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Gold, incentives and meh

Cox-2 cardiovascular risks outweigh GI benefits

By Nigel Praities

The risks posed by cox-2 inhibitors outweigh their benefits for many patients in clinical practice, research by the UK drugs regulator reveals.

Over 90,000 patients remain on cox-2s in the UK, latest figures from CSD Patient Data show, despite a long-running controversy over the drugs' cardiovascular risks.

GPs largely use cox-2s because of their lower risk of gastro-intestinal events. But the new study of 155,000 patients concludes that the GI benefit of cox-2s is reduced in routine practice and is outweighed by the risk of myocardial infarction.

The study, which examined patients on the UK general practice research database, found only 6% of patients experienced any significant benefit with cox-2 inhibitors, while 23% experienced significant harm. The research was published online in the latest issue of the International Journal of Epidemiology.

Study leader Dr Tjeerd van Staa, head of research at the GPRD, which is run by the Medicines and Healthcare Regulatory Agency, said under the ‘precautionary principle' GPs should be wary about prescribing sox-2s until more research is conducted on their safety. ‘Until we establish there is no problem with myocardial infarction then be careful, especially in patients at risk,' he said.

Dr Terry McCormack, a GP in Whitby, North Yorkshire, and chair of the Primary Care Cardiovascular Society, said GPs should continue to use their clinical judgement.

‘These drugs have to be available for some patients with rheumatic conditions, because they would just a have a miserable life without them. Doctors can only weigh up the drugs on a one to one basis,' he said.

A spokesperson for Pfizer, which manufactures leading cox-2 celecoxib, emphasised that the European regulatory authorities had said the balance of benefits and risks remained positive for cox-2 inhibitors, when used appropriately.

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