August 31, 2005 12:26 ET

COX-2 Users Gain No Apparent GI Protection Compared With Nonselective NSAID Users; Also, Drug Costs and Potential Drug Therapy Problems Are Reduced in a Medication Therapy Management Program

ALEXANDRIA, VA -- (MARKET WIRE) -- August 31, 2005 -- The September 2005 issue of the Journal of Managed Care Pharmacy (JMCP) is now available in print and online. Featured articles include:

Actual Rates of GI Bleed Not Lower for COX-2 vs. Nonselective NSAID Users...

Examination of medical and pharmacy claims data for approximately 2.7 million managed care members in five states for the period January 1999 to August 2002 revealed 375 cases of GI bleed among 19,201 follow-up years for COX-2 users (19.5 cases per 1,000 person-years) versus 228 cases of GI bleed among 12,680 follow-up years for nonselective NSAID users (18.0 cases per 1,000 person-years). The risk of GI bleed was not significantly different for COX-2 users compared with nonselective NSAID users (risk ratio [RR] 1.07 with a 95% confidence interval [CI] of 0.90-1.26). Even among patients at high risk of a GI bleed, there was no reduction in the actual incidence of GI bleed for COX-2 users compared with nonselective NSAID users (RR 0.995; 95% CI, 0.84-1.19).

An accompanying editorial points out that not only is there no apparent GI protection with COX-2 drugs versus nonselective NSAIDs in the real world of managed care, but COX-2 inhibitors have also been associated with an increased risk of cardiovascular events: The sole remaining COX-2 inhibitor on the market contains a warning label for potential increased risk of cardiovascular events. In addition, the cost of COX-2 inhibitors is four times the cost of alternative therapy, with diclofenac 150 mg per day plus omeprazole OTC 20 mg per day.

Medication Therapy Management Performed by Clinical Pharmacists in Long-term Care Reduced Drug Costs by $19.04 per Patient per Month...

A clinical pharmacy intervention program that targeted long-term care patients with more than 18 prescription fills in 90 days was associated with drug costs savings and a reduction in alerts of potential drug therapy problems (PDTPs). Clinical consulting pharmacists offered 6,360 recommendations across 5 PDTP alert categories for 3,400 patients, an average of 1.87 recommendations per patient. Physicians agreed to 3,801 (59.8%) of the recommendations to change drug therapy; about half involving a switch to a lower-cost drug. Drug cost savings were about 4% for the intervention group versus the control group, or about $19.04 per patient per month, annualized to $228 per patient per year. This clinical pharmacy intervention program has components that might serve as the basis for medication therapy management under the Medicare Part D prescription drug benefit program that begins January 1, 2006.

The Journal of Managed Care Pharmacy is published nine times per year and is a benefit of membership in the Academy of Managed Care Pharmacy. A peer-reviewed publication of original research for pharmacy practitioners and health care providers, JMCP is approved by the National Library of Medicine and indexed in MEDLINE/PubMed. The current edition is available at:

Questions about the publication may be directed to Editor-in-Chief Frederic R. Curtiss, PhD, RPh, CEBS, at

The Academy of Managed Care Pharmacy's mission is to empower its members to serve society by using sound medication management principles and strategies to achieve positive patient outcomes. AMCP has more than 4,800 members nationally who provide comprehensive coverage and services to the more than 200 million Americans served by managed care. More news and information about AMCP can be obtained on its website,

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