Prescriptions for nonsteroidal anti-inflammatory drugs (NSAIDs) have decreased over time among patients with osteoarthritis (OA), with variations in prescription patterns across different geographic areas, according to a recent study published in Arthritis Care and Research.
Investigators assessed the proportion of, and factors associated, with NSAID prescriptions among patients with OA.
Researchers performed a systematic review and meta-analysis of observational studies including adult patients with OA who were prescribed NSAIDs by their healthcare provider. Subgroup analyses were performed to assess differences in prescribing estimates across study sites, geographic regions (grouped according to World Health Organization (WHO) regions), and income levels, as well as differences in NSAID type, dose, and method of delivery.
A total of 6,494,509 patients across 51 studies published between 1989 and 2022 were included in the analysis. The mean patient age was 64.7 years.
The pooled estimate for the proportion of patients with OA who were prescribed NSAIDs was 43.8% (95% CI, 36.8%-51.1%).
Prescribing was associated with WHO region (P =.026), with greater numbers of prescriptions in Europe and Central Asia (coefficient, 1.26; 95% CI, 0.23-2.28; P =.02) and South Asia (coefficient, 3.02; 95% CI, 1.27-4.76; P =.001), compared with North America.
A decrease in NSAID prescribing over time was found (coefficient, -0.04; 95% CI, -0.08 to 0.00; P =.05).
NSAIDs were more commonly prescribed to patients with spinal OA (66.9%) compared with hip (34.9%) and knee OA (46.3%).
NSAID prescribing varied across geographical locations and was highest in South Asia at 83.4%. Prescribing was highest in middle-income countries at 83.4%, though no studies included low-income countries.
Approximately half of the included studies reported on specific types of prescribed NSAIDs, with the most common being diclofenac, ibuprofen, and naproxen.
The study is limited by reporting bias and insufficient data available for spine-related OA and specific dosing regimens.
The study authors concluded, “Our review established that four in every ten participants diagnosed with osteoarthritis seeking healthcare were prescribed a type of NSAIDs over thirty years. Prescribing was greater in middle-income countries, but there was no evidence available from low-income countries. NSAID prescribing was influenced by geographic region, and there has been a decrease in prescribing over time.”
Yang Z, Mathieson S, Kobayashi S, et al. Prevalence of nonsteroidal antiinflammatory drugs prescribed for osteoarthritis: a systematic review and meta-analysis of observational studies. Arthritis Care Res (Hoboken). Published online May 23, 2023. doi:10.1002/acr.25157