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?
ebooksA celebration of British elections
  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating

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

iJobs Job Widget
iJobs General

Recruitment Genius: Senior Digital Marketing Consultant

£28000 - £45000 per annum: Recruitment Genius: A Senior Digital Marketing Cons...

Recruitment Genius: Assistant Stores Keeper

£16640 - £18500 per annum: Recruitment Genius: An Assistant Stores Keeper is r...

Recruitment Genius: Claims Administrator

£16000 - £18500 per annum: Recruitment Genius: This is an excellent opportunit...

Recruitment Genius: Software Developer - C# / ASP.NET / SQL

£17000 - £30000 per annum: Recruitment Genius: Developer required to join a bu...

Day In a Page

'It was first time I had ever tasted chocolate. I kept a piece, and when Amsterdam was liberated, I gave it to the first Allied soldier I saw'

Bread from heaven

Dutch survivors thank RAF for World War II drop that saved millions
Britain will be 'run for the wealthy and powerful' if Tories retain power - Labour

How 'the Axe' helped Labour

UK will be 'run for the wealthy and powerful' if Tories retain power
Rare and exclusive video shows the horrific price paid by activists for challenging the rule of jihadist extremists in Syria

The price to be paid for challenging the rule of extremists

A revolution now 'consuming its own children'
Welcome to the world of Megagames

Welcome to the world of Megagames

300 players take part in Watch the Skies! board game in London
'Nymphomaniac' actress reveals what it was really like to star in one of the most explicit films ever

Charlotte Gainsbourg on 'Nymphomaniac'

Starring in one of the most explicit films ever
Robert Fisk in Abu Dhabi: The Emirates' out-of-sight migrant workers helping to build the dream projects of its rulers

Robert Fisk in Abu Dhabi

The Emirates' out-of-sight migrant workers helping to build the dream projects of its rulers
Vince Cable interview: Charging fees for employment tribunals was 'a very bad move'

Vince Cable exclusive interview

Charging fees for employment tribunals was 'a very bad move'
Iwan Rheon interview: Game of Thrones star returns to his Welsh roots to record debut album

Iwan Rheon is returning to his Welsh roots

Rheon is best known for his role as the Bastard of Bolton. It's gruelling playing a sadistic torturer, he tells Craig McLean, but it hasn't stopped him recording an album of Welsh psychedelia
Russell Brand's interview with Ed Miliband has got everyone talking about The Trews

Everyone is talking about The Trews

Russell Brand's 'true news' videos attract millions of viewers. But today's 'Milibrand' interview introduced his resolutely amateurish style to a whole new crowd
Morne Hardenberg interview: Cameraman for BBC's upcoming show Shark on filming the ocean's most dangerous predator

It's time for my close-up

Meet the man who films great whites for a living
Increasing numbers of homeless people in America keep their mobile phones on the streets

Homeless people keep mobile phones

A homeless person with a smartphone is a common sight in the US. And that's creating a network where the 'hobo' community can share information - and fight stigma - like never before
'Queer saint' Peter Watson left his mark on British culture by bankrolling artworld giants

'Queer saint' who bankrolled artworld giants

British culture owes a huge debt to Peter Watson, says Michael Prodger
Pushkin Prizes: Unusual exchange programme aims to bring countries together through culture

Pushkin Prizes brings countries together

Ten Scottish schoolchildren and their Russian peers attended a creative writing workshop in the Highlands this week
14 best kids' hoodies

14 best kids' hoodies

Don't get caught out by that wind on the beach. Zip them up in a lightweight top to see them through summer to autumn
Robert Fisk in Abu Dhabi: The acceptable face of the Emirates

The acceptable face of the Emirates

Has Abu Dhabi found a way to blend petrodollars with principles, asks Robert Fisk