Satisfaction and Preferences for NSAIDs and COX-2 Specific Inhibitors among Patients with Rheumatoid Arthritis

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Satisfaction and Preferences for NSAIDs and COX-2 Specific Inhibitors among

Patients with Rheumatoid Arthritis

Category:  17 RA‹treatment

Frederick Wolfe1, Kaleb Michaud2, Z Zhao3, A Burke3, Dan

Pettitt4

1National Data Bank for Rheumatic Diseases, Wichita, KS;2National Data Bank

for Rheumatic Disease, Wichita, KS;3Pharmacia, Inc., Peapack, NJ;4Pfizer,

Inc., New York, NY

Presentation Number: 373

Poster Board Number: 373

Keywords: NSAID, COX-2, Rheumatoid Arthritis

Background. Randomized trials usually find that NSAIDs and COX-2 specific

inhibitors are superior to placebo in terms of efficacy, and generally

equivalent to each other. In clinical practice, however, patients may have

preferences based on impressions of effectiveness, side effects, costs, or

other reasons. With the advent of COX-2 specific inhibitors, issues of

comparative effectiveness have arisen. In the current study, we evaluated

patient preferences with treatment in a large cohort of RA patients

participating in a long term outcome study.

Methods. In 2002, 2,450 RA patients were surveyed regarding NSAID use and

effectiveness. Patients were grouped by their current NSAID: celecoxib

(N=779), rofecoxib (415), naproxen (262), ibuprofen (212), aspirin (161) and

others (622). Preferences were assessed on 5 point scales that ranged from

very satisfied to very dissatisfied. For analysis, scales were further

dichotomized into satisfied and not satisfied (1/0).

Results. In all analyses, no differences were found among any of the NS

NSAIDs. We therefore combined naproxen, ibuprofen, aspirin, and other NS

NSAIDs into a single variable, called NS_NSAID. Overall rates of

satisfaction considering effectiveness, side effects, and side effects and

effectiveness were 77.9%, 81.7% and 78.1%, respectively. In addition, 71.5%

would continue their current NSAID even if they had the option to switch.

Logistic regression, adjusted for age and sex, was used to test whether

satisfaction with treatment differed among the drugs. Compared with

celecoxib, rofecoxib and NS_NSAID, respectively, were not significantly

different in effectiveness satisfaction (odds ratio 0.82 (95% 0.61, 1.10)

and OR 0.86 (0.69, 1.08) or overall satisfaction (OR 0.91 (0.68, 1.22) and

OR 0.92 (0.74, 1.14)). However, when side effects were considered, rofecoxib

and NS_NSAID were both less satisfactory than celecoxib: OR 0.60 (0.44,

0.81) and OR 0.72 (0.56, 0.92). Rofecoxib and NS_NSAID did not differ for

any of these 3 analyses. We then performed the same analyses but also tested

whether high doses or low doses of the various NSAIDs contributed to

satisfaction results. Dose was not significantly associated with

satisfaction in any analysis. We also asked patients, ³Given the option to

take any other NSAID medication available, would you like to continue to

take your current medication?² Compared with celecoxib, patients were not as

likely to want to continue their rofecoxib OR 0.75 (0.58, 0.98) or NS_NSAID

OR 0.80 (0.65, 0.98).

Conclusions. RA patients are generally satisfied with their NSAIDs, and more

than 2/3 would continue on it if they had the option to switch. Although

drug ratings were similar for the groups, patients were more satisfied with

celecoxib when considering side effects, and more would continue taking

celecoxib than either rofecoxib or NS_NSAID.