| Summary: | 碩士 === 高雄醫學大學 === 藥學研究所 === 99 === Background: Osteoarthritis is a degenerative joint disease. It can result in joint pain and limited function. Nonsteroidal Antiinflammatory Drugs (NSAIDs) are the most common medications to relieve pain of Osteoarthritis. Compared with traditional NSAIDs, the new-generation NSAIDs lead to less GI adverse effects. Nevertheless, most patients with Osteoarthritis are the elders and require long-term use of NSAIDs. It must therefore be used cautiously and with careful consideration. Glucosamine Sulfate, also commonly used to relieve symptoms of Osteoarthritis, is thought to be safe. However the effect of Glucosamine Sulfate still remains controversial.
Purposes: The purposes of the present study were to examine the current uses of Glucosamine Sulfate and NSAIDs in the treatment of Osteoarthritis and to evaluate the incidence rate of new-generation NSAID-induced gastric toxicity.
Materials & Methods: The data of the present study was collected from the National Health Insurance Research Database (NHIRD) during 2004- 2008. The subjects were selected from the patients who were identified Osteoarthritis as ICD-9 codes 715, classified by International Classification Disease (ICD) coding system. The study was analyzed according to the following three parts: 1) In order to investigate the prescription pattern of Osteoarthritis, the Anatomical Therapeutic Chemical (ATC) Classification System, established by WHO, was used to assess the prescription drugs and frequency; 2) according to the prescription pattern of Osteoarthritis, the study aims to examine the patients who have started to use Glucosamine Sulfate since 2005. The analyses of the prescription pattern include the proportion of patients undergoing knee replacement surgery, prescribed daily dose of Glucosamine Sulfate and the utilization patterns of Glucosamine Sulfate; and 3) in order to investigate the incidence rate of new-generation NSAID-induced gastric toxicity, the proportion and age distribution of gastric toxicity were analyzed among the patients with Osteoarthritis who use the new-generation NSAIDS. SAS and SPSS were applied to analyze the data in the present study.
Results: First, according to Osteoarthritis prescription pattern, NSAIDs were the most commonly prescribed medications, followed by Glucosamine, Paracetamol, Corticosteroids, and Opioids. Second, according to the prescription pattern of Glucosamine Sulfate, the incidence of undergoing knee replacement surgery after Glucosamine Sulfate was significantly higher than unused(OR=3.06，95%CI：1.58-5.95). In analysis of Glucosamine Sulfate utilization patterns, it indicated that the frequency of prescribing is the highest among the patients who have stopped taking Glucosamine Sulfate and started using NSAIDs (69.7%). Finally, according to the incidence rate of new-generation NSAID-induced gastric toxicity, the incidence rate was 142.15 cases of peptic ulcers per 100.000 persons a day
Conclusion: Nowadays, NSAIDs are still the main drugs used for the treatment of Osteoarthritis. However, due to the clinical cases of new-generation NSAID-induced gastric toxicity, NSAIDs must be used with particularly careful consideration. Finally, according to the utilization patterns of Glucosamine Sulfate, the result showed that the patients using Glucosamine Sulfate have the higher incidence rate of undergoing knee replacement surgery. However, since it is lack of sufficient evidence to reveal whether the incidence rate is correlated with the patients’ degree of illness, further investigations may be necessary.
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