Ped Rheumatologists Most Likely to Give COX-2s to Kids

Many physicians who care for children feel that selective cyclooxygenase-2 nonsteroidal anti-inflammatory agents have equivalent or greater safety, efficacy, or tolerability and fewer side effects than do coventional NSAIDs. However, in the years since the voluntary withdrawal of rofecoxib and valdecoxib from the market, few practitioners aside from rheumatologists prescribe selective COX-2 NSAIDs for children, according to a report of survey results published in Pediatric Rheumatology.

Investigators e-mailed a link to a 22-question survey to 1,289 pediatricians, pediatric rheumatologists, sports medicine physicians, pediatric surgeons, and pediatric orthopedic surgeons. In all, 84 e-mails were returned as “undeliverable.” Despite reminders and incentives, only 338 (28%) of the 1,205 e-mail recipients completed the surveys. Response rate varied by specialty, with the highest response rates from pediatric rheumatologists (100 of 247, 40%) and the lowest for sports medicine specialists (12 of 106, 11%).

Indeed, one limitation of the study was that it was skewed to include a large percentage of pediatric rheumatologists, since investigators were particularly interested in hearing from those who often prescribe NSAIDs, according to Dr. Deborah M. Levy, a pediatric rheumatologist at the Hospital for Sick Children in Toronto, and Dr. Lisa F. Imundo, a pediatric rheumatologist at the Morgan Stanley Children's Hospital of New York–Presbyterian, Columbia University.

Nonrheumatologists frequently (more than once a week) prescribed ibuprofen, naproxen, and ketorolac, but they rarely prescribed any other NSAID. Rheumatologists used a wider variety of medications, most notably ibuprofen, diclofenac, indomethacin, naproxen, celecoxib, and rofecoxib.

About half of the respondents (164 of 330) had never prescribed a selective COX-2 NSAID. By specialty, 72% of pediatricians, 52% of orthopedic surgeons, 79% of pediatric surgeons, and 4% of rheumatologists had never prescribed a selective COX-2 NSAID. The most common reasons for prescribing a selective COX-2 NSAID were for arthritis, musculoskeletal pain, soft-tissue injury, and fracture. Use of these agents was more likely after failure of an NSAID.

Pediatric rheumatologists reported that certain adverse events were more common with conventional NSAIDs than with selective COX-2 agents. Abdominal pain (81% vs. 23%), epistaxis (13% vs. 2%), easy bruising (64% vs. 8%), headaches (21% vs. 1%), and fatigue (12% vs. 1%) were more common with conventional NSAIDs (n = 99), compared with the selective COX-2 medications (n = 95).

COX-2 NSAIDs were rated as equivalent or superior to conventional NSAIDs for safety (66%), pain relief (72%), relief of inflammation (74%), and tolerability (83%) in the opinion of physicians who had prescribed the agents.

Eleven physicians reported that one or more patients had a cardiovascular event while taking an NSAID, all of which were attributed to the patients' underlying diseases, and not to the use of either a conventional or selective COX-2 NSAID, according to the investigators.

Rofecoxib was voluntarily withdrawn from the market in September 2004, and valdecoxib was withdrawn in April 2005, and these events affected physician prescribing habits. For pediatric rheumatologists, 57% said they prescribed selective COX-2 NSAIDs less frequently and 26% said they no longer prescribed them. Consequently, 44% increased their prescriptions of conventional NSAIDs.

Nine conventional NSAIDS (aspirin, etodolac, ibuprofen, indomethacin, ketorolac, meloxicam, naproxen, oxaprozin, and tolmetin) and one selective COX-2 NSAID (celecoxib) currently have Food and Drug Administration–approved pediatric indications. At the time of the survey, no COX-2 NSAID had a pediatric indication. The authors suggest that phase IV, open-label postmarketing studies of conventional and selective COX-2 NSAIDs in children are needed to more accurately assess the risks and benefits of these medications (Pediatr. Rheumatol. Online J. 2010 Feb. 4 [doi:10.1186/1546-0096-8-7]).

Disclosures: Dr. Levy received support through an independent research grant from Pfizer, manufacturer of valdecoxib. Dr. Imundo reported that she has no financial conflicts of interest.

