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A Population Based Historical Cohort Study of the Mortality Associated with Nabumetone, Arthrotec®, Diclofenac, and Naproxen
NIGEL L. ASHWORTH, PAUL M. PELOSO, NAZEEM MUHAJARINE, and MARYROSE STANG
ABSTRACT. Methods. We performed a population based historical cohort study using linked data from several provincial health care databases. Logistic regression was used to produce estimates of the mortality associated with the study drugs unbiased by known confounders. The entire population of the province of Saskatchewan, Canada entitled to drug plan benefits in 1995 was eligible (approximately 91% of 1 million people). Participants were identified if they filled a prescription for one of the 4 study NSAID (18,424 individuals). They were then followed forward in time for 6 months to determine all cause mortality. Results. Compared to nabumetone, the adjusted odds of death for participants taking Arthrotec was 1.4 (95% confidence interval, CI: 0.9-2.1), for diclofenac+ 2.0 (1.3-3.1), and naproxen 3.0 (1.9-4.6). Conclusion. The multivariate analysis showed patients taking nabumetone and Arthrotec had significantly lower mortality than those taking other study drugs. Nabumetone had 1/3 to 1/5 the mortality associated with the diclofenac+ and naproxen groups. It appears that inherent gastroprotective strategies in the study NSAID may translate into decreased mortality at the population level. (J Rheumatol 2004;31:951-6) Key Indexing Terms:
NSAID
From the Division of Physical Medicine & Rehabilitation, University of Alberta, Edmonton, Alberta; the Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon; Saskatchewan Health, Regina, Saskatchewan, Canada; and the Departments of Internal Medicine and Rheumatology, University of Iowa Health Care, Iowa City, IA, USA. Supported by an unrestricted grant from Searle Canada and Searle USA to Dr. Peloso. N.L. Ashworth, MBChB, MSc, FRCPC, Associate Professor and Director, Division of Physical Medicine & Rehabilitation, University of Alberta; P.M. Peloso MD, MSc, Associate Professor of Internal Medicine and Staff Rheumatologist, University of Iowa Health Care; N. Muhajarine, PhD, National Health Research Scholar, Saskatchewan Population Health and Evaluation Research Unit, Associate Professor, Department of Community Health and Epidemiology, University of Saskatchewan; M.R. Stang, PhD, Saskatchewan Health. Address reprint requests to Dr. N. Ashworth, Glenrose Rehabilitation Hospital, Room 1229, 10230-111 Avenue, Edmonton, AL, T5G 0B7, Canada. E-mail: ashworth@cha.ab.ca Submitted July 2, 2003; revision accepted December 3, 2003. |