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GPs are defying NICE on gastroprotection

Many GPs are ignoring a National Institute for Clinical Excellence ruling that they should not prescribe gastroprotective agents to patients on Cox-2 inhibitors because they believe it is safer to do so, new research reveals.

At the same time a

large number of patients on traditional non-steroidal anti-inflammatory drugs who should be given gastroprotection are missing out, according to the study of 844 patients.

NICE guidelines state it is not justified to prescribe a gastroprotective agent to patients on a Cox-2 inhibitor.

But 30 per cent of such patients were also prescribed a gastroprotective agent such as a proton pump inhibitor, prostaglandin analogue or H2-antagonist.

Only 37 per cent of patients on traditional NSAIDs were prescribed gastroprotection. The National Prescribing Centre, which informs NICE, recommends gastroprotection in patients on NSAIDs at high risk of a gastrointestinal event ­ for example, over-65s and smokers.

Primary Care Rheumatology Society member Dr Louise Warburton said many GPs ignored NICE guidance because they felt it was in their patients' best interests.

'People just don't believe the press that Cox-2s are going to be better at preventing gastrointestinal haemorrhag-es,' said Dr Warburton, a GP in Cannock, Staffordshire.

'For the majority of my patients I would try to stick to the guidelines but there might be some I would consider prescribing [gastroprotection] for.'

Dr Gill Hosie, also a member of the Primary Care Rheumatology Society and a GP in Glasgow, said: 'Most people would still be a bit concerned about putting very high-risk patients on a Cox-2 alone and perhaps there's a feeling that you need to be safer.'

The study ­ which covered patients attending a rheumatology clinic at Queen Alexander Hospital in Portsmouth ­ found that prescribing Cox-2 inhibitors or gastroprotection alongside NSAIDs in at-risk groups varied from only 30 per cent in smokers to 100 per cent in those with hepatic and renal disease.

Other at-risk groups as defined by NICE include patients with previous peptic ulcer disease, cardiovascular disease, hypertension, diabetes and those on steroids, aspirin or


Patients in the study were reviewed over four weeks as they visited the clinic.

Some 32 per cent were found to be on an NSAID and 11 per cent were on a Cox-2 inhibitor.

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