Pharmacological management of knee and hip osteoarthritis stratified by oral nonsteroidal anti-inflammatory drugs safety status

INTRODUCTION: Knee and hip osteoarthritis are treated with oral nonsteroidal anti-inflammatory drugs (NSAIDs); however, pharmacological management by NSAID safety status remains unclear. We characterized pharmacological treatment patterns across safety strata. MATERIALS AND METHODS: We used Japanese health insurance claims database (2014-2024). Adults aged ≥40 years with incident knee or hip osteoarthritis were classified as having oral NSAID contraindications, precautions, or neither. Outcomes were receipt of oral NSAIDs within 90 days of osteoarthritis diagnosis. Adjusted risk differences (RDs) were estimated with identity-link binomial models and facility-clustered standard errors. RESULTS: For knee osteoarthritis, oral NSAIDs were prescribed to 49.0%, 44.0%, and 30.2% of patients in the no contraindications or precautions, precaution, and contraindication groups, respectively, and to 53.4%, 48.6%, and 34.5% of patients with hip osteoarthritis. Compared with patients with no contraindications or precautions, the adjusted RDs for receiving oral NSAIDs were -2.0 (95% confidence interval [CI], -2.6 to -1.4) and -12.9 (95% CI -14.1 to -11.7) for knee osteoarthritis, and -1.9 (95% CI -3.3 to -0.5) and -13.0 (95% CI -15.7 to -10.3) for hip osteoarthritis, for the precaution and contraindication groups, respectively. Adjusted RDs for receiving non-NSAID treatments were 0.5 (95% CI -0.1 to 1.1) and -2.0 (95% CI -3.4 to -0.6) for knee osteoarthritis, and 1.1 (95% CI -0.2 to 2.3) and 3.1 (95% CI 0.3 to 5.8) for hip osteoarthritis, respectively. CONCLUSION: Oral NSAID use was less frequent among patients classified as having oral NSAID precautions or contraindications than among those without such classifications in both cohorts.