding the appropriate use of low dose aspirin and NSAIDs.
There has been a rapid evolution of information addressing the use of aspirin, NSAIDs, COX-2 selective NSAIDs and gastroprotective agents (GPAs). As such, it is important to identify those areas in which PCPs need further education. In 2003, we surveyed 1000 US PCPs to assess their perceptions and prescribing habits as they pertain to these agents. That survey identified multiple areas of misinformation regarding the risk-benefit of NSAIDs and aspirin as well as appropriate utilization of gastroprotective strategies. For example, a majority of PCPs felt that enteric coating reduced the risk of adverse GI events. In addition, at the time of our original survey, PCPs recommended a COX-2 selective NSAID in a patient requiring an NSAID over 40% of the time. There was confusion about the interaction between aspirin and COX-2 selective NSAIDs and the use of gastroprotection in patients at increased risk for GI adverse events who required ongoing treatment with an NSAID or aspirin.
In light of changes in COX-2 selective NSAID availability in the US and new data on indications and the safety of aspirin and NSAIDs, we conducted a follow-up survey to assess current perceptions on the safety and appropriate use of these drugs.
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