Prescribing pattern of drugs in the treatment of osteoarthritis in Italian general practice: The effect of rofecoxib withdrawal

Objective. In October 2004, rofecoxib was removed from the world market because of an increased risk of myocardial infarction. The aim of the present study was to compare the trend of nonsteroidal antiinflammatory drug (NSAID) use and other analgesics in osteoarthritis (OA) treatment before and after rofecoxib withdrawal in Italian general practice. Methods. From the Caserta-1 Local Health Service database, 97 general practitioners were recruited. Prevalence and incidence of use of any study drug were calculated within 1 year before and after rofecoxib withdrawal. Results. One-year prevalence of nonselective and preferential NSAID use did not change after rofecoxib withdrawal, whereas coxib use fell from 4.4% (95% confidence interval [95% CI] 4.2-4.5%) in the period before rofecoxib withdrawal (period I) to 1.6% (95% CI 1.5-1.7%) in the period after withdrawal (period II). Weak opioids were used in no more than 0.4% (95% CI 0.3-0.5%) in period II, after their introduction to reimbursement in December 2004. Also, 1-year incidence of coxib decreased from 31.3 per 1,000 (95% CI 30.2-32.4%) in period I to 8.7 per 1,000 (95% CI 8.1-9.2%) in period II. The disappearance of rofecoxib was associated with replacement drugs such as newly marketed dexibuprofen and aceclofenac, whereas nimesulide use coincidentally decreased. Conclusion. Rofecoxib withdrawal has markedly changed the prescribing pattern of drugs that are used in OA-related pain treatment, with a striking decrease of coxib use in Italian general practice. Education strategies addressed to health professionals should be planned to improve the management of pain treatment, particularly in degenerative joint diseases.