Rheumatology Advance Access originally published online on June 21, 2005
Rheumatology 2005 44(10):1308-1310; doi:10.1093/rheumatology/kei016
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Long-term NSAID use in primary care: changes over a decade and NICE risk factors for gastrointestinal adverse events
1 Studland Centre, Poole Hospital NHS Trust, Poole, Dorset BH15 2JB, 2 Institute of Health and Community Studies, Bournemouth University, Royal London House, Bournemouth BH1 3LT and 3 Upton Health Centre, Blandford Road North, Upton, Dorset, UK.
Correspondence to: P. W. Thompson, Poole Hospital NHS Trust, Poole, Dorset BH15 2JB, UK.E-mail: paul.thompson{at}poole.nhs.uk
Objectives. To examine prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) in general practice and to compare the results with a 1993 study. To assess numbers at risk of gastrointestinal adverse events using the National Institute for Clinical Excellence (NICE) guidance on the use of cyclo-oxygenase (Cox) II selective drugs.
Methods. Patients currently prescribed a NSAID for 2 months or more were identified from practice records. Demographic information, indications, previous gastrointestinal disease, serious co-morbidity and concomitant prescriptions were recorded. Data were compared with the 1993 survey and the NICE guidance.
Results. Seven thousand nine hundred and fifty-eight patients were registered with the practice in 2003. Two hundred and four patients were receiving repeat prescriptions for conventional NSAIDs and 63 for Cox II selective drugs. As in 1993 diclofenac (38%) and ibuprofen (24%) were the commonest individual agents and the main indication was regional pain. Seventy-three per cent of patients prescribed Cox II selective drugs and 64% of patients prescribed conventional NSAIDs had at least one NICE risk factor for gastrointestinal adverse events. Frequency of co-prescription of aspirin or antacids was similar for conventional NSAIDs and Cox II selective drugs, but prescription of antacids was higher with NICE risk factors.
Conclusion. The indications for NSAIDs have not changed since 1993. Cox II selective drug prescribing was within the NICE guidance but a substantial proportion of patients taking other NSAIDs had risk factors for gastrointestinal adverse events. Discussion with the GPs highlighted the difficulties of balancing perceived risk of gastrointestinal adverse events with cardioprotection and further guidance is urgently needed.
KEY WORDS: NSAIDs, Cox II selective drugs, NICE, Primary care
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