Low-risk arthritis drugs 'could save lives': Better prescribing for elderly patients could prevent 200 deaths a year from bleeding ulcers, study finds

TWO THOUSAND hospital admissions and perhaps 100 to 200 lives a year could be saved if doctors used the least risky of a group of drugs widely prescribed for arthritis and other joint and muscle pains, a large-scale British study has shown.

The finding comes from an investigation of more than 1,100 patients admitted over four years with bleeding peptic ulcers to hospitals in Birmingham, Glasgow, Nottingham, Newcastle upon Tyne and Portsmouth.

The anti-inflammatory pain-killers, known as non-steroidal anti- flammatory drugs (NSAIDs) have long been known to carry some risk of stomach and gut bleeding. But the study found that the risk of ulcer complications in patients aged 60 and over varied more than ten- fold according to which particular drug was being taken.

If doctors prescribed the least risky - ibuprofen - in place of aspirin and the other common NSAIDs, about 2,000 admissions a year could be prevented, the study team led by Michael Langman, Professor of Medicine at Birmingham University, found.

With deaths from bleeding ulcers among over-60s running at between 5 and 10 per cent of admissions, between 100 and 200 lives a year could therefore be saved, Professor Langman said. Hospital admissions could be lowered still further if the drugs were used in low rather than high dose, the study found.

NSAIDs are commonly prescribed for various forms of arthritis, gout and a whole range of less specific joint and muscle pains which afflict older people. Their anti-inflammatory qualities both reduce pain and increase mobility. But the study published in the Lancet shows there are wide variations in the risk they carry of causing bleeding ulcers.

None were risk free, but of the seven most commonly prescribed NSAIDs, ibuprofen followed by diclofenac carried the lowest risk. Indomethicin, naproxen and piroxicam carried intermediate risks. Azapropazone and keoprofen were the highest risk, both being more than 10 times more likely than ibuprofen to be linked to bleeding ulcers.

The individual risk is small - about one in 10,000 prescriptions among people aged 60 and over. But the drugs are very widely used, with more than 20 million prescriptions a year written for them. As a result, they account for between 3,500 and 4,000 hospital admissions annually due to bleeding ulcers, according to the study - a figure which the Lancet, in a leading article, said could be halved if doctors followed the 'few simple guidelines' that emerge from the study by Professor Langman and his colleagues.

'If an NSAID is indicated, the least toxic agent should be given at the lowest effective dose. On this basis, ibuprofen should be the initial choice, at a dose of less than 1,500 milligrams per day.' Meanwhile, the licensing authorities should reconsider the risk-benefit ratio of the other drugs, especially for the elderly, the Lancet said.

The study has again shown up the value of the 'yellow card' system, through which doctors report suspected adverse reactions to drugs. By 1985, the number of yellow cards being sent to the Committee on Safety of Medicines suggested there were wide differences in the risk of stomach bleeding from different NSAIDs. That voluntary reporting system could not quantify the risk, but it raised sufficient questions for the Medical Research Council to back the five-city study which Professor Langman and his colleagues have now reported, showing some NSAIDs are much safer for the gut than others.

Start your day with The Independent, sign up for daily news emails
Arts and Entertainment
The Doctor and Clara have their first real heart to heart since he regenerated in 'Deep Breath'
TV
Life and Style
Apple showed no sign of losing its talent for product launches with the new, slightly larger iPhone 6 making headlines
techSecurity breaches and overhyped start-ups dominated a year in which very little changed (save the size of your phone)
Arts and Entertainment
Jamie Oliver
filmTV chef Jamie Oliver turned down role in The Hobbit
News
The official police photograph of Dustin Diamond taken after he was arrested in Wisconsin
peopleDownfall of the TV star charged with bar stabbing
PROMOTED VIDEO
Have you tried new the Independent Digital Edition apps?
ebooks
ebooksA year of political gossip, levity and intrigue from the sharpest pen in Westminster
Arts and Entertainment
Jeremy Clarkson, left, and Richard Hammond upset the locals in South America
tvReview: Top Gear team flee Patagonia as Christmas special reaches its climax in the style of Butch and Sundance
News
people
Sport
Ashley Barnes of Burnley scores their second goal
footballMan City vs Burnley match report
Arts and Entertainment
Peter Mayhew as Chewbacca alongside Harrison Ford's Han Solo in 'Star Wars'
film
News
i100
Arts and Entertainment
Man of action: Christian Bale stars in Exodus: Gods and Kings
film
Arts and Entertainment
Tracy Emin's 1998 piece 'My Bed' on display at Christie's
artOne expert claims she did not
News
Ernesto Che Guevara and Fidel Castro, right, met at Havana Golf Club in 1962 to mock the game
newsFidel Castro ridiculed the game – but now investment in leisure resort projects is welcome
News
Hackers revealed Oscar-winning actress Lawrence was paid less than her male co-stars in American Hustle
people
Arts and Entertainment
Clueless? Locked-door mysteries are the ultimate manifestation of the cerebral detective story
booksAs a new collection of the genre’s best is published, its editor explains the rules of engagement
Sport
Robin van Persie is blocked by Hugo Lloris
footballTottenham vs Manchester United match report
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

