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GPs face a surge in workload and new uncertainty over cox-2 inhibitors after the UK's drug regulator advised all patients on the drugs to seek a medication review.

The Medicines and Healthcare Products Regulatory Agency also warned GPs not to use cox-2s in patients with cardiovascular disease after a trial found an increased risk of heart attack and stroke in patients on celecoxib.

The MHRA is convening an expert working group to scrutinise cox-2s while the European Medicines Agency announced it would be accelerating its review of the drugs.

Meanwhile, NICE suspen-ded its own review of cox-2s to await the EMEA report and said safety rulings would override its guidance.

But GP prescribing experts warned that media hysteria could lead to the loss of an important treatment option if safety reviews led to all cox-2 inhibitors being withdrawn.

RCGP prescribing lead Dr Jim Kennedy said more robust data was needed and warned against 'pulling drugs based purely on adverse effects'.

The latest concerns were sparked by a long-term cancer prevention trial in the US which found patients on 400mg celecoxib daily were 2.5 times more likely than those on placebo to suffer a cardiovascular event. Patients on 800mg daily were at a 3.4-fold increased risk.

But a second study sponsored by Pfizer showed no increased risk for patients taking 400mg celecoxib daily compared with placebo.

A New England Journal of Medicine editorial claimed a second Pfizer drug ­ valdecoxib ­ should be prescribed only 'in extraordinary circumstanc-es' because of safety fears.

But Pfizer's UK managing director Dr Olivier Brandicourt said: 'At this point I do not think Pfizer is considering withdrawing any of its cox-2s.'

Pfizer said valdecoxib had just been through a regulatory review and most data on celecoxib was 'very reassuring' on cardiovascular safety.

Dr Peter Elliott, prescribing lead for Redbridge PCT and a GP in east London, said: 'Working out the risk in a busy surgery is going to be tough'.

Around 690,000 patients in the UK are currently on celecoxib, 180,000 on etoricoxib and 22,000 on valdecoxib.

MHRA interim prescribing advice

·All patients on cox-2s should visit their GP for a non-urgent medication review

·Patients with established ischaemic heart disease or cerebrovascular disease should be switched to a non cox-2 drug as soon as convenient

·Alternative treatments should be considered for all patients after individual assessment of cardiovascular and gastrointestinal risk factors and cox-2 risks and benefits

·For all NSAIDs, including cox-2s, the lowest effective dose should be used for the shortest period necessary

·For patients switched to chronic non-selective NSAIDs, GPs should consider gastro-protective treatments

By Nerys Hairon

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