Nonaspirin Nonsteroidal Antiinflammatory Drug Use in the Nordic Countries from a Cardiovascular Risk Perspective, 2000-2016

A Drug Utilization Study

Kasper Bruun Kristensen, Øystein Karlstad, Jaana E Martikainen, Anton Pottegård, Jonas W Wastesson, Helga Zoega, Morten Schmidt

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

STUDY OBJECTIVE: Evidence on the cardiotoxicity of nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs)-particularly diclofenac and the newer selective cyclooxygenase (COX)-2 inhibitors-has accumulated over the last decade. Our objective was to examine whether the use of NSAIDs in the Nordic countries changed with the emerging evidence, regulatory statements, and clinical guidelines advocating caution for use of specific NSAIDs.

DESIGN: Drug utilization study.

DATA SOURCES: Nationwide wholesale statistics and prescription registries in Denmark, Finland, Iceland, Norway, and Sweden (2000-2016).

MEASUREMENTS AND MAIN RESULTS: Our main outcome measures were yearly total sales, expressed as number of sold defined daily doses (DDD)/1000 inhabitants/day, and yearly prevalence of prescription use, expressed as number of prescription users per 1000 inhabitants. The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. Total sales of NSAIDs increased in all countries and were highest in Iceland, with 74.3 DDDs/1000 inhabitants/day sold in 2016, followed by Finland (73.9), Sweden (54.4), Norway (43.8), and Denmark (31.8). Diclofenac use declined after 2008 in all countries but remained the most widely prescribed NSAID in Norway, with 63 prescription users/1000 inhabitants in 2016. Diclofenac sales also remained high in Iceland (12.7 DDD/1000 inhabitants/day), Norway (8.1), and Sweden (7.8). Since its introduction in 2003, the use of etoricoxib, a newer selective COX-2 inhibitor, increased in all countries except Denmark, with highest sales in Finland (6.7 DDD/1000 inhabitants/day in 2016).

CONCLUSION: Sales and prescription patterns of NSAIDs in the Nordic countries has changed along with the accumulating evidence for the cardiovascular risks of specific NSAIDs. However, given existing evidence on the cardiovascular risks associated with use of diclofenac and etoricoxib, the persistent high use of diclofenac in Iceland, Norway, and Sweden, the persistent over-the-counter availability of diclofenac in Norway and Sweden, and the increasing use of etoricoxib in most of the Nordic countries pose a cardiovascular health concern. This article is protected by copyright. All rights reserved.

Original languageEnglish
JournalPharmacotherapy
Volume39
Issue number2
Pages (from-to)150-160
ISSN0277-0008
DOIs
Publication statusPublished - 1. Feb 2019

Fingerprint

Drug Utilization
Scandinavian and Nordic Countries
etoricoxib
Diclofenac
Norway
Iceland
Prescriptions
Pharmaceutical Preparations
Denmark
Finland
Cyclooxygenase 2 Inhibitors
Dichlorodiphenyldichloroethane
Registries
Outcome Assessment (Health Care)
Guidelines
Health

Keywords

  • NSAID
  • Nordic countries
  • cardiac risk factors and prevention
  • drug utilization

