[Epidemiological description of long-term oral glucocorticoid use: Results from the French health insurance database]. / Description épidémiologique de la corticothérapie orale prolongée : résultats issus de la base de données de l'assurance maladie.

BACKGROUND: There is very little epidemiologic data available in the literature concerning long-term corticosteroid prescriptions in France. METHODS: The information was collected from a national public health-insurance database in our geographic area of Provence-Alpes-Côte-d'Azur and Corsica. We included in the analysis, patients using a daily glucocorticoid above 7,5 milligrams for a period exceeding 90 days. RESULTS: Among the patients, 4,1 million were included in the analysis. The prevalence of glucocorticoids was around 0.8% and the incidence was 2.3/1000 inhabitants/year. The mean age of the patients was 57.6±18.8 years old. The median prednisone-equivalent dose was 11.9mg/day (Interquartile range: 8.6-20.0). The average treatment duration was 206 days (CI 95% 202-210). Most prescriptions (72,0%) were started by general practitioners. CONCLUSION: Long-term corticosteroid therapy is frequent in France. Its description is close to what is already known in Europe.

Influence of flare design on symptomatic efficacy of non-steroidal anti-inflammatory drugs in osteoarthritis: a meta-analysis of randomized placebo-controlled trials.

INTRODUCTION: Non-steroidal anti-inflammatory drugs' (NSAIDs) symptomatic efficacy in osteoarthritis (OA) is often assessed in trials with a "flare design", i.e., including only patients with an increase in their pain after stopping their usual treatment (NSAIDs or analgesic). OBJECTIVE: To evaluate the influence of the "flare design" on NSAIDs apparent symptomatic efficacy in OA. SEARCH STRATEGY: a systematic literature research was performed in Medline, EMBASE and The Cochrane Register up to March 2009. All randomized controlled trials comparing NSAIDs vs placebo symptomatic efficacy in hip, knee, or digital OA were included. DATA COLLECTION AND ANALYSIS: efficacy was evaluated on pain (visual analog scale), and on function (Western Ontario and McMaster Universities OA index or Lequesne index). The magnitude of the treatment effect was evaluated by calculating Cohen's effect size (ES). Meta-analysis of ES according to flare design yes/no was performed. RESULTS: Among the 343 identified studies, 33 (20,915 patients) were included: 27 (18,667 patients) vs 6 (2248 patients) respectively in the group with vs without "flare design". Populations were comparable in each group. ESs were, for pain, -0.66 (95% confidence interval, -0.71 to -0.61), vs -0.45 (-0.54 to -0.36) in the flare design vs "no flare design" group, and for function, -0.50 (-0.55 to -0.44) vs -0.25 (-0.36 to -0.14) respectively. CONCLUSION: Our study suggests that the flare design used in clinical trials evaluating NSAIDs results in a treatment effect of higher magnitude. These results should be considered when designing a trial and/or interpreting the results of a trial.