Findings reported in a study published today in the Archives of Internal Medicine
found that over half of patients within a predominantly retiree population taking COX-2 anti-inflammatory drugs on a long-term basis were also taking aspirin therapy for its cardio-protective benefit.
Previously published clinical research has shown that using aspirin along with COX-2 therapies can negate the gastrointestinal (GI) benefit of using COX-2’s, one of the primary reasons for using these more costly medications.
Researchers at pharmacy benefit manager Express Scripts examined aspirin and other over-the-counter pain reliever use among COX-2 users from a large employer group. In addition to the high rate of aspirin use, half of the aspirin users were taking daily doses of 325mg or more, which is considered higher than necessary for the primary prevention of cardiovascular disease and stroke. Aspirin use has been shown to significantly increase the risk of bleeding in the GI tract, even at low doses, and guidelines state that patients who require aspirin therapy for cardio-protection should use the lowest dose possible.
“These findings have important implications for patient safety and cost,” said Emily Cox, PhD, lead author of the study. “For patients needing both cardio-protective and anti-inflammatory therapy, the GI protective effects of a COX-2 agent are lost by taking aspirin and don't justify their higher expense. Patients should ask their physician about changing to another equally effective lower cost non-steroidal anti-inflammatory drug (NSAID) instead of a COX-2 agent.”
In patients at high risk for gastric irritation (those over age 65 or with other risk factors), physicians should consider adding therapies such as a generic proton pump inhibitor (PPI) to protect against stomach irritation rather than a COX-2.
"After the decision to use NSAID therapy to treat pain, it is important for physicians to determine which NSAID is most cost-effective and safe for the patient. Balancing the patients’ need for the right combination of therapies that provide adequate cardiovascular and GI protection is a complex issue, but one that must be addressed in order to provide high quality, cost-effective healthcare,” Cox added.
For more than a decade, Express Scripts has employed a company-paid research staff, which now numbers fifteen professionals, representing the fields of pharmacy, economics, health services research and epidemiology. Many of the studies they conduct are published in peer-reviewed journals, reported in the national media and presented at scientific or professional conferences, including the annual Express Scripts Outcomes Conference held for clients. First published in 1996, the annual Express Scripts Drug Trend Report quickly earned national recognition as the most comprehensive, publicly available analysis of U.S. drug-cost trends. Express Scripts also conducted the first national study of regional variation in prescription-drug utilization patterns across the United States.
More information about these and other studies are available at http://www.express-scripts.com/other/news_views/outcomes_research.htm.