Journal of Preventive Medicine and Public Health

The Korean Society for Preventive Medicine (대한예방의학회)
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Nonsteroidal Anti-inflammatory Drugs Utilization Patterns among the Elderly with Osteoarthritis at Primary Ambulatory Care Units in Busan Metropolitan City, Korea

부산지역 의원급 외래 노인 골관절염환자의 비스테로이드소염제 사용양상평가

  • 최남경 (서울대학교 의과대학 예방의학교실) ;
  • 김윤이 (서울대학교 의과대학 예방의학교실) ;
  • 이승미 (서울대학교 의과대학 예방의학교실) ;
  • 박병주 (서울대학교 의과대학 예방의학교실)
  • Published : 2004.06.01
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Abstract

Objectives : To investigate the utilization patterns of non-steroidal anti-inflammatory drugs (NSAIDs) among the elderly with osteoarthritis (OA) undergoing primary ambulatory care in Busan metropolitan city, Korea. Methods : OA patients, aged 65 years and over, were identified from the Korean National Health Insurance Review Agency drug prescription database. The subjects had at least one episode of claim for OA (ICD-10-CM: M15-M19) between August 1, 2000 and February 28, 2002. Trends in the determinations of NSAIDs utilization were identified using chi-squared tests for trend. Results : There were 47,711 osteoarthritic patients. The total number of visits by these patients was 177,443, with a total frequency for NSAID prescriptions of 214,952. Seventy-nine percent of the OA patients were female. NSAIDs were prescribed on 133,284 visits (75.1%) and the proportion of prescriptions was significantly increased with age. Only the proportion of visit when NSAIDs were prescribed decreased, from 65.1 to 43.5%, during the study period (p<0.001). However, the proportion of combined treatments with anti-ulcer drugs was increased. The use of NSAIDs injections was decreased. Of the individual NSAIDs, diclofenac (28.7% of total frequency of NSAID prescriptions), piroxicam (15.0%) and talniflumate (8.7%), were the most frequently prescribed. Among the NSAIDs prescribed OA visits, 45.7% used two or more NSAIDs. Conclusion : The total proportion of NSAIDs prescribed to the osteoarthritic patients was higher than in other studies. The decline in the use of NSAIDs during the study period, and the frequent selection of safer medications, such as combination therapy with anti-ulcer drug, may reflect the risk awareness of the use of NSAIDs.

