Article date: November 2009
By: Benedict W. Wheeler, Chris Metcalfe, David Gunnell, Peter Stephens, Richard M. Martin, in Volume 68, Issue 5, pages 752-764
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT
AIMS
To investigate impacts of withdrawal and regulatory advice regarding cyclooxygenase‐2 (COX‐2) inhibitors on UK population rates of gastrointestinal haemorrhage and acute myocardial infarction (MI).
METHODS
Ecological time series study of prescribing, mortality and hospital admission trends in people aged ≥55 years.
RESULTS
Withdrawal and regulatory advice limiting COX‐2 inhibitor availability from 2004 were temporally associated with reversal of previously unfavourable trends in emergency MI admissions among people aged ≥65 years. Annual admission rate trends changed from +4.6% to −3.1% (P < 0.001) among women and from +2.1% to −3.8% (P= 0.003) among men. Absolute changes in average annual trend in the number of individuals aged ≥65 years admitted following MI were from +981 (1999–2004) to −819 (2004–2006) per year for women and from +713 to −995 for men. No change in trend was apparent among people aged 55–64 years, or in MI mortality trends. There was some suggestion of an unfavourable change in admission trends for gastrointestinal haemorrhage among 55−64‐year‐olds, although this appeared to occur prior to COX‐2 inhibitor withdrawal/regulation by up to 2 years. These trends were not apparent in older people, or in gastrointestinal haemorrhage mortality rates.
CONCLUSIONS
Withdrawal/regulation of COX‐2 inhibitors was temporally associated with a favourable reversal of population‐level hospital admission trends in MI among people aged ≥65 years. Unfavourable reversal of previous declines in gastrointestinal haemorrhage admissions probably occurred before changes in COX‐2 inhibitor availability. Withdrawal/ regulation of COX‐2 inhibitors did not appear to have any adverse impact on population health and may have been beneficial.
DOI: 10.1111/j.1365-2125.2009.03500.x
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