Survey highlights need for primary care guidance on NSAID use

Jun 10 2005

New guidance on NSAID (non-steroidal anti-inflammatory drug) use is urgently needed to ensure the best patient care, European experts said today. The news coincides with the results from a European survey of 626 arthritis patients which found that many are confused and worried about the potential side-effects of their medication.

Primary care physicians now face an increasingly limited range of prescribing options for long-term arthritis pain management, following the withdrawal of Vioxx (rofecoxib) and the suspension of Bextra (valdecoxib), and the safety restrictions on the use of remaining drugs in the COX-2 selective NSAID class.

All NSAIDs - which include aspirin and ibuprofen - carry a risk of distressing and sometimes fatal upper gastrointestinal (GI) side-effects. For example, each year in the UK NSAIDs cause approximately 3,500 hospitalisations for, and 400 deaths from, ulcer bleeding in patients aged 60 years and above.

Despite these well-known risks, more than 45 per cent (46.18 per cent) of those patients participating in the survey felt they had received little or no support on managing the side-effects of their treatment from their doctor. More than one in six patients with arthritis (17.8 per cent) were still unaware of potential drug side-effects.

Professor Greg Rubin, Chairman of the European Society for Primary Care Gastroenterology (ESPCG) and Professor of Primary Care at the University of Sunderland, UK, said: “These results confirm our current thinking, that there is a lot of conflicting information on the risks of NSAIDs, including COX-2 selective NSAIDs. This makes it more difficult for primary care physicians to weigh up the risks and benefits of each treatment option and thus to make the correct decision for each individual patient. The ESPCG is eager to develop guidance to support European primary care practitioners in this decision making process.”

A cost-effectiveness study recently found that the combination of a non-selective NSAID and a proton pump inhibitor (PPI) is a more cost-effective treatment option than a COX-2 selective NSAID alone in preventing ulcer complications for many arthritis patients, particularly those at high risk of a GI or cardiovascular adverse event.

Combining NSAID therapy with Nexium effectively resolves symptoms of heartburn and acid regurgitation, as well as preventing peptic and gastric ulcers in at-risk patients, and healing gastric ulcers associated with long-term use of NSAIDs, including COX-2 selective NSAIDs.

Results of the European survey also showed that 25 per cent of people with arthritis had been offered treatment to protect against the upper GI side-effects of their medication.