The 56th Edition of the British National Formulary is currently being printed and distributed.
New or revised content in this version includes:
- Lipid-regulating drugs for prevention of cardiovascular disease
- Atrial fibrillation
- Application and labelling of topical corticosteroids
- Human papilloma virus vaccine
- Safety advice on erythropoietins and hypersensitivity to penicillins and cephalosporins
- Updated tables for acute asthma management and HRT risk
The web version has already been updated and printed version is available for purchase.
The print version is distributed by the Department of Health to Dentists, Doctors, Nurses and Pharmacists providing NHS services.
Action: All clinicians should start using BNF 56 as soon as the print version arrives. The web version can be used to access the latest information if necessary.
The New England Journal of Medicine has published the results of a study that aimed to assess the efficacy of arthroscopic surgery in patients with osteoarthritis of the knee. The general media have reported this study (BBC).
The study recruited 178 patients with moderate to severe osteoarthritis of the knee. All patients received optimized physical and medical therapy with 92 patients randomly assigned to undergo surgery to involve lavage and debridement. 86 patients actually underwent the surgical procedure.
The primary outcome of the study was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score that assesses symptoms, pain, stiffness and functioning. A secondary outcome assessed quality of life.
At the end of the two-year study there was no statistical difference in either the primary or secondary outcome. Additionally, there were no differences at any of the interim analyses. The authors conclude that, "arthroscopic surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy".
Current NICE Guidance (PDF) does allow this procedure on the NHS however the document states that, "treatment options depend on the severity of the osteoarthritis" and that, "patient selection is important".
Action: Clinicians should ensure that this procedure is only carried out on patients who are likely to gain most benefit. All patients should receive optimized physical and medical therapy.
The Scottish Medicines Consortium (SMC) has issued its monthly advice on new medicines.
Arirpiprazole (Abilify®) has been rejected for the treatment of moderate to severe manic episodes in bipolar 1 disorder and for the prevention of a new manic episode because the economic analysis was not sufficiently robust to gain acceptance.
Ropinirole prolonged release (Requip XL®) has been accepted for the treatment of idiopathic Parkinson’s disease in patients already taking ropinirole immediate release tablets and have attained adequate symptomatic control.
Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.
Clinical Knowledge Summaries (CKS) has been updated in September for the following clinical areas:
Action: Clinicians who see patients with any of these conditions may find the updated information useful when reviewing current clinical practice.
The Annals of Internal Medicine has published a review of internal documents that were made public during legal proceedings that confirm the existence of seeding trials.
It has been suspected for some time that drug companies entice some clinicians into prescribing drugs that are new to the market by designing clinical study protocols.
This review examined several internal documents related to the ADVANTAGE study that compared rofecoxib to naproxen in terms of gastrointestinal safety and tolerability in patients with osteoarthritis. These documents reveal that the marketing division were involved in the design, analysis and publication of this study.
Action: This review confirms the existence of seeding trials. Clinicians who are involved in clinical research should ensure that they only participate in studies that answer clinically valid and necessary questions. Any suspicion that the study is a marketing exercise should immediately discourage participation.
Thanks to Kevin Ashworth for spotting this review.