Cite this

Kristensen, Kasper Bruun ; Karlstad, Øystein ; Martikainen, Jaana E ; Pottegård, Anton ; Wastesson, Jonas W ; Zoega, Helga ; Schmidt, Morten. / Nonaspirin Nonsteroidal Antiinflammatory Drug Use in the Nordic Countries from a Cardiovascular Risk Perspective, 2000-2016 : A Drug Utilization Study. In: Pharmacotherapy. 2019 ; Vol. 39, No. 2. pp. 150-160.
@article{c81338c4f07e44649bb86b0cb7460f66,
title = "Nonaspirin Nonsteroidal Antiinflammatory Drug Use in the Nordic Countries from a Cardiovascular Risk Perspective, 2000-2016: A Drug Utilization Study",
abstract = "STUDY OBJECTIVE: Evidence on the cardiotoxicity of nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs)-particularly diclofenac and the newer selective cyclooxygenase (COX)-2 inhibitors-has accumulated over the last decade. Our objective was to examine whether the use of NSAIDs in the Nordic countries changed with the emerging evidence, regulatory statements, and clinical guidelines advocating caution for use of specific NSAIDs.DESIGN: Drug utilization study.DATA SOURCES: Nationwide wholesale statistics and prescription registries in Denmark, Finland, Iceland, Norway, and Sweden (2000-2016).MEASUREMENTS AND MAIN RESULTS: Our main outcome measures were yearly total sales, expressed as number of sold defined daily doses (DDD)/1000 inhabitants/day, and yearly prevalence of prescription use, expressed as number of prescription users per 1000 inhabitants. The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. Total sales of NSAIDs increased in all countries and were highest in Iceland, with 74.3 DDDs/1000 inhabitants/day sold in 2016, followed by Finland (73.9), Sweden (54.4), Norway (43.8), and Denmark (31.8). Diclofenac use declined after 2008 in all countries but remained the most widely prescribed NSAID in Norway, with 63 prescription users/1000 inhabitants in 2016. Diclofenac sales also remained high in Iceland (12.7 DDD/1000 inhabitants/day), Norway (8.1), and Sweden (7.8). Since its introduction in 2003, the use of etoricoxib, a newer selective COX-2 inhibitor, increased in all countries except Denmark, with highest sales in Finland (6.7 DDD/1000 inhabitants/day in 2016).CONCLUSION: Sales and prescription patterns of NSAIDs in the Nordic countries has changed along with the accumulating evidence for the cardiovascular risks of specific NSAIDs. However, given existing evidence on the cardiovascular risks associated with use of diclofenac and etoricoxib, the persistent high use of diclofenac in Iceland, Norway, and Sweden, the persistent over-the-counter availability of diclofenac in Norway and Sweden, and the increasing use of etoricoxib in most of the Nordic countries pose a cardiovascular health concern. This article is protected by copyright. All rights reserved.",
keywords = "NSAID, Nordic countries, cardiac risk factors and prevention, drug utilization",
author = "Kristensen, {Kasper Bruun} and {\O}ystein Karlstad and Martikainen, {Jaana E} and Anton Potteg{\aa}rd and Wastesson, {Jonas W} and Helga Zoega and Morten Schmidt",
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Nonaspirin Nonsteroidal Antiinflammatory Drug Use in the Nordic Countries from a Cardiovascular Risk Perspective, 2000-2016 : A Drug Utilization Study. / Kristensen, Kasper Bruun; Karlstad, Øystein; Martikainen, Jaana E; Pottegård, Anton; Wastesson, Jonas W; Zoega, Helga; Schmidt, Morten.

In: Pharmacotherapy, Vol. 39, No. 2, 01.02.2019, p. 150-160.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Nonaspirin Nonsteroidal Antiinflammatory Drug Use in the Nordic Countries from a Cardiovascular Risk Perspective, 2000-2016

T2 - A Drug Utilization Study

AU - Kristensen, Kasper Bruun

AU - Karlstad, Øystein

AU - Martikainen, Jaana E

AU - Pottegård, Anton

AU - Wastesson, Jonas W

AU - Zoega, Helga

AU - Schmidt, Morten

N1 - This article is protected by copyright. All rights reserved.

