GI Disease (gi + disease)

Distribution by Scientific Domains


Selected Abstracts


Quantitative assessment of the gastrointestinal and cardiovascular risk-benefit of celecoxib compared to individual NSAIDs at the population level,,

PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 4 2007
Cristina Varas-Lorenzo MD
Abstract Purpose To estimate the net cardiovascular (CV) (coronary heart disease, stroke, congestive heart failure), and gastrointestinal (GI) (peptic ulcer complications) risk-benefit public health impact of the use of celecoxib compared to non-selective NSAIDs in the arthritis population. Methods We applied discrete event simulation models to data from the US National Health Surveys, CV risk-prediction models from the Framingham Heart Study, and population-based studies. Models took into account the multifactorial effect of risk factors, comorbidity, and competing risk of mortality. We simulated the natural history of CV and GI disease in the U.S. arthritis population over 1 year, through the individual baseline cardiovascular and gastrointestinal risk profile. This model was modified with relative risks associated with the use of each treatment. The mean number of events was estimated for each end-point in each model: natural history, celecoxib, diclofenac, ibuprofen, naproxen. The number of events for celecoxib was compared with each NSAID. Results The evaluation included 1% of the U.S. population with arthritis. Celecoxib, when applied to 100,000 patients over 1 year, resulted in 570 (range from sensitivity analysis: 440,691), 226 (124,313), and 746 (612,868) fewer ulcer complications than diclofenac, ibuprofen, and naproxen, respectively. There were 20 (16,25), 8 (4,12), and 27 (22,32) fewer deaths from ulcer complications, respectively. No increase in cardiovascular events or all cause mortality was observed for celecoxib versus the other individual NSAIDs. Conclusion Results from these simulations suggest a gastrointestinal benefit for celecoxib not offset by increased cardiovascular events or mortality. The methodology used here provides a risk-benefit assessment framework for evaluating the public heath impact of drugs. Copyright © 2006 John Wiley & Sons, Ltd. [source]


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PRESCRIBER, Issue 11 2006
Article first published online: 14 SEP 2010
NSAIDs linked to erectile dysfunction Use of NSAIDs may double the risk of erectile dysfunction, according to an observational study from Finland (J Urol 2006;175:1812-6). A survey of 1683 men aged 50-70 showed that, over a five-year period, the incidence of erectile dysfunction was 93 per 1000 person-years of NSAID use compared with 35 per 1000 person-years in nonusers. After controlling for risk factors and compared with nonusers of NSAIDs who did not have arthritis, the relative risk was greater in NSAID users whether they had arthritis (1.9, 95% CI 1.2-3.1) or not (2.0, 95% CI 1.2-3.5). The risk was somewhat higher in nonusers with arthritis (1.3, 95% CI 0.9-1.8). Inhaled steroids do not modify asthma course Fluticasone does not ameliorate the course of asthma in young children, say US investigators (N Engl J Med 2006;354:1985-97). Fluticasone 88,g twice daily controlled symptoms for two years in 285 children aged two to three. However, in the following treatment-free year there were no differences from placebo in asthma-free days, lung function or exacerbation frequency. Fluticasone was associated with a 1.1cm reduction in growth during treatment, though this decreased to 0.7cm after a year without treatment. A second study (N Engl J Med 2006;354:1998-2005) found that introducing an inhaled steroid after a three-day episode of wheezing in one-month-old infants did not prevent the development of persistent wheezing in the first three years of life. Prescribing for fracture prevention increases Prescribing of medicines to reduce fracture risk in post-menopausal women has tripled in the last five years, according to a PPA prescribing review (www.ppa.org.uk/news/pact-052006.htm). The change predates NICE guidance on secondary prevention, published in 2005. Approximately 480 000 women in the UK receive treatment. Alendronic acid accounts for almost a third of prescriptions and half of the £45 million spent in the last quarter of 2005. There was a two-fold variation in prescribing costs between strategic health authorities. Pharmacist prescribing for hypertension A survey of patients attending a pharmacist-led clinic for hypertension has found overwhelming support for pharmacist prescribing (Pharm J 2006;276:567-9). All 127 patients offered an appointment at a hypertension clinic run by pharmacist supplementary prescribers were surveyed; the response rate was 87 per cent. Eighteen respondents chose not to attend, of whom five preferred their usual medical care. Responses from 88 patients revealed that 57 per cent believed the standard of care was better than previously, and 86 per cent said they now understood more about their condition, felt more involved in treatment decisions and were able to make an appointment easily. Ninety-two per cent considered pharmacist supplementary prescribing a good idea. Anti-TNFs linked to malignancy/infections The anti-TNF monoclonals infliximab (Remicade) and adalimumab (Humira) are associated with an increased risk of cancer and serious infections in patients with rheumatoid arthritis (JAMA 2006;295:2275-85). A meta-analysis of nine randomised trials involving 3493 treated patients showed that, compared with placebo, these agents were associated with an odds ratio (OR) of 3.3 (95% CI 1.2-9.1) for malignancy, and there was evidence of a dose-response effect. The number needed to harm (NNH) for one additional malignancy in 6-12 months' treatment was 154. There was also an increased risk of serious infection (OR 2.0; 95% CI 1.3-3.1), for which the NNH was 59 for one case in 3-12 months' treatment. The authors say that the findings were based on low numbers of events and should be interpreted cautiously. Travelling abroad with CDs Aintree Hospitals NHS Trust has published a guide to help patients who travel abroad while taking controlled drugs (www.aintree hospitals.nhs.uk/publications/file.aspx?int_version_id=912). The leaflet explains the need for a licence and provides contact details for relevant organisations. New PCTs announced The government has announced the long-awaited reorganisation of PCTs in England (www.dh.gov.uk/PublicationsAndStatistics/PressReleases/PressReleases Notices/fs/en?CONTENT_ID=4135001&chk=j12UcL). The current total will be reduced from 303 to 152 from 1 October. More than 70 per cent will be co-terminous with local authorities in the hope that services will be delivered more efficiently. The changes will reduce administrative costs, with anticipated savings of £250 million in the next two years. The reorganisation of PCTs follows a restructuring of strategic health authorities and was the subject of a major public consultation exercise in 2005/06. There will also be a reorganisation of ambulance trusts, reducing the number from 29 to 12. Regional maps of the new PCT boundaries are available atwww.dh.gov.uk/ NewsHome/NewsArticle/fs/en?CONTENT_ID=4135088&chk=oJufTo. New and updated guides New medicines guides for GI disease have been published by the Medicines Information Project at http://medguides.medicines.org.uk. PRODIGY has issued 11 updated and five new full guides and has also updated five of its quick reference guides (www.prodigy.nhs.uk). [source]


