Farrokh Alemi, Ph.D.. Compare effectiveness Low dose rofecoxib (Vioxx) High dose rofecoxib...
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Transcript of Farrokh Alemi, Ph.D.. Compare effectiveness Low dose rofecoxib (Vioxx) High dose rofecoxib...
Farrokh Alemi, Ph.D.
Compare effectiveness Low dose rofecoxib (Vioxx) High dose rofecoxib (Vioxx) Celecoxib Other medication
Data from Kaiser Permanente in California
All patients age 18–84 yearsTreated with the medication From Jan 1, 1999, to Dec 31, 20012,302,029 person-years of follow-up
8,143 cases of serious coronary heart disease
2,210 or 27% fatal.
Study group 18 to 84 years old At least one prescription At least 12 months of health plan
membership No diagnosis of other serious diseases
Nested Control Group Intervention group of high or low dose
rofecoxib Matched control of patients on celecoxib
1. Acute MI Code 410 (acute myocardial infarction) Code 411·1 (intermediate coronary
syndrome)▪ Raised creatine kinase MB fraction or troponin I
2. Sudden cardiac death From hypertensive heart disease, ischaemic
heart disease, conduction disorders, dysrhythmias, heart failure, atherosclerotic heart disease, sudden death
From an unknown cause
From ICD-9-CM claims data Cardiovascular admissions Emergency room visits for cardiovascular reasons Outpatient diagnoses for tobacco use Non-cardiovascular admissions and emergency
room visits Same-day admissions for medical procedures Outpatient diagnoses of alcohol dependence Rheumatoid arthritis
From prescription data Cardiovascular prescription drug use Hormone replacement therapy Oral prednisone Antirheumatic drugs
Logistic regression10 category score
12 fold increase in risk
Rofecoxib vs celecoxib exposed cases Older More likely to be women More likely to be treated by a rheumatologist More likely to have used:▪ anticoagulants▪ oral prednisone
Lower cardiovascular risk scores compared to patients treated with celecoxib
Conclusions