English abstract
Background: Non-steroidal anti-inflammatory drugs (NSAIDs), are one of the most widely used, prescribed and over-the-counter drugs in the world. They have been the cornerstone of pain management. They are used to reduce inflammation and fever, long and short-management of various conditions including osteoarthritis and rheumatoid arthritis and for symptomatic treatment of musculoskeletal pain. However, NSAIDs are the most common cause of reported serious adverse reactions but there are no current local guidelines on the use of NSAIDs. The safe and effective use of NSAIDs is complex.
Aim:
Evaluate the usage pattern of two NSAIDs (diclofenac capsule 75mg and celecoxib tablet 200mg) at Sultan Qaboos University Hospital (SQUH) and assess the cardiovascular (CVD) and gastrointestinal (GIT) profiles of patients receiving these drugs.
Methods:
A retrospective study of 900 patients aged 18 years and above over a period of one year (2014) at SQUH. Data were retrieved from the hospital information system software called "Trackcare". The study included all patients on diclofenac capsule 75mg or celecoxib tablet 200mg in 2014 at SQUH.
Results:
The overall mean age of the 900 patients taking NSAIDs with was 47+16 years ranging from 19 to 89 years with 21% (n=192) of the subjects being >60 years of age. The majority of study cohort were females. The celecoxib group was associated with smoking, comorbidity (hypertension, diabetes mellitus, CVD, CVS, and abnormal LFTs, peptic ulcer history), and concurrent use of interacting medicines (antiplatelets, angiotensin converting enzyme inhibitors (ACEI), diuretics & corticosteroids.
Celecoxib group was more associated with chronic conditions (osteoarthritis, cancer & osteoporosis). While the diclofenac group was more associated with acute conditions such as trauma. Gastrointestinal events were associated with longer treatment duration & corticosteroid use, while cardiovascular events were more likely to be associated with those with major chronic conditions (hypertension & diabetes mellitus) with concurrent interacting drugs use (celecoxib, antiplatelet, diuretic & ACEI). Those with gastrointestinal events were more likely to be protected with proton pump inhibitors (PPIs) than those without gastrointestinal events. The celecoxib group was associated with concurrent PPI use while the diclofenac group was more associated with concurrent use of histamine-receptor-type2 blockers (H2Bs).
Conclusion: There is a high prevalence of celecoxib use among elderly female patients at
risk for significant drug-related adverse events or who have major chronic conditions that are relative contraindications to NSAIDs use. CVS events were more likely to be associated with those that were older female patients with major chronic conditions (hypertension & diabetes mellitus) and with concurrent use of interacting drugs (celecoxib, antiplatelet, diuretics & ACEIS). GIT events were associated with those that were older female patients, longer treatment duration and corticosteroid use which were more likely to be protected with proton pump inhibitors (PPIs). The celecoxib group was associated with concurrent PPI use while the diclofenac group was associated with concurrent use of histamine receptor type-2 blockers (H2Bs).
