Use of Non-Steroidal Anti-Inflammatory Drugs That Elevate Cardiovascular Risk: An Examination of Sales and Essential Medicines Lists in Low-, Middle-, and High-Income Countries
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{"title"=>"Use of Non-Steroidal Anti-Inflammatory Drugs That Elevate Cardiovascular Risk: An Examination of Sales and Essential Medicines Lists in Low-, Middle-, and High-Income Countries", "type"=>"journal", "authors"=>[{"first_name"=>"Patricia", "last_name"=>"McGettigan", "scopus_author_id"=>"6603713381"}, {"first_name"=>"David", "last_name"=>"Henry", "scopus_author_id"=>"36012659800"}], "year"=>2013, "source"=>"PLoS Medicine", "identifiers"=>{"scopus"=>"2-s2.0-84874489375", "sgr"=>"84874489375", "issn"=>"15491277", "doi"=>"10.1371/journal.pmed.1001388", "pmid"=>"23424288", "isbn"=>"1549-1676", "pui"=>"368439115"}, "id"=>"15004081-5b5b-31c6-b192-8ad8f6cb00fc", "abstract"=>"BACKGROUND Certain non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., rofecoxib [Vioxx]) increase the risk of heart attack and stroke and should be avoided in patients at high risk of cardiovascular events. Rates of cardiovascular disease are high and rising in many low- and middle-income countries. We studied the extent to which evidence on cardiovascular risk with NSAIDs has translated into guidance and sales in 15 countries. METHODS AND FINDINGS Data on the relative risk (RR) of cardiovascular events with individual NSAIDs were derived from meta-analyses of randomised trials and controlled observational studies. Listing of individual NSAIDs on Essential Medicines Lists (EMLs) was obtained from the World Health Organization. NSAID sales or prescription data for 15 low-, middle-, and high-income countries were obtained from Intercontinental Medical Statistics Health (IMS Health) or national prescription pricing audit (in the case of England and Canada). Three drugs (rofecoxib, diclofenac, etoricoxib) ranked consistently highest in terms of cardiovascular risk compared with nonuse. Naproxen was associated with a low risk. Diclofenac was listed on 74 national EMLs, naproxen on just 27. Rofecoxib use was not documented in any country. Diclofenac and etoricoxib accounted for one-third of total NSAID usage across the 15 countries (median 33.2%, range 14.7-58.7%). This proportion did not vary between low- and high-income countries. Diclofenac was by far the most commonly used NSAID, with a market share close to that of the next three most popular drugs combined. Naproxen had an average market share of less than 10%. CONCLUSIONS Listing of NSAIDs on national EMLs should take account of cardiovascular risk, with preference given to low risk drugs. Diclofenac has a risk very similar to rofecoxib, which was withdrawn from worldwide markets owing to cardiovascular toxicity. Diclofenac should be removed from EMLs.", "link"=>"http://www.mendeley.com/research/nonsteroidal-antiinflammatory-drugs-elevate-cardiovascular-risk-examination-sales-essential-medicine", "reader_count"=>180, "reader_count_by_academic_status"=>{"Unspecified"=>4, "Professor > Associate Professor"=>4, "Student > Doctoral Student"=>13, "Researcher"=>25, "Student > Ph. D. Student"=>24, "Student > Postgraduate"=>11, "Other"=>19, "Student > Master"=>41, "Student > Bachelor"=>29, "Lecturer > Senior Lecturer"=>2, "Professor"=>7, "Lecturer"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>4, "Professor > Associate Professor"=>4, "Student > Doctoral Student"=>13, "Researcher"=>25, "Student > Ph. D. 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  • {"files"=>["https://ndownloader.figshare.com/files/484641", "https://ndownloader.figshare.com/files/484643", "https://ndownloader.figshare.com/files/484648"], "description"=>"<div><h3>Background</h3><p>Certain non-steroidal anti-inflammatory drugs (NSAIDs) (e.g., rofecoxib [Vioxx]) increase the risk of heart attack and stroke and should be avoided in patients at high risk of cardiovascular events. Rates of cardiovascular disease are high and rising in many low- and middle-income countries. We studied the extent to which evidence on cardiovascular risk with NSAIDs has translated into guidance and sales in 15 countries.</p> <h3>Methods and Findings</h3><p>Data on the relative risk (RR) of cardiovascular events with individual NSAIDs were derived from meta-analyses of randomised trials and controlled observational studies. Listing of individual NSAIDs on Essential Medicines Lists (EMLs) was obtained from the World Health Organization. NSAID sales or prescription data for 15 low-, middle-, and high-income countries were obtained from Intercontinental Medical Statistics Health (IMS Health) or national prescription pricing audit (in the case of England and Canada). Three drugs (rofecoxib, diclofenac, etoricoxib) ranked consistently highest in terms of cardiovascular risk compared with nonuse. Naproxen was associated with a low risk. Diclofenac was listed on 74 national EMLs, naproxen on just 27. Rofecoxib use was not documented in any country. Diclofenac and etoricoxib accounted for one-third of total NSAID usage across the 15 countries (median 33.2%, range 14.7–58.7%). This proportion did not vary between low- and high-income countries. Diclofenac was by far the most commonly used NSAID, with a market share close to that of the next three most popular drugs combined. Naproxen had an average market share of less than 10%.