Treatment of functional GI disease: the complex pharmacology of serotonergic drugs.

BRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 6 2002
Reply from author
No abstract is available for this article. [source]


Amoxicillin Resistance in Helicobacter pylori: Studies from Tokyo, Japan from 1985 to 2003

HELICOBACTER, Issue 1 2005
Kazuhiro Watanabe
ABSTRACT Background., Previous reports revealed no resistant strains of amoxicillin (AMPC), which is usually used in eradication therapy for H. pylori infection. However, the frequency and evolution of natural AMPC-resistant strains in the Japanese population remains unknown. Aim., To assess the prevalence of H. pylori resistance against AMPC in the Tokyo area, a collection of 648 H. pylori strains isolated from patients with GI diseases from 1985 to 2003 was tested for their sensitivity to AMPC. Methods., The susceptibility of the strains was assessed by determination of the minimal inhibitory concentration (MIC) using the E -test and/or the Dry-plate method. The susceptibility breakpoints of AMPC for H. pylori were: sensitive (AMPC-S); MIC < 0.04 µg/ml, intermittent resistance (AMPC-I); 0.04,1, resistant (AMPC-R); > 1. Results., No AMPC-R strains were detected in the strains isolated between 1985 and 1996, while the rate of resistance was determined to be 1.1%, 2.1%, 5.4%, 5.6%, 0%, 8.8%, and 1.5% every year, respectively, from 1997 to 2003. The percentage of AMPC-I strains increased from 2000 to 2003. The total eradication rate of H. pylori in the patients who received triple therapy containing AMPC was 81.4% (214/263). Classified as above, the rates of AMPC-S, AMPC-I, and AMPC-R were 84.6%, 77.8%, 25%, respectively. Conclusion.,H. pylori resistance to AMPC is still rare in Japan, although the percentage of AMPC-I strains has increased over the last 4 years. The frequency of isolation of strains showing true resistance to AMPC may increase in the future, along with an increase in the frequency of isolation of AMPC-I strains. [source]