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GI protection advised in all NSAID patients

All patients requiring NSAIDs should be prescribed gastroprotectants to safeguard them from adverse events, an NHS-funded study concludes.

The researchers found using H2 receptor antagonists was cost-effective in all patients, however low their risk of gastro-intestinal events.

The research, part of a Health Technology Assessment scheduled to be circulated to PCTs in May, also found the drugs were more cost-effective than proton pump inhibitors in all patients apart from those at the highest risk of GI events.

Study leader Professor Deborah Symmons, professor of rheumatology and musculo-skeletal epidemiology at the University of Manchester, said: 'We would say if they have any risk to give them an H2 antagonist. I would do that.

'For the cost of prescribing it for everyone we would actually save money because it's ex-pensive to get a GI bleed or an ulcer.'

She added: 'It was surprising because you'd probably think to prescribe a drug to everyone, many of whom as individuals wouldn't benefit, [wouldn't be cost-effective] but in this instance it would be.'

The economic analysis, published online by Rheumatology, found prescribing an NSAID plus H2 receptor antagonist cost an average of £120 per patient, taking into account the need to treat GI events.

Using an NSAID alone cost £139 per patient and an NSAID plus proton pump inhibitor cost £200 per patient.

But Professor Symmons said proton pump inhibitors were more clinically effective than H2 receptor antagonists and should still be prescribed to patients at high risk.

Professor Tony Avery, head of the primary care division at the University of Nottingham's School of Community Health Sciences, said: 'They are interesting findings. It's interesting that, in health economic terms, treatment may be of benefit in low-risk patients as well.'

But Dr Jim Kennedy, RCGP prescribing spokesman, cautioned that many patients were already on multiple medications.

He said: 'This population would tend to be on a lot of drugs.

'How would they react to being on five or six drugs rather than two or three? It raises an interesting debate but it doesn't answer it.'

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