USE OF DRUGS FOR RHEUMATOLOGICAL AND BONE DISORDERS … · 110 MALAYSIAN STATISTICS ON MEDICINES...
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109 MALAYSIAN STATISTICS ON MEDICINES 2007 CHAPTER 18 | USE OF DRUGS FOR RHEUMATOLOGICAL AND BONE DISORDERS H. Hussein 1 , H. Hussain 2 , Salbiah M.S. 3 , Muhaini O. 4 , Low Y.L. 5 , Beh P.K. 6 1. Putrajaya Hospital, 2. Putrajaya Health Clinic, 3. Pharmaceutical Services Division, MOH, 4. Serdang Hospital 5. Tengku Ampuan Rahimah Hospital, Klang, 6. Taiping Hospital Anti-inflammatory and antirheumatic products ranked 8 th as the most used drugs by therapeutic group in Malaysia in 2007 (12.311DDD/1000 population/day) with estimated 1.23% population utilising them. The acetic acid derivatives and related substances were the most used Non- Steroidal Anti-Inflammatory Drugs (NSAIDs) by drug class (4.48DDD/1000 population/day) followed by the fenamates (3.48), coxibs (1.83) and oxicams (1.28). Diclofenac acid was the most consumed NSAID (1.11 and 2.92DDD/1000 population/day, public and private sectors respectively). The second commonest NSAID used was mefenamic acid (total DDD 3.48). The newer group of NSAIDs which are more cyclooxygenase-2 (COX-2) selective called coxibs (DDD 1.83) saw an increase in usage from the previous year. This is due to the reduced gastrointestinal side effects of the coxibs. Etoricoxib (DDD 0.91) was mainly used by private hospitals (78%) while celecoxib was mainly prescribed in the public hospitals (63.7%). The usage of celecoxib has doubled in public hospitals in 2007 (DDD 0.58) compared to 2006 (DDD 0.27). However, Malaysians consumed less anti-inflammatory and antirheumatic products (DDD 12.311) compared to Nordic countries (DDD 53.14) in 2007. 1 In Australia, coxibs (DDD 10.27) were the highest prescribed, followed closely by Oxicams (DDD 8.28) and acetic acid derivatives (DDD 5.56). 2 Among all the drugs for rheumatological and bone disorders, anti-inflammatory and antirheumatic products ranked the highest (DDD 12.311), followed by antigout preparations (DDD 1.77), then drugs for treatment of bone diseases (DDD 0.6338). This can be explained by the increasing burden of musculoskeletal diseases in this country. 3 For the usage of antirheumatic drugs, statistics showed that the usage is in increasing trend for all drug classes except penicillamine and similar agents. The emergence of newer disease-modifying antirheumatic drugs (DMARD) has resulted in the usage of penicillamine to remain in status quo. There is no usage of butylpyrazolidines in both private and public practices due to the availability of newer and better options of treatment. As for antigout preparations, all drugs are in increasing trend. This is probably due to lifestyle changes in our population. 4 The three commonest muscle relaxants prescribed were orphenadrine, baclofen and eperisone. Generally, all are in increasing trend except the use of eperisone in total. 5 The public hospitals used baclofen more to treat non-inflammatory muscle spasm e.g., in cerebral palsy. Dantrolene, another muscle relaxant, is rarely used in Malaysia because it is reserved for malignant hyperthermia. Increased demand in usage of antiosteoporosis drugs is expected with increasing lifespan and awareness in health professionals as well as patients. The three commonest drugs used in 2007 were the biphosphonates, followed by selective oestrogen receptor modulators (SORMs) and calcitonin groups. The usage of combination of alendronic acid with cholecalciferol showed remarkable increment compared to alendronic acid alone. This is not unexpected as this is more economical. The weekly or monthly dosing of bisphosphonates resulting in better compliance made their usage popular. Strontium emerged as a new drug for osteoporosis. However, it was only available in private institutions in 2007.
