Are traditional NSAIDs prescribed appropriately among French elderly with osteoarthritis? Results from the CADEUS cohort

Aim To describe the inappropriate use of traditional nonsteroidal anti-inflammatory drugs (tNSAIDs) in elderly subjects in the CADEUS cohort using the Beers 2003 criteria modified by recommendations from the French Medicines Agency. Methods Of the 23,217 subjects in the CADEUS cohort, 1,851 were >= 65 years old, had bee diagnosed with osteoarthritis (OA), and had been dispensed a tNSAID at least once in the 6 months before the index date. Data were obtained from the French national reimbursement database and from patient and prescriber questionnaires. The Beers criteria for inappropriate use were modified to include all tNSAIDs, and long-term high-dose use was defined as having been dispensed at least five dispensations for tNSAID over a 6-month period with a gap of <45 days between each dispensation and when the gap was >45 days, medicine availability >50% [i.e., defined daily dose (DDD) delivered/theoretical DDD] for the gap. Results The most frequently dispensed tNSAIDs were piroxicam (25%), diclofenac (24%), ibuprofen (18%), ketoprofen (18%), and naproxen (10%). Of the study population, 1.5% were dispensed indomethacin; 15%, two tNSAIDs; 15%, a tNSAIDs with a platelet aggregation inhibitor; 4.6%, a tNSAID with low-dose aspirin; 0.2%, a tNSAID with vitamin K antagonists. The analysis revealed that 18% of the study population were high-dose and long-term users of tNSAIDs and that 70% of these were dispensed a proton pump inhibitor. Conclusions The most common inappropriate tNSAID dispensation was the co-prescription of two different tNSAIDs within 1 month or of a platelet aggregation inhibitor. The real-life consequences of our results need to be ascertained, and it would be interesting to update the Beers criteria.