Many physicians who care for children feel that selective cyclooxygenase-2 nonsteroidal anti-inflammatory agents have equivalent or greater safety, efficacy, or tolerability and fewer side effects than do coventional NSAIDs. However, in the years since the voluntary withdrawal of rofecoxib and valdecoxib from the market, few practitioners aside from rheumatologists prescribe selective COX-2 NSAIDs for children, according to a report of survey results published in Pediatric Rheumatology.

Investigators e-mailed a link to a 22-question survey to 1,289 pediatricians, pediatric rheumatologists, sports medicine physicians, pediatric surgeons, and pediatric orthopedic surgeons. In all, 84 e-mails were returned as “undeliverable.” Despite reminders and incentives, only 338 (28%) of the 1,205 e-mail recipients completed the surveys. Response rate varied by specialty, with the highest response rates from pediatric rheumatologists (100 of 247, 40%) and the lowest for sports medicine specialists (12 of 106, 11%).

Indeed, one limitation of the study was that it was skewed to include a large percentage of pediatric rheumatologists, since investigators were particularly interested in hearing from those who often prescribe NSAIDs, according to Dr. Deborah M. Levy, a pediatric rheumatologist at the Hospital for Sick Children in Toronto, and Dr. Lisa F. Imundo, a pediatric rheumatologist at the Morgan Stanley Children's Hospital of New York–Presbyterian, Columbia University.

Nonrheumatologists frequently (more than once a week) prescribed ibuprofen, naproxen, and ketorolac, but they rarely prescribed any other NSAID. Rheumatologists used a wider variety of medications, most notably ibuprofen, diclofenac, indomethacin, naproxen, celecoxib, and rofecoxib.

About half of the respondents (164 of 330) had never prescribed a selective COX-2 NSAID. By specialty, 72% of pediatricians, 52% of orthopedic surgeons, 79% of pediatric surgeons, and 4% of rheumatologists had never prescribed a selective COX-2 NSAID. The most common reasons for prescribing a selective COX-2 NSAID were for arthritis, musculoskeletal pain, soft-tissue injury, and fracture. Use of these agents was more likely after failure of an NSAID.

Pediatric rheumatologists reported that certain adverse events were more common with conventional NSAIDs than with selective COX-2 agents. Abdominal pain (81% vs. 23%), epistaxis (13% vs. 2%), easy bruising (64% vs. 8%), headaches (21% vs. 1%), and fatigue (12% vs. 1%) were more common with conventional NSAIDs (n = 99), compared with the selective COX-2 medications (n = 95).

COX-2 NSAIDs were rated as equivalent or superior to conventional NSAIDs for safety (66%), pain relief (72%), relief of inflammation (74%), and tolerability (83%) in the opinion of physicians who had prescribed the agents.

Eleven physicians reported that one or more patients had a cardiovascular event while taking an NSAID, all of which were attributed to the patients' underlying diseases, and not to the use of either a conventional or selective COX-2 NSAID, according to the investigators.

Rofecoxib was voluntarily withdrawn from the market in September 2004, and valdecoxib was withdrawn in April 2005, and these events affected physician prescribing habits. For pediatric rheumatologists, 57% said they prescribed selective COX-2 NSAIDs less frequently and 26% said they no longer prescribed them. Consequently, 44% increased their prescriptions of conventional NSAIDs.

Nine conventional NSAIDS (aspirin, etodolac, ibuprofen, indomethacin, ketorolac, meloxicam, naproxen, oxaprozin, and tolmetin) and one selective COX-2 NSAID (celecoxib) currently have Food and Drug Administration–approved pediatric indications. At the time of the survey, no COX-2 NSAID had a pediatric indication. The authors suggest that phase IV, open-label postmarketing studies of conventional and selective COX-2 NSAIDs in children are needed to more accurately assess the risks and benefits of these medications (Pediatr. Rheumatol. Online J. 2010 Feb. 4 [doi:10.1186/1546-0096-8-7]).

Disclosures: Dr. Levy received support through an independent research grant from Pfizer, manufacturer of valdecoxib. Dr. Imundo reported that she has no financial conflicts of interest.