Transcript of USE OF DRUGS FOR RHEUMATOLOGICAL AND BONE DISORDERS … · 110 MALAYSIAN STATISTICS ON MEDICINES...
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MALAYSIAN STATISTICS ON MEDICINES 2007
CHAPTER 18 | USE OF DRUGS FOR RHEUMATOLOGICAL AND BONE DISORDERS H. Hussein1, H. Hussain2, Salbiah M.S.3, Muhaini O.4, Low Y.L.5, Beh P.K.6
1. Putrajaya Hospital, 2. Putrajaya Health Clinic, 3. Pharmaceutical Services Division, MOH, 4. Serdang Hospital 5. Tengku Ampuan Rahimah Hospital, Klang, 6. Taiping Hospital
Anti-inflammatory and antirheumatic products ranked 8th as the most used drugs by therapeutic group in Malaysia in 2007 (12.311DDD/1000
population/day) with estimated 1.23% population utilising them. The acetic acid derivatives and related substances were the most used Non-
Steroidal Anti-Inflammatory Drugs (NSAIDs) by drug class (4.48DDD/1000 population/day) followed by the fenamates (3.48), coxibs (1.83) and
oxicams (1.28). Diclofenac acid was the most consumed NSAID (1.11 and 2.92DDD/1000 population/day, public and private sectors respectively).
The second commonest NSAID used was mefenamic acid (total DDD 3.48).
The newer group of NSAIDs which are more cyclooxygenase-2 (COX-2) selective called coxibs (DDD 1.83) saw an increase in usage from the
previous year. This is due to the reduced gastrointestinal side effects of the coxibs. Etoricoxib (DDD 0.91) was mainly used by private hospitals
(78%) while celecoxib was mainly prescribed in the public hospitals (63.7%). The usage of celecoxib has doubled in public hospitals in 2007 (DDD
0.58) compared to 2006 (DDD 0.27). However, Malaysians consumed less anti-inflammatory and antirheumatic products (DDD 12.311) compared
to Nordic countries (DDD 53.14) in 2007.1 In Australia, coxibs (DDD 10.27) were the highest prescribed, followed closely by Oxicams (DDD 8.28)
and acetic acid derivatives (DDD 5.56).2
Among all the drugs for rheumatological and bone disorders, anti-inflammatory and antirheumatic products ranked the highest (DDD 12.311),
followed by antigout preparations (DDD 1.77), then drugs for treatment of bone diseases (DDD 0.6338). This can be explained by the increasing
burden of musculoskeletal diseases in this country.3
For the usage of antirheumatic drugs, statistics showed that the usage is in increasing trend for all drug classes except penicillamine and similar
agents. The emergence of newer disease-modifying antirheumatic drugs (DMARD) has resulted in the usage of penicillamine to remain in status
quo. There is no usage of butylpyrazolidines in both private and public practices due to the availability of newer and better options of treatment.
As for antigout preparations, all drugs are in increasing trend. This is probably due to lifestyle changes in our population.4
The three commonest muscle relaxants prescribed were orphenadrine, baclofen and eperisone. Generally, all are in increasing trend except the
use of eperisone in total.5 The public hospitals used baclofen more to treat non-inflammatory muscle spasm e.g., in cerebral palsy. Dantrolene,
another muscle relaxant, is rarely used in Malaysia because it is reserved for malignant hyperthermia.
Increased demand in usage of antiosteoporosis drugs is expected with increasing lifespan and awareness in health professionals as well as
patients. The three commonest drugs used in 2007 were the biphosphonates, followed by selective oestrogen receptor modulators (SORMs) and
calcitonin groups. The usage of combination of alendronic acid with cholecalciferol showed remarkable increment compared to alendronic acid
alone. This is not unexpected as this is more economical. The weekly or monthly dosing of bisphosphonates resulting in better compliance made
their usage popular. Strontium emerged as a new drug for osteoporosis. However, it was only available in private institutions in 2007.
