Management pattern for patients with osteoarthritis treated with traditional non-steroidal anti-inflammatory drugs in Spain prior to introduction of Coxibs.

OBJECTIVE: To investigate the use of traditional non-steroidal anti-inflammatory drugs (tNSAIDs) in the management of osteoarthritis (OA) in primary care in Spain and to quantify patient and physician satisfaction with tNSAID therapy. METHODS: A 6-month retrospective, observational study conducted in 29 Spanish primary-care centres shortly before the first introduction of selective COX-2 inhibitors (Coxibs). RESULTS: A total of 897 patients with a mean age 66 +/- 9 years and radiologically documented OA were included: most (76%) were women. Three-quarters of the patients had primary generalised OA, with the knees (> 60% of cases) and lumbar spine (> 50% of cases) being the sites most commonly affected. Pain was an almost universal feature of the clinical presentation. More than 96% of patients had been prescribed tNSAIDs during the observation period, predominantly for pain relief. The most commonly prescribed agents were diclofenac, aceclofenac and piroxicam. Twenty-six per cent of discontinuations of tNSAIDs during the observation period were due to limited effectiveness of these drugs, making this the largest single cause of discontinuation apart from prescription expiry. Almost half of patients and physicians (46% in both categories) were not satisfied with OA treatment and only one patient in six regarded their overall health status during tNSAID therapy as satisfactory. Gastroprotective medications (GPMs) were prescribed for just over half the participating patients (51%), but use of these drugs appeared haphazard: 25% of those who received GPMs had no compelling indications for this therapy whereas more than half of the patients at high risk for gastrointestinal complications on the basis of clinical criteria were not receiving GPMs. CONCLUSIONS: There is a high level of dissatisfaction with tNSAID therapy of OA, arising in large part from a perception among many patients and physicians that these drugs are not always adequately effective in relieving the symptoms of this disease. These findings, together with the low patient perceptions of general health, indicate the need for new therapeutic approaches to OA.

Experience of rofecoxib in patients with osteoarthritis previously treated with traditional non-steroidal anti-inflammatory drugs in Spain: results of phase 2 of the VICOXX study.

OBJECTIVES: To compare patient and physician attitudes to osteoarthritis (OA) treatment with rofecoxib or traditional non-steroidal anti-inflammatory drugs (tNSAIDs). METHODS: A 6-month prospective study involving 562 OA patients enrolled at 29 Spanish primary-care centres. Patients were continued on established tNSAID therapy for the first 3 months then switched to rofecoxib 12.5 or 25 mg/day. RESULTS: Both patients and physicians were significantly more likely to be satisfied with rofecoxib treatment than with tNSAIDs (p < 0.001) and assessments of overall health status improved significantly during rofecoxib therapy (p < 0.001). Adherence to therapy was significantly better with rofecoxib than during tNSAID treatment (p < 0.001). Use of rofecoxib was associated with a significant reduction in the proportion of discontinuations attributed to lack of effectiveness (p < 0.001) or gastrointestinal (GI) adverse events (p < 0.001 compared with tNSAIDs). Rofecoxib was also associated with a > 60% reduction in the proportion of patients experiencing a GI adverse event and a halving in the proportion of patients who received GI co-medications; concomitant analgesic use decreased by one-third during rofecoxib therapy. CONCLUSIONS: Use of rofecoxib was associated with marked improvements in several indices of treatment effectiveness and tolerability, and in patient and physician satisfaction and perception of general health status compared with tNSAIDs. Rofecoxib is a valuable additional medication for relieving the symptoms of OA and its use in place of tNSAIDs may lead to a reduction in the prescription of concomitant medications.