J Korean Med Sci.  2022 May;37(18):e148. 10.3346/jkms.2022.37.e148.

COX-2 Inhibitor Use as an Early Treatment Option for Knee Osteoarthritis Patients in Korea: A Population-Based Cross-Sectional Study

• Cho SK
• Choi S
• Kim H
• Song YJ
• Jung SY
• Jang EJ
• Sung YK

• KMID: 2529714
• DOI: http://doi.org/10.3346/jkms.2022.37.e148

Abstract

Background
To investigate the use of cyclooxygenase-2 (COX-2) inhibitors as an initial drug treatment for knee osteoarthritis (OA) patients.
Methods
From 2013 to 2015, patients with knee OA were identified from the Korean nationwide claims database. Among them, we extracted incident cases of knee OA to identify the initial drug treatment. Trends in the use of non-steroid anti-inflammatory drugs (NSAIDs) including COX-2 inhibitors were analyzed during the first year after their diagnosis. Associated factors for COX-2 inhibitor use were examined using a multivariate logistic regression model.
Results
We identified 2,857,999 incident knee OA patients (955,259 in 2013, 981,314 in 2014, and 921,426 in 2015). The mean ± standard deviation age of patients was 64.2 ± 9.8 years. The frequency of COX-2 inhibitor use as initial treatment increased from 3.5% in 2013 to 7.2% in 2015 (P < 0.01). In patients taking the medication regularly for one year after diagnosis (medication possession ratio ≥ 50%), COX-2 inhibitor use also rapidly increased from 5.5% in 2013 to 11.1% in 2015 (P < 0.01). However, the frequencies of non-selective NSAID and analgesic use did not decrease remarkably. Factors associated with patients using COX-2 inhibitors on initial drug treatment were older age (odds ratio [OR], 1.08), female (OR, 1.24), and comorbidity (OR, 1.03). Type of institution, physician speciality, and insurance type of patients were also associated.
Conclusion
In Korea, COX-2 inhibitors have rapidly increased as an initial treatment for knee OA patients, but it has not appeared to reduce the use of non-selective NSAIDs and analgesics.

Keyword

Osteoarthritis; Knee; Medical Management; COX Inhibitor; Nonsteroidal; Anti-inflammatory Drugs

Figure

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  Fig. 1 Patients’ selection flow.OA = osteoarthritis.

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  Fig. 2 Trend of initial treatment for knee osteoarthritis between 2013 and 2015.nsNSAID = non-selective non-steroidal anti-inflammatory drug, SYSADOA = symptomatic slow-acting drug in osteoarthritis, COX = cyclooxygenase.

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