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Posted on 01.19.01
Toxicity and Nonsteroidal Anti-inflammatory Drugs
By Amy Mudano, MPH, UAB CERTs Program Manager
Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly prescribed class of drugs for people with muscle, joint, or bone disorders, such as arthritis. Although these medications generally are considered to be safe, toxicities and serious adverse events can occur in some patients.
Complications involving the digestive tract (gastrointestinal complications) are the most common NSAID toxic effect, resulting in over 100,000 hospitalizations and 16,500 deaths each year and in total costs greater than half a billion dollars. Newer types of NSAIDs may aid in reducing these numbers, however.
The newest class of NSAIDs is the cyclo-oxygenase (COX)-2 inhibitors, such as Celebrex (celecoxib) and Vioxx (rofecoxib). These drugs are considered just as effective as traditional NSAIDs while being less toxic to the digestive tract. It is unknown, however, whether these COX-2 agents will show better long-term safety for all potential adverse events compared with traditional NSAIDs.
The University of Alabama at Birmingham's (UAB) Centers for Education and Research on Therapeutics (CERTs) of Musculoskeletal Disorders is examining how physicians monitor toxicity with NSAID use. In partnership with United HealthCare of Alabama, we have identified a group of long-term NSAID users and their prescribing physicians. We are reviewing patients' medical records, using state-of-the-art data-abstracting tools, to identify patterns of use for all NSAIDs and how physicians monitor their toxicity.
After we complete the baseline record review, we will give physicians feedback on their performance using the Achievable Benchmarks of Care (ABC) method, which was developed by UAB investigators. The ABC is a novel approach to physician feedback that not only compares the performance of doctors with established guidelines but also compares physicians with their peers.
This study will provide important information about how both traditional and newer NSAIDs are used in a regional population of patients. We also will explore differences in NSAID toxicity and in the ways physicians monitor for and treat NSAID toxicity. Our approach to changing physician behavior, which has been applied in other areas of medicine, is an effective educational tool to reduce medical errors.