People with Arthritis Remain "At-Risk" Despite NICE Guidance

People with Arthritis Remain 'At-Risk' Despite NICE Guidance Despite familiarity with the NICE prescribing guidance on Cox-2 selective inhibitors, a substantial proportion of GPs have not significantly increased their prescription of this class of medication, according to the results of a new survey.1 The research, commissioned by Arthritis Care, the UK's leading arthritis support group, involved 196 GPs nationwide. It found that 77 per cent were aware of the NICE guidance on the use of Cox-2 selective inhibitors for osteoarthritis (OA) and rheumatoid arthritis (RA), published in July 2001.1 Yet of those GPs aware of the recent NICE guidance, only 11 per cent claimed they had significantly increased their prescription of these drugs to appropriate patients.1 Kieran Kettleton, Director of Communications at Arthritis Care said: "We appreciate that healthcare professionals such as GPs are bombarded with information on the latest advances in the management of not only arthritis but a huge range of conditions. We also understand the time pressures under which they have to work. We would however encourage GPs to follow the NICE guidance and ensure that arthritis patients at high risk of developing serious gastrointestinal problems are receiving appropriate treatment". He continued: "Increasingly in the GP-patient setting, patients are bringing specific information and knowledge to the table and together they can get the best possible result. Too often the person with arthritis feels it is just something that they have to put up with and there is nothing that can be done - and that attitude is reflected by the GP. With a combination of knowledge and treatment options, an open discussion can take place to find the best outcome". Traditional NSAIDS are known to be associated with gastrointestinal side- effects; each year, more than 2,000 patients per year die as a result of NSAID associated gastrointestinal complications and 12,000 patients are hospitalised.2 [REMOVED GRAPHICS]The NICE guidance states that Cox-2s should be used, in preference to traditional NSAIDs, only in patients with OA or RA who may be at 'high risk' of developing serious gastrointestinal adverse effects. Patients at high risk include those 65 years of age and over; those using concomitant medications known to increase the likelihood of upper gastrointestinal adverse events; those with serious co-morbidity; or those requiring the prolonged use of maximum recommended doses of traditional NSAIDs. 3 Those with a previous clinical history of gastroduodenal ulcer, gastrointestinal bleeding or gastroduodenal perforation are at very high risk, therefore even use of a Cox-2 should be considered with care.3 However, of the 196 GPs questioned, only 30 per cent selected a Cox-2 selective inhibitor for the treatment of an osteoarthritis patient aged 67; 31 per cent for an osteoarthritis patient with diabetes; 39 per cent for an osteoarthritis patient with a history of peptic ulcers; and 21 per cent for a rheumatoid arthritis patient receiving 150mg of diclofenac for the past two years.1 According to the NICE guidance on the use of Cox-2s for OA and RA, all of these patients would be considered at high risk of developing serious gastrointestinal side effects and, therefore, may be suitable to receive a Cox-2 selective inhibitor, instead of a traditional NSAID.3 The Department of Health and National Welsh Assembly has recently committed to making extra prescribing budget available to fund NICE recommendations and will now require Hospital and Primary Health Care Trusts to adhere to this guidance from April 2002. It is hoped that in Scotland and Northern Ireland similar funding will be made available. Arthritis Care is the UK's leading voluntary organisation working with and for all people with arthritis. It works to promote health, well- being and independence through services, self management courses and publications covering exercise, diet and complementary therapies as well as up-to-date information on new medication. -Ends- For further information, please contact Neil Crump / Sarah Berglas, CPR UK Healthcare, tel: 020 7282 1200 References: 1. Arthritis Care NOP Healthcare Online Quota-based GP Omnibus, March 2002 2. Blower AL, Brooks A, Fenn GC, et al. Emergency admissions for upper gastrointestinal disease and their relation to NSAID use. Aliment Pharmocol Ther 1997; 11: 283-291 3. NICE Technical Appraisal Guidance - No. 27. Guidance on the use of cylco-oxygenase (Cox) II selective inhibitors, celecoxib, rofecoxib, meloxicam and etodolac for osteoarthritis and rheumatoid arthritis. July 2001 ------------------------------------------------------------ This information was brought to you by Waymaker http://www.waymaker.net The following files are available for download: http://www.waymaker.net/bitonline/2002/05/07/20020507BIT01040/wkr0001.doc http://www.waymaker.net/bitonline/2002/05/07/20020507BIT01040/wkr0002.pdf