Recruitment Genius: Business Manager

£32000 - £40000 per annum: Recruitment Genius: A Business Manager is required ...

Recruitment Genius: Operations Manager

£45000 - £55000 per annum: Recruitment Genius: This is an exciting opportunity...

Recruitment Genius: Panel & Cabinet Wireman

£20000 per annum: Recruitment Genius: Panel Wireman required for small electro...

Recruitment Genius: Electronics Test Engineer

£25000 - £27000 per annum: Recruitment Genius: An SME based in East Cheshire, ...

Day In a Page

A timely reminder of the bloody anniversary we all forgot

A timely reminder of the bloody anniversary we all forgot

Who remembers that this week we enter the 150th anniversary year of the end of the American Civil War, asks Robert Fisk
Homeless Veterans appeal: Former soldiers pay their respects to a friend who also served

Homeless Veterans appeal

Former soldiers pay their respects to a friend who also served
Downfall of Dustin 'Screech' Diamond, the 'Saved By The Bell' star charged with bar stabbing

Scarred by the bell

The downfall of the TV star charged with bar stabbing
Why 2014 was a year of technological let-downs

Why 2014 was a year of technological let-downs

Security breaches and overhyped start-ups dominated a year in which very little changed (save the size of your phone)
Cuba's golf revolution: But will the revolutionary nation take 'bourgeois' game to its heart?

Will revolutionary Cuba take 'bourgeois' golf to its heart?

Fidel Castro ridiculed the game – but now investment in leisure resort projects is welcome
The Locked Room Mysteries: As a new collection of the genre’s best is published, its editor Otto Penzler explains the rules of engagement

The Locked Room Mysteries

As a new collection of the genre’s best is published, its editor explains the rules of engagement
Amy Adams on playing painter Margaret Keane in Tim Burton's Big Eyes

How I made myself Keane

Amy Adams hadn’t wanted to take the role of artist Margaret Keane, because she’d had enough of playing victims. But then she had a daughter, and saw the painter in a new light
Ed Richards: Parting view of Ofcom chief. . . we hate jokes on the disabled

Parting view of Ofcom chief... we hate jokes on the disabled

Bad language once got TV viewers irate, inciting calls to broadcasting switchboards. But now there is a worse offender, says retiring head of the media watchdog, Ed Richards
A look back at fashion in 2014: Wear in review

Wear in review

A look back at fashion in 2014
Ian Herbert: My 10 hopes for sport in 2015. Might just one of them happen?

Ian Herbert: My 10 hopes for sport in 2015

Might just one of them happen?
War with Isis: The West needs more than a White Knight

The West needs more than a White Knight

Despite billions spent on weapons, the US has not been able to counter Isis's gruesome tactics, says Patrick Cockburn
Return to Helmand: Private Davey Graham recalls the day he was shot by the Taliban

'The day I was shot by the Taliban'

Private Davey Graham was shot five times during an ambush in 2007 - it was the first, controversial photograph to show the dangers our soldiers faced in Helmand province
Revealed: the best and worst airlines for delays

Revealed: the best and worst airlines for delays

Many flyers are failing to claim compensation to which they are entitled, a new survey has found
The stories that defined 2014: From the Scottish independence referendum to the Ice Bucket Challenge, our writers voice their opinions

The stories that defined 2014

From the Scottish independence referendum to the Ice Bucket Challenge, our writers voice their opinions
Stoke-on-Trent becomes first British city to be classified as 'disaster resilient' by the United Nations

Disaster looming? Now you know where to head...

Which British city has become the first to be awarded special 'resilience' status by the UN?