</p> <h3>Conclusions</h3><p>Listing of NSAIDs on national EMLs should take account of cardiovascular risk, with preference given to low risk drugs. Diclofenac has a risk very similar to rofecoxib, which was withdrawn from worldwide markets owing to cardiovascular toxicity. Diclofenac should be removed from EMLs.</p> <p> <em>Please see later in the article for the Editors' Summary</em></p> </div>", "links"=>[], "tags"=>["non-steroidal", "anti-inflammatory", "drugs", "elevate", "cardiovascular", "medicines", "lists", "high-income", "countries"], "article_id"=>156533, "categories"=>["Biotechnology", "Pharmacology"], "users"=>["Patricia McGettigan", "David Henry"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001388.s001", "https://dx.doi.org/10.1371/journal.pmed.1001388.s002", "https://dx.doi.org/10.1371/journal.pmed.1001388.s003"], "stats"=>{"downloads"=>29, "page_views"=>54, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Use_of_Non_Steroidal_Anti_Inflammatory_Drugs_That_Elevate_Cardiovascular_Risk_An_Examination_of_Sales_and_Essential_Medicines_Lists_in_Low_Middle_and_High_Income_Countries__/156533", "title"=>"Use of Non-Steroidal Anti-Inflammatory Drugs That Elevate Cardiovascular Risk: An Examination of Sales and Essential Medicines Lists in Low-, Middle-, and High-Income Countries", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2013-02-12 01:48:53"}
  • {"files"=>["https://ndownloader.figshare.com/files/490242"], "description"=>"a<p>celecoxib and rofecoxib analysed together.</p><p>AMI, acute myocardial infarction; APTC, Anti-Platelet Trialists Collaboration; CV, cardiovascular; nr, not reported.</p>", "links"=>[], "tags"=>["estimates", "cardiovascular", "events", "nsaids"], "article_id"=>160767, "categories"=>["Biotechnology", "Pharmacology"], "users"=>["Patricia McGettigan", "David Henry"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001388.t001", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Summary_of_relative_risk_estimates_for_cardiovascular_events_with_individual_NSAIDs_versus_non_use_/160767", "title"=>"Summary of relative risk estimates for cardiovascular events with individual NSAIDs (versus non-use).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-12 00:12:47"}
  • {"files"=>["https://ndownloader.figshare.com/files/490268"], "description"=>"<p>Percentage refers to proportion of total NSAID sales in all countries studied. HMIC (high-/high middle-income countries): Australia, China, China (Hong Kong), Malaysia, New Zealand, Singapore, Taiwan, Thailand, UK/England, Canada; LMIC (low-/low middle-income countries): Bangladesh, Indonesia, Pakistan, Philippines, Vietnam.</p>a<p>Diclofenac, etoricoxib.</p>", "links"=>[], "tags"=>["nsaids", "15"], "article_id"=>160803, "categories"=>["Biotechnology", "Pharmacology"], "users"=>["Patricia McGettigan", "David Henry"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001388.t002", "stats"=>{"downloads"=>0, "page_views"=>22, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Analysis_of_use_of_selected_NSAIDs_in_15_countries_/160803", "title"=>"Analysis of use of selected NSAIDs in 15 countries.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-02-12 00:13:23"}
  • {"files"=>["https://ndownloader.figshare.com/files/490159"], "description"=>"<p>Data reflect retail pharmacy and hospital sales in all countries except Bangladesh and Pakistan [retail pharmacy sales], China [hospital sales], and England and Canada [prescription sales only].</p>", "links"=>[], "tags"=>["nsaid", "defined", "doses", "ddd"], "article_id"=>160679, "categories"=>["Biotechnology", "Pharmacology"], "users"=>["Patricia McGettigan", "David Henry"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001388.g001", "stats"=>{"downloads"=>2, "page_views"=>28, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Individual_NSAID_defined_daily_doses_DDD_expressed_as_a_percentage_of_total_NSAID_DDD_sales_in_each_country_in_2011_/160679", "title"=>"Individual NSAID defined daily doses (DDD) expressed as a percentage of total NSAID DDD sales in each country in 2011.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-02-12 00:11:19"}

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Relative Metric

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