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
Have you tried new the Independent Digital Edition apps?
ebooks
ebooksAn introduction to the ground rules of British democracy
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
SPONSORED FEATURES
Independent Dating
and  

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

iJobs Job Widget
iJobs General

Recruitment Genius: Project Assistant

£17000 per annum: Recruitment Genius: They are a leading company in the field ...

Recruitment Genius: DBA Developer - SQL Server

£30000 - £35000 per annum: Recruitment Genius: This is an exciting opportunity...

Recruitment Genius: Office Manager

£26041 - £34876 per annum: Recruitment Genius: There has never been a more exc...

Recruitment Genius: Travel Customer Service and Experience Manager

£14000 - £17000 per annum: Recruitment Genius: The fastest growing travel comp...

Day In a Page

Blairites be warned, this could be the moment Labour turns into Syriza

Andrew Grice: Inside Westminster

Blairites be warned, this could be the moment Labour turns into Syriza
HMS Victory: The mystery of Britain's worst naval disaster is finally solved - 271 years later

The mystery of Britain's worst naval disaster is finally solved - 271 years later

Exclusive: David Keys reveals the research that finally explains why HMS Victory went down with the loss of 1,100 lives
Survivors of the Nagasaki atomic bomb attack: Japan must not abandon its post-war pacifism

'I saw people so injured you couldn't tell if they were dead or alive'

Nagasaki survivors on why Japan must not abandon its post-war pacifism
Jon Stewart: The voice of Democrats who felt Obama had failed to deliver on his 'Yes We Can' slogan, and the voter he tried hardest to keep onside

The voter Obama tried hardest to keep onside

Outgoing The Daily Show host, Jon Stewart, became the voice of Democrats who felt the President had failed to deliver on his ‘Yes We Can’ slogan. Tim Walker charts the ups and downs of their 10-year relationship on screen
RuPaul interview: The drag star on being inspired by Bowie, never fitting in, and saying the first thing that comes into your head

RuPaul interview

The drag star on being inspired by Bowie, never fitting in, and saying the first thing that comes into your head
Secrets of comedy couples: What's it like when both you and your partner are stand-ups?

Secrets of comedy couples

What's it like when both you and your partner are stand-ups?
Satya Nadella: As Windows 10 is launched can he return Microsoft to its former glory?

Satya Nadella: The man to clean up for Windows?

While Microsoft's founders spend their billions, the once-invincible tech company's new boss is trying to save it
The best swimwear for men: From trunks to shorts, make a splash this summer

The best swimwear for men

From trunks to shorts, make a splash this summer
Mark Hix recipes: Our chef tries his hand at a spot of summer foraging

Mark Hix goes summer foraging

 A dinner party doesn't have to mean a trip to the supermarket
Ashes 2015: With an audacious flourish, home hero Ian Bell ends all debate

With an audacious flourish, the home hero ends all debate

Ian Bell advances to Trent Bridge next week almost as undroppable as Alastair Cook and Joe Root, a cornerstone of England's new thinking, says Kevin Garside
Aaron Ramsey interview: Wales midfielder determined to be centre of attention for Arsenal this season

Aaron Ramsey interview

Wales midfielder determined to be centre of attention for Arsenal this season
Community Shield: Arsene Wenger needs to strike first blow in rivalry with Jose Mourinho

Community Shield gives Wenger chance to strike first blow in rivalry with Mourinho

As long as the Arsenal manager's run of games without a win over his Chelsea counterpart continues it will continue to dominate the narrative around the two men
The unlikely rise of AFC Bournemouth - and what it says about English life

Unlikely rise of AFC Bournemouth

Bournemouth’s elevation to football’s top tier is one of the most improbable of recent times. But it’s illustrative of deeper and wider changes in English life
A Very British Coup, part two: New novel in pipeline as Jeremy Corbyn's rise inspires sequel

A Very British Coup, part two

New novel in pipeline as Jeremy Corbyn's rise inspires sequel
Philae lander data show comets could have brought 'building blocks of life' to Earth

Philae lander data show comets could have brought 'building blocks of life' to Earth

Icy dust layer holds organic compounds similar to those found in living organisms