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Table 18.1 : Use of Drugs for Rheumatological and Bone Disorders, in DDD/1000 population/day 2006-2007
ATC Drug Class 2006 2007 Trend (%)
G03X C Selective oestrogen receptor modulators 0.1293 0.1277 -1.25
H05B A Calcitonin preparations 0.0058 0.0081 39.66
M01 Anti-inflammatory and antirheumatic products 9.9729 12.311 23.44
M03 Muscle relaxants 0.5549 0.3302 -40.49
M04 Antigout preparations 1.5347 1.7736 15.57
M05 Drugs for treatment of bone diseases 0.4360 0.6142 40.87
Table 18.2.1 : Use of Non-Steroidal Anti-Inflammatory Drugs by Drug Class, in DDD/1000 population/ day 2006-2007
ATC Drug Class 2006 2007 Trend (%)
M01A A Butylpyrazolidines - - -
M01A B Acetic acid derivatives and related substances 4.0494 4.4801 10.64
M01A C Oxicams 1.0311 1.2836 24.49
M01A E Propionic acid derivatives 0.8315 1.088 30.85
M01A G Fenamates 2.6833 3.4759 29.54
M01A H Coxibs 1.2649 1.8349 45.06
M01A X Other anti-inflammatory and antirheumatic agents, non-steroids 0.1078 0.1432 19.89
M01C C Penicillamine and similar agents 0.0050 0.0053 6.00
Table 18.2.2 : Use of Non-Steroidal Anti-Inflammatory Drugs by Drug Class and Agents, in DDD/1000 population/day 2006-2007
ATC Drug Class and Agents Sector 2006 2007 Trend (%)
M01A A Butylpyrazolidines
M01A A01 Phenylbutazone
Public - - -
Private - - -
Total - - -
M01A A02 Mofebutazone
Public - - -
Private - - -
Total - - -
M01A A03 Oxyphenbutazone
Public - - -
Private - - -
Total - - -
M01A A05 Clofezone
Public - - -
Private - - -
Total - - -
M01A B Acetic acid derivatives and related substances
M01A B01 Indometacin
Public 0.3642 0.3474 -4.61
Private 0.0897 0.1010 12.60
Total 0.4539 0.4484 -1.21
M01A B02 Sulindac
Public - - -
Private <0.0001 - -
Total <0.0001 - -
M01A B05 Diclofenac
Public 1.4652 1.1058 -24.53
Private 2.1251 2.9248 37.63
Total 3.5902 4.0306 12.27
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ATC Drug Class and Agents Sector 2006 2007 Trend (%)
M01A B Acetic acid derivatives and related substances
M01A B06 Alclofenac
Public - - -
Private - - -
Total - - -
M01A B11 Acemetacin
Public - - -
Private - - -
Total - - -
M01A B15 Ketorolac
Public 0.0007 0.0007 0.00
Private 0.0045 0.0003 -93.33
Total 0.0052 0.0010 -80.77
M01A B16 Aceclofenac
Public - - -
Private - - -
Total - - -
M01A B55 Diclofenac, combinations
Public - - -
Private - - -
Total - - -
M01A C Oxicams
M01A C01 Piroxicam
Public 0.0538 0.0380 -29.37
Private 0.3958 0.5405 36.56
Total 0.4496 0.5785 28.67
M01A C02 Tenoxicam
Public 0.0001 - -
Private 0.0372 0.0535 43.82
Total 0.0373 0.0535 43.43
M01A C06 Meloxicam
Public 0.1999 0.2418 20.96
Private 0.3443 0.4098 19.02
Total 0.5443 0.6517 19.73
M01A E Propionic acid derivatives
M01A E01 Ibuprofen
Public 0.1584 0.1111 -29.86
Private 0.2328 0.3513 50.90
Total 0.3912 0.4624 18.20
M01A E02 Naproxen
Public 0.0981 0.0935 -4.69
Private 0.3248 0.5133 58.04
Total 0.4229 0.6068 43.49
M01A E03 Ketoprofen
Public 0.0106 0.0047 -53.49
