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GPs criticised over COX-2 use

By Nigel Praities

GPs are failing to reserve COX-2 inhibitors for those most at risk of gastrointestinal problems, say researchers.

The Medicines and Healthcare Regulatory Agency-funded study looked at the characteristics of 172,000 patients starting therapy with selective COX-2 inhibitors before and after rofecoxib was withdrawn due to concerns over an increased risk of myocardial infarction with the drug.

Between January 2004 to December 2005 GPs used the drugs for shorter periods and there was a trend towards using them in patients with lower cardiovascular risk. The proportion of high risk patients on COX-2 inhibitors fell slightly from 17% to 15%.

But the researchers warned there was a trend of using COX-2 inhibitors in younger patients and in those at low GI risk, with the proportion of patients prescribed the drug despite having with one GI risk factor or more falling from 44% to 34%.

Dr Tjeerd van Staa, head of research at the General Practice Research Database, which is run by the MHRA, said the data raised concerns over the cost of using COX-2s in patients with a lower risk of gastrointestinal disease.

‘What has generally been the view from NICE is that these drugs, because they are more expensive, should only be used in people at risk of stomach problems. But what we have seen is the opposite,' he said.

NICE recommends COX-2 inhibitors should only be used in people with rheumatoid arthritis at high risk of developing serious GI problems, but recently revised its guidance on osteoarthritis to recommend GPs ‘take into account individual risk factors' when deciding between a COX-2 and an NSAID and co-prescribe a PPI.

Dr Louise Warburton, a musculoskeletal GPSI who works in Shropshire, said the results were misleading as they showed GP prescribing habits in the middle of a major change.

‘We all prescribed COX-2s for everyone when they first came out as they were sold as being the next best thing to sliced bread. No-one assessed GI risk, hence the large numbers of low GI risk patient on COX-2s,' she explained.

The study is published in this month's edition of the journal Arthritis and Rheumatism.

GPs must consider risk factors when deciding between a Cox-2 and an NSAID GPs must consider risk factors when deciding between a Cox-2 and an NSAID

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