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Since the withdrawal of popular COX-2 selective NSAID used to treat arthritis,
Vioxx (rofecoxib), and the
suspension of Bextra (valdecoxib), after studies linked them to increased cardiovascular risk in long-term use, many patients now face a serious dilemma over alternative treatment options to manage their arthritis. All
NSAIDs – which include
aspirin and
ibuprofen – carry a risk of upper gastrointestinal (GI) side-effects. For example, each year in the UK NSAIDs cause approximately 3,500
hospitalizations for, and 400 deaths from, ulcer bleeding in patients aged 60 years and above.
Despite the well-publicized risks, more than 45 per cent of those questioned said they had received little or no support on managing the side-effects of their treatment from their doctor. More than one in six people with arthritis (17.8 per cent) were still unaware of potential drug side-effects. The survey findings support work by professional
organizations who are calling for improved guidance on arthritis treatments, to help doctors address patient concerns. (Related:
How to lower back pain)
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 reflect the fact that it is not only patients who are confused over the side-effects of non-selective and COX-2 selective NSAIDs – doctors have also received a huge amount of conflicting information on the drugs. This means that GPs face the serious task of
counseling people with arthritis on the different treatment options, without themselves feeling totally confident of the best course of action. With this in mind, we have already begun formulating some sort of guidance to help GPs through this difficult time.”
Combining NSAID therapy with the proton pump inhibitor (PPI)
Nexium (esomeprazole) 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 continuous use of NSAIDs. A cost-effectiveness study recently determined that the
combination of a non-selective NSAID plus a PPI is a more cost-effective treatment option than a COX-2 selective NSAID alone in preventing ulcer complications for many arthritic patients, particularly those at high risk of a GI or cardiovascular adverse event. However, the European survey of 626 arthritis sufferers found that only 25 per cent had been offered treatment to protect against the upper GI side-effects associated with the long-term use of their medication. A
consumer research organization in the US is making identical recommendation to American arthritis
patients.
Related article: Nexium
class action lawsuits
Chondroitin
and glucosamine for arthritis patients |