Private 0.0068 0.0141 107.33
Total 0.0174 0.0188 8.05
M01A E09 Flurbiprofen
Public - - -
Private - - -
Total - - -
M01A E11 Tiaprofenic acid
Public - - -
Private - - -
Total - - -
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ATC Drug Class and Agents Sector 2006 2007 Trend (%)
M01A G Fenamates
M01A G01 Mefenamic acid
Public 1.2609 1.4147 12.20
Private 1.4223 2.0612 44.92
Total 2.6833 3.4759 29.54
M01A G02 Tolfenamic acid
Public - - -
Private - - -
Total - - -
M01A G03 Flufenamic acid
Public - - -
Private - - -
Total - - -
M01A H Coxibs
M01A H01 Celecoxib
Public 0.2733 0.5791 111.89
Private 0.3151 0.3324 5.49
Total 0.5884 0.9114 54.89
M01A H02 Rofecoxib
Public - - -
Private - <0.0001 -
Total - <0.0001 -
M01A H03 Valdecoxib
Public - - -
Private 0.0014 0.0007 -50.00
Total 0.0014 0.0007 -50.00
M01A H04 Parecoxib
Public 0.0008 0.0014 75.00
Private 0.0038 0.0047 23.68
Total 0.0046 0.0062 34.78
M01A H05 Etoricoxib
Public 0.0604 0.2038 237.42
Private 0.6101 0.7126 16.80
Total 0.6705 0.9165 36.69
M01A X Other anti-inflammatory and antirheumatic agents, non-steroids
M01A X02 Niflumic acid
Public - - -
Private - - -
Total - - -
M01A X05 Glucosamine
Public - - -
Private - - -
Total - - -
M01A X07 Benzydamine
Public - 0.0001
Private - - -
Total - 0.0001
M01A X13 Proquazone
Public - - -
Private - - -
Total - - -
M01A X17 Nimesulide
Public - - -
Private 0.1078 0.1431 32.75
Total 0.1078 0.1431 32.75
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ATC Drug Class and Agents Sector 2006 2007 Trend (%)
M01C B Gold preparations
M01C B04 Aurothioglucose
Public - - -
Private - - -
Total - - -
M01C C Penicillamine and similar agents
M01C C01 Penicillamine
Public 0.0048 0.0051 26.52
Private 0.0002 0.0002 0.00
Total 0.0050 0.0053 6.00
Table 18.3.1 : Use of Muscle Relaxants by Drug Class and Agents, in DDD/1000 population/day 2006-2007
ATC Drug Class and Agents Sector 2006 2007 Trend (%)
M03B Muscle relaxants, centrally acting agents
M03B A01 Phenprobamate
Public - - -
Private - - -
Total - - -
M03B B03 Chlorzoxazone
Public - - -
Private - 0.0035
Total - 0.0035
M03B B52Chlormezanone, combinations excl. psycholeptics
Public - - -
Private 0.2807 0.0357 -87.28
Total 0.2807 0.0357 -87.28
M03B B53Chlorzoxazone, combinations excl. psycholeptics
Public - - -
Private 0.0266 0.0240 -9.77
Total 0.0266 0.0240 -9.77
M03B C01 Orphenadrine (citrate)
Public 0.0153 0.0071 -33.59
Private 0.0848 0.1280 50.94
Total 0.1001 0.1350 34.87
M03B X01 Baclofen
Public 0.0504 0.0572 13.49
Private 0.0044 0.0060 36.36
Total 0.0548 0.0632 15.33
M03B X09 Eperisone
Public 0.0236 0.0332 40.68
Private 0.0690 0.0357 -48.26
Total 0.0927 0.0689 -25.67
M03B X30 Fenyramidol
Public - - -
Private - - -
Total - - -
M03C Muscle relaxants, directly acting agents
M03C A01 Dantrolene
Public - <0.0001
Private - <0.0001
Total - <0.0001
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Table 18.4.1 : Use of Antigout Preparations by Drug Class and Agents, in DDD/1000 population/day 2006-2007
