Drug utilization in patients with OA: a population-based study

Nicholas Wilson; Lidia Sanchez-Riera; Rosa Morros; Adolfo Diez-Perez; M Kassim Javaid; Cyrus Cooper; Nigel K Arden; Daniel Prieto-Alhambra

doi:10.1093/rheumatology/keu403

Drug utilization in patients with OA: a population-based study

Rheumatology (Oxford). 2015 May;54(5):860-7. doi: 10.1093/rheumatology/keu403. Epub 2014 Oct 21.

Authors

Nicholas Wilson¹, Lidia Sanchez-Riera¹, Rosa Morros¹, Adolfo Diez-Perez², M Kassim Javaid¹, Cyrus Cooper¹, Nigel K Arden¹, Daniel Prieto-Alhambra³

Affiliations

¹ Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
² Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK.
³ Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Català de la Salut, Primary Care Department, IDIAP Jordi Gol, SIDIAP Database, Institut Català de la Salut, URFOA-IMIM and RETICEF, Internal Medicine, Parc de Salut Mar-Instituto Carlos III, Barcelona, Spain, Musculoskeletal Epidemiology Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford and MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK Institute of Bone and Joint Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, NSW, Australia, Global Burden of Diseases Study 2010 Working Group, University of Washington, Seattle, WA, USA, Institut d'Investigació Biomèdica de Bellvitge, Hospital Universitari de Bellvitge, Departament de Reumatologia, L'Hospitalet de Llobregat, Institut Catal

PMID: 25339639
DOI: 10.1093/rheumatology/keu403

Abstract

Objective: Patients with OA use different drugs in their search for relief. We aimed to study the prevalence of use and combinations of different medications for OA in a population-based cohort of OA patients in Catalonia, Spain, while characterizing users of each of the drugs available, with a particular focus on cardiovascular risk factors.

Methods: Data were obtained from the Sistema d'Informació per al Desenvolupament de l'Investigació en Atenció Primària (SIDIAP) database, which includes electronic medical records and pharmacy invoice data for >5 million people from Catalonia. Study participants were those with a clinical diagnosis of OA in 2006-10. Drugs studied included oral and topical NSAIDs, analgesics (paracetamol, metamizole), opioids (tramadol, fentanyl), cyclooxygenase 2 (COX-2) inhibitors and symptomatic slow-acting drugs in OA. Drug utilization was described using medication possession ratios (MPRs), equivalent to the proportion of days covered with the drug of interest. The annual incidence of new users in the first year after OA diagnosis from 2006 to 2010 was estimated for all studied drugs among newly diagnosed OA patients using Poisson regression.

Results: We identified 238 536 study participants. The most common regimen of treatment consisted of at least three drugs (53.9% of patients). The drugs most frequently used regularly (MPR ≥50%) were chondroitin (21.2%), glucosamine (15.8%) and oral NSAIDs (14.4%). The incidence of the use of opioids, COX-2 inhibitors and chondroitin increased over the 5 year period, whereas all others decreased.

Conclusion: Drug combinations are common in the treatment of OA patients, who are thus exposed to potential drug interactions, with unknown impacts on their health. The increasing use of opioids and COX-2 inhibitors is noteworthy because of the potential impact on safety and costs.

Keywords: Catalonia; drug utilization; electronic health records; osteoarthritis; pharmaceutical therapy; pharmacoepidemiology; population-based cohort.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Analgesics / therapeutic use
Analgesics, Opioid / therapeutic use
Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
Antirheumatic Agents / therapeutic use*
Chondroitin / therapeutic use
Cohort Studies
Cyclooxygenase 2 Inhibitors / therapeutic use
Databases, Factual / statistics & numerical data*
Drug Therapy, Combination
Female
Humans
Male
Medical Records / statistics & numerical data*
Middle Aged
Osteoarthritis / drug therapy*
Osteoarthritis / epidemiology*
Pharmacy / statistics & numerical data*
Retrospective Studies
Spain / epidemiology

Substances

Analgesics
Analgesics, Opioid
Anti-Inflammatory Agents, Non-Steroidal
Antirheumatic Agents
Cyclooxygenase 2 Inhibitors
Chondroitin

Abstract

Publication types

MeSH terms

Substances

Grants and funding