รูปแบบการสั่งจ่ายยาต้านอักเสบที่ไม่ใช่สเตียรอยด์ในผุ้ป่วยโรคข้อเสื่อม

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) has been generally used as a specific treatment for the patients with osteoarthritis, particularly in the elderly people who are often at risk of adverse reactions from using NSAIDs. In Thailand, it has less information about NSAIDs that used in osteoarthritis case especially patients with cardiovascular risk. This study aims to examine the prescribing patterns and proportion of NSAIDs usage in osteoarthritis patients with or without cardiovascular risk. In addition, the factors affecting doctor's decision in choosing types of NSAIDs by cross-sectional study was investigated. The data was collected retrospectively from the osteoarthritis patients' medical records at Veteran general hospital since 1 July 2560 until 30 December 2560. The questionnaires were distributed to 42 orthopedic physicians of Veteran general hospital and Phramongkutklao hospital to collect the data of physicians' decision in selecting the types of NSAIDs for prescribing. There were 1,550 osteoarthritis patients, 67.4% were female (64.3 ± 10.8 years old) with 90% of knee osteoarthritis. Overall, 64.5% of patients were prescribed NSAIDs with 84.1% of these were prescribed selective COX-2 inhibitors. Of the 213 patients with cardiovascular risks, 66.2% treated with NSAIDs and 82.3% of these were selective COX-2 inhibitor. According to non-selective NSAIDs, diclofenac is most prescribing drug (7%) whereas Naproxen was prescribed with 1.1%. Overall of NSAIDs prescribing, celecoxib and etoricoxib were most commonly prescribed drugs with 36.3% and 31.8%, respectively. It was found inappropriate over dosing in 95% and 34.2% of etoricoxib and celecoxib prescriptions. Of 1,550 osteoarthritis, patients with cardiovascular and gastrointestinal risks were 13.5% (210 cases). Of these, 82.3% (116 cases) were prescribed with selective COX-2 inhibitors, 25 of cases were non- selective NSAIDs and only 1 case was prescribed with naproxen. In patients without gastrointestinal risks, 83.8% received gastro-protective agents from NSAIDs, which 69.7% were selective COX-2 inhibitors. The physicians gave the key potential factors for considering in NSIADS prescribing were the efficiency of NSAIDs using, age and medical welfare of patients. In summary, sixty-four percent of osteoarthritis patients were treated with NSAIDs with four-fifth were selective COX-2 inhibitors. Selective COX-2 inhibitors were over prescribed to the patients without gastrointestinal risk from NSAIDs. Two- third of patients with cardiovascular risk received NSAIDs.