ATC Drug Class and Agents Sector 2006 2007 Trend (%)
M04A Antigout preparations
M04A A01 Allopurinol
Public 0.9627 1.0825 12.44
Private 0.3601 0.4317 19.88
Total 1.3227 1.5142 14.48
M04A B01 Probenecid
Public 0.0004 0.0023 475.00
Private 0.0031 0.0032 3.23
Total 0.0036 0.0055 52.78
M04A C01 Colchicine
Public 0.0664 0.0616 -7.23
Private 0.1421 0.1923 35.33
Total 0.2084 0.2538 21.79
Table 18.5.1 : Use of Bone Diseases Therapy by Drug Class and Agents, in DDD/1000 population/day 2006-2007
ATC Drug Class and Agents Sector 2006 2007 Trend (%)
M05 Drugs for treatment of bone diseases
M05B A01 Etidronic acid
Public - - -
Private 0.0005 0.0011 120.00
Total 0.0005 0.0011 120.00
M05B A02 Clodronic acid
Public 0.0018 0.0015 -16.67
Private 0.0020 0.0025 25.00
Total 0.0038 0.0040 5.26
M05B A03 Pamidronic acid
Public 0.0003 0.0004 33.33
Private <0.0001 <0.0001 0.00
Total 0.0004 0.0004 0.00
M05B A04 Alendronic acid
Public 0.2570 0.2858 11.21
Private 0.1148 0.0632 -44.96
Total 0.3718 0.3490 -6.13
M05B A06 Ibandronic acid
Public - - -
Private <0.0001 - -
Total <0.0001 - -
M05B A07 Risedronic acid
Public 0.0036 0.0034 -5.56
Private 0.0212 0.0305 43.67
Total 0.0248 0.0339 36.69
M05B A08 Zolendronic acid
Public <0.0001 <0.0001 -
Private <0.0001 0.0002 -
Total 0.0002 0.0003 50.00
M05B B01 Etidronic acid and calcium, sequential
Public - - -
Private - - -
Total - - -
M05B B03 Alendronic acid and cholecalciferol
Public 0.0004 0.0979Significantly increased
Private 0.0341 0.1053 208.80
Total 0.0345 0.2032 488.99
M05B X03 Strontium ranelate
Public - - -
Private - 0.0222 -
Total - 0.0222 -
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Table 18.6.1 : Use of Selective Oestrogen Receptor Modulators by Drug Class and Agents, in DDD/1000 population/ day 2006-2007
ATC Drug Class and Agents Sector 2006 2007 Trend (%)
G03 Sex hormones and modulators of the genital system
G03X C01 Raloxifene
Public 0.0646 0.0638 -1.24
Private 0.0647 0.0639 -1.24
Total 0.1293 0.1277 -1.24
Table 18.7.1 : Use Calcitonin preparations of by Drug Class and Agents, in DDD/1000 population/day 2006-2007
ATC Drug Class and Agents Sector 2006 2007 Trend (%)
H05 Calcium homeostasis
H05B A01 Calcitonin (salmon synthetic)
Public 0.0044 0.0056 27.27Private 0.0013 0.0025 92.31Total 0.0058 0.0081 39.66
References:
1. Nordic Medico Statistical Committee. Medicines Consumption in the Nordic Countries 2004-2008. Copenhagen 2009
2. Australian Government Department of Health and Ageing. Australian Statistics on Medicines. 2007 13th Edition. Commonwealth of Australia 2009
3. Institute for Health Management. Malaysian Burden of Disease and Injury Study. Ministry of Health 2004
4. National Clinical Practice Guidelines Management of Gout. Ministry of Health Malaysia 2008
5. Pharmaceutical Services Division & Clinical Research Centre. Malaysian Statistics on Medicines 2006. Ministry of Health Malaysia 2009
CHAPTER 18 | USE OF DRUGS FOR RHEUMATOLOGICAL AND BONE DISORDERS
