Prescribing Advice for GPs

BMJ debates international medical conferences

July 3, 2008 on 3:27 pm | In Prescribing Extra - Other |  Print | No Comments

The British Medical Journal carries a debate about international medical conferences and the environmental impact they have upon the planet.

Malcolm Green, professor emeritus respiratory medicine at Imperial College argues that face-to-face events should be a thing of the past in the medical world just as they are in many other industry sectors and that technology should be used to set up virtual conferences instead.

James Owen Drife, professor of obstetrics and gynaecology at Leeds General Infirmary argues that fact-to-face meetings allow for more effective communication which engenders the inspiration to implement change and that other mechanisms of education fail to match up.

It is notable that the voluntary ethical code administered by the Prescription Medicines Code of Practice Authority (PMCPA) on behalf of the Association of the British Pharmaceutical Industry (ABPI) contains clauses specific to this area noting that only economy travel should be funded and that “the venue must be appropriate and conducive to the main purpose of the meeting; lavish, extravagant or deluxe venues must not be used, companies must not sponsor or organise entertainment (such as sporting or leisure events) and companies should avoid using venues that are renowned for their entertainment facilities“.

Action: Clinicians may want to consider the environmental impact of attending conferences. Clinicians should also ensure that any educational event is fully complaint with the Pharmaceutical Industry’s own ethical code.

QRISK2 CV risk predictor

July 2, 2008 on 12:27 pm | In Prescribing Extra - Other |  Print | No Comments

QResearch have made the QRISK2 risk calculator available online after the British Medical Journal published a prospective validation of the tool.

This cardiovascular risk prediction tool is an improvement over a modified Framingham score based on the validation sample used. Perhaps this is due to the tool incorporating ethnicity, deprivation and a wider range of clinical conditions into the prediction model.

The authors of the paper conclude that, “QRISK2 is likely to be a more efficient and equitable tool for treatment decisions for the primary prevention of cardiovascular disease“.

The National Institute of Health and Clinical Excellence (NICE) recently published guidance on Lipid Modification recommended using Framingham risk scores but noted several limitations including excluded patient groups and corrections to ensure accuracy in a European population.

Action: Clinicians should consider which risk prediction tool to use in clinical practice. Accuracy, reliability and ease of use should all be considered.

Stronger warnings recommended for etoricoxib

July 1, 2008 on 11:07 am | In Prescribing Extra - Drugs |  Print | No Comments

The European Medicines Agency (EMEA) has recommended that the warnings and contraindications for etoricoxib are strengthened following a review conducted as part of a licence extension application.

The review assessed the risks and benefits of etoricoxib at a dose of 90mg per day for rheumatoid arthritis and ankylosing spondylitis. It was concluded that the benefits outweigh the risks but that several measures are added to prescribing information to reduce the risks of treatment.

These recommendations are detailed in a question and answer document. It is recommend that:

• Etoricoxib must not be used in patients whose blood pressure is persistently above 140/90 mmHg
• Blood pressure must be controlled before starting treatment
• Blood pressure should be monitored for two weeks after the start of treatment and regularly thereafter

Action: Clinicians should be aware of these new recommendations. As with all non-steroidal anti-inflammatory drugs (NSAIDs), cardiovascular, gastrointestinal and renal risks should be assessed before starting treatment.

Rimonabant restricted by NICE

June 30, 2008 on 11:12 am | In Prescribing Extra - Drugs |  Print | No Comments

The National Institute for Health and Clinical Excellence (NICE) has issued guidance (PDF) for using rimonabant (Acomplia^®) for the treatment of obesity.

The guidance allows the use of rimonabant but only in patients for whom orlistat and sibutramine has proved inadequate, been poorly tolerated or is contraindicated. The guidance further qualifies that steatorrhoea associated with orlistat when not adhering to dietary advice is not considered as intolerance.

Action: NICE has clearly placed rimonabant as the third line treatment for obesity after orlistat and sibutramine. Clinicians should ensure that treatment of obesity reflects this advice.

HPV vaccine announced

June 19, 2008 on 9:25 am | In Prescribing Extra - Drugs |  Print | 4 Comments

The Department of Health has announced that the national contract for human papillomavirus vaccine (HPV) has gone to Cervarix^®. This announcement has also been reported in the general media (BBC, The Times).

As previously noted, Gardasil^® has a wider range of licensed indications based on the current Summaries of Product Characteristics (Cervarix and Gardasil). In addition to the wider range of indications, Gardasil is also licensed in a wider age group and for both genders.

The official announcement notes that the decision was based on a wide range of criteria such as their scientific qualities and cost effectiveness but that the price remains commercially confidential. At a time when the NHS has a significant cash surplus it must be hoped that, for reasons of transparency, the rationale for choosing what appears to be an inferior vaccine are made public.

Action: Clinicians need to be aware of the national HPV vaccination programme and the chosen vaccine.