(213) Temporal trend in the commercialization of selective cyclooxygenase-2 inhibitors in drugstores in Brazil from 2014 to 2021

Background: Selective cyclooxygenase-2 inhibitor anti-inflammatory drugs (coxibs) are widely prescribed for various clinical conditions, usually for limited periods to reduce risk. The analysis of consumption trends and understanding drug use are pivotal tools in drug utilization studies.

Objectives: To assess the trends in coxibs sales in Brazil.

Methods: This is a time trend analysis of coxibs sales in Brazil from January 2014 to December 2021 using the Brazilian National Controlled Products Management System, a free and accessible system to record data concerning the sales of drugs subject to special control. We considered eligible records of sales from drugstores of the following coxibs licensed in Brazil: celecoxib and etoricoxib. The primary outcomes measured were the consumption of coxibs in defined daily dose (DDD) and DDD per 1,000 inhabitants per day (DID), which were analyzed by Brazilian region (North, Northeast, South, Southeast and Midwest). The trends in coxibs consumption in DDD were analyzed using a segmented regression model and calculated the average annual percent change (AAPC) with 95% confidence interval (95%CI). Statistical significance was considered for p< 0.05. The analyses were performed using Stata 14.2 software.

Results: Celecoxib and etoricoxib sales increased in Brazil in the period. Celecoxib sales rose from 0.21 to 0.45 DID (AAPC 14.99; 95% CI 8.85; 21.47), with highest increase in the Northeast from 0.11 in 2014 to 0.35 DID in 2021 (AAPC 20.58; 95% CI -1.95; 48.28). Etoricoxib sales increased from 0.14 to 0.26, particularly in the Midwest (AAPC 10.61; 95% CI 5.47; 16.00). The North region had the lowest consumption, which also rose in the period. A national change in etoricoxibs’ sales was observed between 2014-2018 (APC 12.16; 95% CI -1.99;28.37) and 2018-2021 (APC -3.61; 95% CI -22.13;19.31).

Conclusions: Coxibs sales in Brazil increased between 2014 and 2021, with more pronounced increase in celecoxib. This trend suggests that restrictive regulatory measures taken in Brazil did not met the intent to promote rational use of this class of drug.