Keywords

References

  1. 통계청. 1999년 장래 인구 추계. 2001
  2. Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, Christy W,Cooke TD, Greenwald R, Hochberg M.Development of criteria for the classification and reporting of osteoarthritis : classification of osteoarthritis of the knee. Arthritis Rheum 1986; 29(8): 1039-1049 https://doi.org/10.1002/art.1780290816
  3. 오정열, 조경환. 노인환자케서의 골관절염. 가정의학회지 1998; 19(11): 1129 -1135
  4. 정수태, 강봉균. 골판절염의 원인과 치료. 가정의학회지 2000; 21(11): S824-S827
  5. Lee CK. Osteoarthritis. Korean J Med 2000; 59(2):246-249 (Korean)
  6. Brandt KD. Management of osteoarthritis, In : Kelly WN, Ruddy S, Harris ED, Sledge CB. Textbook of rheumatology, 5th ed. p.1394 , philadepmι W.B. Saun ders,1997
  7. Silverstein FE, Faich G, Goldstein JL, Simon LS, Pincus T,Whelton A, Makuch R, Eisen G, Agrawal NM, Stenson WF, Burr AM, Zhao WW, Kent JD, Lefkowith JB, Verburg KM, Geis GS. Gastrointestional toxicity with celecoxib vs nonsterio dal anti-inflammatory drugs for oste oarthritis and rheumatoid arthritis: the ClASS study: A ramdomized controlled trial. Celecoxib Long-term Arthritis Safety Study. JAMA 2000; 284(10); 1247-1255
  8. Goldstein JL, Silverstein FE, Agrawal NM, Hubbard RC, Kaiser J, Maurath CJ, Verburg KM, Geis GS. Reduced risk of upper gastrointestional ulcer complications with celecoxib, a novel COX-2 inhibitor. Am J Gastroenterol 2000; 95(7): 1681-1690 https://doi.org/10.1111/j.1572-0241.2000.02194.x
  9. Traversa G, Walker AM, Ippolito FM, Caffari B, Capurso L, Dezi A, Koch M, Maggini M, Alegiani SS, Raschetti R. Gastroduodenal toxicity of different non steroidal antiinflammatory drugs. Epidemiology 1995; 6(1): 49-54 https://doi.org/10.1097/00001648-199501000-00010
  10. 통계청. 한국표준질병사인분류. 1993
  11. Goodman, Gilman. Goodman & Gilman's the pharmacological basis of therapeutics 9th ed., pp621
  12. Ausiello JC, Stafford RS. Trend in medication use for osteoartjrotos treatment. J Rheumatol 2002; 29(5): 999-1005
  13. Bradley JD, Brandt KD, Katz BP, Kalasinski LA, Ryan SI. Comparison of an antii-inflamrnatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. NEJM 1991; 325(2): 87-91 https://doi.org/10.1056/NEJM199107113250203
  14. Brandt KD. Should osteoarthritis be treated with nonsteroidal anti-inflammatory drugs? Rheum Dis Clin North Am. 1993; 19(3): 697-712
  15. Brandt KD, Bradley JD. Should the initial drug be used to treat osteoarthritis pain be a nonsteroidal anti-inflammatory drug? J Rheumatol. 2001; 28(3): 467 -473
  16. Hochberg MC, Altman RD, Brandt KD, Clark BM, Dieppe PA, Griffin MR, Moskowitz RW, Schnitzer TJ. Guidelines for the medical management of osteoar thritis: I. Osteoarthritis of the hip. Arth ritis Rheum 1995; 38(11): 1535-1540 https://doi.org/10.1002/art.1780381103
  17. Hochberg MC, Altman RD, Brandt KD, Clark BM, Dieppe PA, Griffin MR, Moskowitz RW, Schnitzer TJ. Guidelines for the medical management of osteoarthritis: $\Pi$. Osteoarthritis of the knee. Arthritis Rheum 1995; 38(11): 1541-1546 https://doi.org/10.1002/art.1780381104
  18. Cho HJ, Woo SK, Honh CT, Seo YK. Comparison of prescription behaviors between practicing physicians and pharmacists by simulated patients of arthritis. J Korean Acad Fam Med 2001; 22(4) 511-516 (Korean)
  19. Ward K, Weir DG. Piroxicam and upper gastrointestinal haemorrhage. Ir Med J. 1982; 75(1): 10-11
  20. Giercksky KE. Piroxicam and gastrointestinal bleeding. Am J Med. 1986; 81 (5B): 2-5
  21. Lipscomb GR, Wallis N, Armstrong G, Rees WD. Gastrointestinal tolerability of meloxicam and piroxicam: a double-blind placebo-controlled study. Br J Clin Phar macol. 1998;46(2): 133-137 https://doi.org/10.1046/j.1365-2125.1998.00761.x
  22. Fries JF, Williams CA, Bloch DA. The ralative toxicity of nonsteroidal antiinflammatory drugs. Arthritis Rheum 1991; 34(11): 1353-1360 https://doi.org/10.1002/art.1780341103
  23. 이상현 관절염 약물 선택지침: 골관절염과 류마티스 관절영을 중심으로 가정의학회지 1998; 19(5) :S240-S251
  24. Needleman P, Isakson PC. Selective inhibition of cylooxygenase 2. Scihed & Med. 1998;Jan/Feb: 26-35
  25. Mukherjee D, Nissem SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors. JAMA 2001; 286(8): 954-959 https://doi.org/10.1001/jama.286.8.954
  26. IMS Health. National disease and therapeutics index, Disease report, Forth quarter 2000, p.1538. Plymonth Meeting. PA:IMS HEALTH2001
  27. 한석원, 윤종구. 위십이지장 궤양의 원인 및 병태생리-NSAIDs 및 기타 원인-. 대 한소화기내시경학회세미나 1998
  28. Manek NJ. Medical Management of Osteoarthritis. Mayo Clin Proc 2001; 76(5): 533-539 https://doi.org/10.4065/76.5.533
  29. Johnson AG, Seidemann P, Day RO. NSAID-related adverse drug interactions with clinical relevance. Int J Clin Pharmacol Ther. 1994; 32(10): 509-532
  30. Wallance JL. Prostaglandins, NSAIDs and cytoprotection. Gastroenterol Clin North Am 1992; 21(3): 631
  31. 박병주, 성주헌, 박기동, 서순원, 김세화. 건강보험 질병코드의 타당도 제공방안 및 자료의 활용방안 수립. 2002년 용역과 제결과보고서 2003