All-cause mortality of elderly Australian veterans using COX-2 selective or non-selective NSAIDs: a longitudinal study.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: • Previous studies have found varying impact of exposure to COX-2 selective and non-selective NSAIDs. WHAT THIS STUDY ADDS: • Individuals receiving a COX-2 selective NSAID had an increased risk of all-cause mortality after correction for age, sex and cardiovascular risk as measured by co-prescription. • Despite differences in the pharmacokinetic properties of the COX-2 selective inhibitor drugs, our study lends no support to clinicians preferring any one COX-2 selective inhibitor drug, or substituting one for another on the grounds of mortality risk alone. • The Australian Department of Veterans' Affairs data sets make it possible to conduct timely record linkage studies of all-cause mortality from use of medicines in a large and clinically relevant population. AIM: To determine hazard ratios for all-cause mortality in elderly Australian veterans taking COX-2 selective and non-selective NSAIDs. METHODS: Patient cohorts were constructed from claims databases (1997 to 2007) for veterans and dependants with full treatment entitlement irrespective of military service. Patients were grouped by initial exposure: celecoxib, rofecoxib, meloxicam, diclofenac, non-selective NSAID. A reference group was constructed of patients receiving glaucoma/hypothyroid medications and none of the study medications. Univariate and multivariate analyses were performed using Cox proportional hazards regression models. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated for each exposure group against each of the reference group. The final model was adjusted for age, gender and co-prescription as a surrogate for cardiovascular risk. Patients were censored if the gap in supply of study prescription exceeded 30 days or if another study medication was initiated. The outcome measure in all analyses was death. RESULTS: Hazard ratios and 95% CIs, adjusted for age, gender and cardiovascular risk, for each group relative to the reference group were: celecoxib 1.39 (1.25, 1.55), diclofenac 1.44 (1.28, 1.62), meloxicam 1.49 (1.25, 1.78), rofecoxib 1.58 (1.39, 1.79), non-selective NSAIDs 1.76 (1.59, 1.94). CONCLUSIONS: In this large cohort of Australian veterans exposed to COX-2 selective and non-selective NSAIDs, there was a significant increased mortality risk for those exposed to either COX-2-selective or non-selective NSAIDs relative to those exposed to unrelated (glaucoma/hypothyroid) medications.

Development and validation of a pharmacy migraine questionnaire to assess suitability for treatment with a triptan.

A questionnaire (Migraine Questionnaire; MQ) was developed to help pharmacists identify consumers with migraine suitable for non-prescription treatment with a triptan. Adults, who knew or thought that they had migraine, participated in three, sequential, community-based studies to validate the MQ. Overall, 1,353 subjects completed independent assessments with a pharmacist and a clinician (reference standard). The accuracy of the pharmacist assessment of suitability for a triptan was compared with the clinician assessment. Clinicians using their standard practice determined that triptan therapy was suitable in 76.8% of cases compared with 48.8% for pharmacists using the MQ. The lack of concordance between pharmacists and clinicians in the false-positive cases (n = 113 of 660 subjects considered suitable for triptan by the pharmacists) usually related to headache diagnosis (57.5%), not safety aspects. The MQ is an effective tool for pharmacists to guide appropriate recommendation of a non-prescription triptan for migraine.

Substance abuse and other comorbidities--management in Australian general practice.

INTRODUCTION: Comorbidity of substance abuse with chronic conditions may have a synergistic impact on patients' health. Recognition of this may improve patient care. METHODS: Associations between substance abuse and three common morbidities from de-identified data from a sample of the electronic records of approximately 360 general practitioners were analysed using one proprietary software. Where 'reason for visit' or 'problem managed' was associated with substance use, multiple logistic regression models tested associations. RESULTS: Significant comorbid associations were found for previous smoking with cardiovascular morbidity and respiratory problems. Current smoking and alcohol abuse were nearly three times as common among patients with chronic obstructive pulmonary disease. Prescription drug abuse and illicit drug use demonstrated significant associations with chronic back pain. Current smoking was less common among patients with hypertension and lipid disorder. DISCUSSION: The well known causes of substance abuse and common chronic conditions may be more than compensated by their prevention among those with cardiovascular disease. However, other substance abuse comorbidity occurs and may be preventable.