COX-2-Specific Inhibitors Associated with Longer Duration of Use Than Nonspecific Nonsteroidal Anti-Inflammatory Drugs

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COX-2-Specific Inhibitors Associated with Longer Duration of Use Than

Nonspecific Nonsteroidal Anti-Inflammatory Drugs

Journal of Rheumatology

02/20/2004

By Beth Nierengarten

The duration of use for COX-2-specific inhibitors, particularly celecoxib,

is longer than it is for nonspecific nonsteroidal anti-inflammatory drugs

(NS NSAID), reports a study from the United States.

Because of the chronic nature of rheumatic disorders and the need for

patients to stay on long-term therapy, treatment discontinuation can be a

problem and may imply inadequate efficacy and/or unacceptable toxicity. A

possible measurement of efficacy and tolerability of treatment therefore may

be time to discontinuation.

To examine the survival time of modern drugs, including the COX-2-specific

inhibitors, their overall acceptability compared to the NS NSAIDs, and the

effects of different diseases on duration of use, Frederick Wolfe, MD,

Arthritis Research Center Foundation, Wichita, Kansas, and colleagues

followed 3,639 patients with rheumatoid arthritis (RA), osteoarthritis, and

fibromyalgia who were initiating treatment with COX-2-specific inhibitors

(celecoxib or rofecoxib) or NS NSAIDs (naproxen or ibuprofen). Evaluation at

6-month intervals for up to 2.5 years included time to treatment

discontinuation, discontinuation rates, and effect of covariates based on

the Weibull parametric survival analyses (controlling for demographic

factors and disease severity).

A shorter median duration of use was found for patients treated with the NS

NSAIDs (10 months for each agent) compared to celecoxib (15 months) and

rofecoxib (13 months). Based on Weibull analyses (adjusted for demographic

and disease severity factors), duration of use was significantly longer for

the COX-2-specific inhibitors than for the NS NSAIDs, and celecoxib had

significantly longer survival time than rofecoxib (P = .005).

Strong predictors of early discontinuation were older age, high school

education, and a diagnosis of an ulcer, whereas predictors of longer

duration of treatment was linked to younger age, being male, and having RA.

Disease severity was not associated with survival times.

These data that show longer duration of use with the COX-2-specific

inhibitors compared to the NS NSAIDs may have important implications,

according to the authors, who conclude that " duration of use can be an

indicator of treatment effectiveness and/or drug acceptability, and provides

additional interpretation beyond the results of clinical trials.

J Rheumatol 2004 Feb;31:2:355-8.