When COX-2 inhibitors were first introduced in 1999, they were promoted as pain relievers, inflammation reducers, and less likely than NSAIDs to cause adverse GI effects. Over the next few years, after being heavily promoted to physicians and the general public, Vioxx and Celebrex became widely used by millions of persons who had little risk of GI bleeding.
The overuse of the COX-2 inhibitors is documented in a study by researchers from the University of Chicago and Stanford University School of Medicine; results were published in the January 24 issue of the Archives of Internal Medicine. Findings of the study, led by Carolanne Dai, MSc, University of Chicago, showed that almost two thirds of the growth in COX-2 inhibitor use from 1999 to 2002 occurred in patients at minimal risk for GI bleeding from NSAIDs.
Researchers looked at data from 2 nationally representative surveys that tracked patient visits to their physicians between 1999 and 2002 and the types of medications prescribed at those visits. The researchers also categorized patients according to their risk of GI bleeding from NSAIDs.
Dai and colleagues found that 73% of patients had either a very low (31%) or low (42%) risk of GI bleeding from NSAIDs and, thus, no pressing medical reason for them to switch to COX-2 inhibitors. However, this was the group in which the greatest growth in COX-2 use occurred. The number of physician visits associated with COX-2 use in these patients increased from 9.5 million in 1999 to 20.9 million in 2002, accounting for 63% of growth in the use of COX-2 inhibitors during that time. Patients most likely to benefit from use of these newer agentsâ€”those with moderate or high risk of GI bleedingâ€”accounted for the remaining 37% increase.