Many physicians who care for children feel that selective cyclooxygenase-2 nonsteroidal anti-inflammatory agents have equivalent or greater safety, efficacy, or tolerability and fewer side effects than do coventional NSAIDs. However, in the years since the voluntary withdrawal of rofecoxib and valdecoxib from the market, few practitioners aside from rheumatologists prescribe selective COX-2 NSAIDs for children, according to a report of survey results published in Pediatric Rheumatology.

Investigators e-mailed a link to a 22-question survey to 1,289 pediatricians, pediatric rheumatologists, sports medicine physicians, pediatric surgeons, and pediatric orthopedic surgeons. In all, 84 e-mails were returned as “undeliverable.” Despite reminders and incentives, only 338 (28%) of the 1,205 e-mail recipients completed the surveys. Response rate varied by specialty, with the highest response rates from pediatric rheumatologists (100 of 247, 40%) and the lowest for sports medicine specialists (12 of 106, 11%).

Indeed, one limitation of the study was that it was skewed to include a large percentage of pediatric rheumatologists, since investigators were particularly interested in hearing from those who often prescribe NSAIDs, according to Dr. Deborah M. Levy, a pediatric rheumatologist at the Hospital for Sick Children in Toronto, and Dr. Lisa F. Imundo, a pediatric rheumatologist at the Morgan Stanley Children's Hospital of New York–Presbyterian, Columbia University.

Nonrheumatologists frequently (more than once a week) prescribed ibuprofen, naproxen, and ketorolac, but they rarely prescribed any other NSAID. Rheumatologists used a wider variety of medications, most notably ibuprofen, diclofenac, indomethacin, naproxen, celecoxib, and rofecoxib.

About half of the respondents (164 of 330) had never prescribed a selective COX-2 NSAID. By specialty, 72% of pediatricians, 52% of orthopedic surgeons, 79% of pediatric surgeons, and 4% of rheumatologists had never prescribed a selective COX-2 NSAID. The most common reasons for prescribing a selective COX-2 NSAID were for arthritis, musculoskeletal pain, soft-tissue injury, and fracture. Use of these agents was more likely after failure of an NSAID.

Pediatric rheumatologists reported that certain adverse events were more common with conventional NSAIDs than with selective COX-2 agents. Abdominal pain (81% vs. 23%), epistaxis (13% vs. 2%), easy bruising (64% vs. 8%), headaches (21% vs. 1%), and fatigue (12% vs. 1%) were more common with conventional NSAIDs (n = 99), compared with the selective COX-2 medications (n = 95).

COX-2 NSAIDs were rated as equivalent or superior to conventional NSAIDs for safety (66%), pain relief (72%), relief of inflammation (74%), and tolerability (83%) in the opinion of physicians who had prescribed the agents.

Eleven physicians reported that one or more patients had a cardiovascular event while taking an NSAID, all of which were attributed to the patients' underlying diseases, and not to the use of either a conventional or selective COX-2 NSAID, according to the investigators.

Rofecoxib was voluntarily withdrawn from the market in September 2004, and valdecoxib was withdrawn in April 2005, and these events affected physician prescribing habits. For pediatric rheumatologists, 57% said they prescribed selective COX-2 NSAIDs less frequently and 26% said they no longer prescribed them. Consequently, 44% increased their prescriptions of conventional NSAIDs.

Nine conventional NSAIDS (aspirin, etodolac, ibuprofen, indomethacin, ketorolac, meloxicam, naproxen, oxaprozin, and tolmetin) and one selective COX-2 NSAID (celecoxib) currently have Food and Drug Administration–approved pediatric indications. At the time of the survey, no COX-2 NSAID had a pediatric indication. The authors suggest that phase IV, open-label postmarketing studies of conventional and selective COX-2 NSAIDs in children are needed to more accurately assess the risks and benefits of these medications (Pediatr. Rheumatol. Online J. 2010 Feb. 4 [doi:10.1186/1546-0096-8-7]).

Disclosures: Dr. Levy received support through an independent research grant from Pfizer, manufacturer of valdecoxib. Dr. Imundo reported that she has no financial conflicts of interest.