Three months in, how's it going?
Inappropriate prescribing of NSAIDs is putting patients at risk of gastrointestinal bleeds and cardiovascular events, a new study concludes.
Just 37 per cent of elderly patients with arthritis were treated according to guidelines from the National Institute for Clinical Excellence.
One in five patients received two NSAIDs, putting them at unacceptable gastrointestinal risk, or an NSAID plus aspirin, reducing the effectiveness of cardiovascular prevention.
Only 20 per cent of patients received a cox-2 inhibitor and of those on standard NSAIDs, just 24 per cent were given a gastroprotective agent.
The research adds to the growing turmoil over NSAID prescribing, after a recent EU safety review found there was no evidence that cox-2 inhibitors were any less gastrotoxic than standard NSAIDs (Pulse, June 28).
The study, presented at an international conference on general practice in Amsterdam last month, looked at 1,120 patients over the age of 65 – classified by NICE as 'at risk' of gastrointestinal complications.
NICE recommends they receive either a cox-2 inhibitor or a non-selective NSAID with a gastroprotective agent,
although it is reviewing its advice on the use of cox-2s.
Dr Graham Davenport, president of the Primary Care Rheumatology Society, said: 'You try to avoid at all costs the co-prescribing of NSAIDs and aspirin or even cox-2s and aspirin.'
Study co-author Dr Elizabeth Koshy, who is a GP in Greenwich, south-east London, said: 'This audit really opened my eyes and I've changed my practice.'
She said that prescribing cost was a big part of the problem, with a 'real sense' that GPs might come under pressure from PCTs over prescribing extra gastroprotective agents.
Dr Davenport said the European review on the safety of cox-2 inhibitors would confuse GPs and allow PCTs to pressure them into prescribing cheaper non-selective NSAIDs.
'I think there's reasonable evidence that cox-2 inhibitors have better gastrointestinal safety. All the main experts
will agree. I would like to see the studies that the review is based on.'
By Rob Finch