PY - 2019/2/1

Y1 - 2019/2/1

N2 - STUDY OBJECTIVE: Evidence on the cardiotoxicity of nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs)-particularly diclofenac and the newer selective cyclooxygenase (COX)-2 inhibitors-has accumulated over the last decade. Our objective was to examine whether the use of NSAIDs in the Nordic countries changed with the emerging evidence, regulatory statements, and clinical guidelines advocating caution for use of specific NSAIDs.DESIGN: Drug utilization study.DATA SOURCES: Nationwide wholesale statistics and prescription registries in Denmark, Finland, Iceland, Norway, and Sweden (2000-2016).MEASUREMENTS AND MAIN RESULTS: Our main outcome measures were yearly total sales, expressed as number of sold defined daily doses (DDD)/1000 inhabitants/day, and yearly prevalence of prescription use, expressed as number of prescription users per 1000 inhabitants. The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. Total sales of NSAIDs increased in all countries and were highest in Iceland, with 74.3 DDDs/1000 inhabitants/day sold in 2016, followed by Finland (73.9), Sweden (54.4), Norway (43.8), and Denmark (31.8). Diclofenac use declined after 2008 in all countries but remained the most widely prescribed NSAID in Norway, with 63 prescription users/1000 inhabitants in 2016. Diclofenac sales also remained high in Iceland (12.7 DDD/1000 inhabitants/day), Norway (8.1), and Sweden (7.8). Since its introduction in 2003, the use of etoricoxib, a newer selective COX-2 inhibitor, increased in all countries except Denmark, with highest sales in Finland (6.7 DDD/1000 inhabitants/day in 2016).CONCLUSION: Sales and prescription patterns of NSAIDs in the Nordic countries has changed along with the accumulating evidence for the cardiovascular risks of specific NSAIDs. However, given existing evidence on the cardiovascular risks associated with use of diclofenac and etoricoxib, the persistent high use of diclofenac in Iceland, Norway, and Sweden, the persistent over-the-counter availability of diclofenac in Norway and Sweden, and the increasing use of etoricoxib in most of the Nordic countries pose a cardiovascular health concern. This article is protected by copyright. All rights reserved.

AB - STUDY OBJECTIVE: Evidence on the cardiotoxicity of nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs)-particularly diclofenac and the newer selective cyclooxygenase (COX)-2 inhibitors-has accumulated over the last decade. Our objective was to examine whether the use of NSAIDs in the Nordic countries changed with the emerging evidence, regulatory statements, and clinical guidelines advocating caution for use of specific NSAIDs.DESIGN: Drug utilization study.DATA SOURCES: Nationwide wholesale statistics and prescription registries in Denmark, Finland, Iceland, Norway, and Sweden (2000-2016).MEASUREMENTS AND MAIN RESULTS: Our main outcome measures were yearly total sales, expressed as number of sold defined daily doses (DDD)/1000 inhabitants/day, and yearly prevalence of prescription use, expressed as number of prescription users per 1000 inhabitants. The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. Total sales of NSAIDs increased in all countries and were highest in Iceland, with 74.3 DDDs/1000 inhabitants/day sold in 2016, followed by Finland (73.9), Sweden (54.4), Norway (43.8), and Denmark (31.8). Diclofenac use declined after 2008 in all countries but remained the most widely prescribed NSAID in Norway, with 63 prescription users/1000 inhabitants in 2016. Diclofenac sales also remained high in Iceland (12.7 DDD/1000 inhabitants/day), Norway (8.1), and Sweden (7.8). Since its introduction in 2003, the use of etoricoxib, a newer selective COX-2 inhibitor, increased in all countries except Denmark, with highest sales in Finland (6.7 DDD/1000 inhabitants/day in 2016).CONCLUSION: Sales and prescription patterns of NSAIDs in the Nordic countries has changed along with the accumulating evidence for the cardiovascular risks of specific NSAIDs. However, given existing evidence on the cardiovascular risks associated with use of diclofenac and etoricoxib, the persistent high use of diclofenac in Iceland, Norway, and Sweden, the persistent over-the-counter availability of diclofenac in Norway and Sweden, and the increasing use of etoricoxib in most of the Nordic countries pose a cardiovascular health concern. This article is protected by copyright. All rights reserved.

KW - NSAID

KW - Nordic countries

KW - cardiac risk factors and prevention

KW - drug utilization

U2 - 10.1002/phar.2217

DO - 10.1002/phar.2217

M3 - Journal article

VL - 39

SP - 150

EP - 160

JO - Pharmacotherapy

JF - Pharmacotherapy

SN - 0277-0008

IS - 2

ER -