Today is No Smoking Day and this year the theme is WeQuit.
The web site contains information and resources to help people quit smoking. This year there is also an increase in use of internet and technology solutions such as a video blog, Twitter and Facebook pages and even an App for the iPhone that counts days, hours minutes and seconds since someone quit smoking and also how much money they have saved.
Action: Clinicians should be aware of these materials and use them to support local smoking cessation activities.
The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for March 2010 (PDF).
This issue contains drug safety advice regarding a possible small increase in the risk of congenital cardiac defects when fluoxetine is taken early in pregnancy. This information comes from an analysis of epidemiological data from seven cohort studies. The background rate of congenital cardiac defects is approximately 1/100 and these results indicate that fluoxetine increased absolute risk to less than 2/100 pregnancies. This is similar to the risk increase seen with paroxetine. Clinicians are advised that this potential for increased risk should be considered in the context of the benefits of treating depression in pregnancy.
Attention is also drawn to inter-test differences when monitoring therapeutic levels of sirolimus. These differences may inadvertently lead to inappropriate dose adjustments. Care should be taken to ensure that the test used is unchanged before making dose adjustments.
Finally, Drug Safety Update has been accredited by NHS Evidence in recognition of the high quality guidance that is issued. Future Drug Safety Updates will be available at http://www.evidence.nhs.uk and will display the accreditation mark.
Action: Clinicians will find this publication to be a useful review of current issues in drug safety.
The Scottish Medicines Consortium (SMC) has issued its monthly advice on new medicines.
Ketoprofen and omeprazole (Axorid®) has been rejected for the symptomatic treatment of rheumatoid arthritis, ankylosing spondylitis and osteoarthritis in patients with a previous history or who are at risk of developing NSAID associated ulcers or erosions in whom continued treatment with ketoprofen is essential. The economic analysis provided was not sufficiently robust to gain approval.
Saxagliptin (Onglyza®) has been accepted for restricted use in adult patients with type 2 diabetes mellitus as add-on combination therapy with metformin, when metformin alone, with diet and exercise, does not provide adequate glycaemic control. This agent is only recommended when the addition of sulphonylureas is not appropriate and is an alternative to other agents such as thiazolidinediones (glitazones).
Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected and restricted medicines should be avoided.
The Journal of the American Medical Association (JAMA) has published the results of a study that aimed to assess the efficacy of aspirin in preventing primary cardiovascular events in patients with a low ankle brachial index (ABI).
ABI is the ratio of systolic blood pressure at the ankle and arm. ABI is used to diagnose peripheral vascular disease and is associated with an elevated risk of coronary events.
3,350 men and women aged 50 to 75 were recruited to the study. None had clinical cardiovascular disease but all had ABI less than or equal to 0.95. Follow up was for a mean of 8.2 years for a primary composite outcome of fatal or nonfatal coronary event, stroke or revascularisation. Participants were randomly assigned to treatment with 100mg aspirin daily or matching placebo.
The study found no significant difference in the rate of the primary outcome between the two study groups (Hazard Ratio 1.03, 95% confidence interval 0.84 - 1.27). Additionally, there were no differences in the two secondary outcomes (a composite of the primary outcome and angina, intermittent claudication or transient ischaemic attack or all-cause mortality). The study also assessed the rate of major haemorrhage requiring a hospital admission. This was higher in the patients treated with aspirin but the difference was not significant (HR 1.71, 95% CI 0.99 - 2.97).
The authors conclude that among this population "the administration of aspirin compared to placebo did not result in a significant reduction in vascular events". The authors also suggest that ABI assessment is unlikely to be a useful screening tool in primary care settings.
The results of the study may be limited by low levels of medication compliance with the treatments taken for 60% of the trial person-years. Also, the study was designed and powered to detect a 25% relative reduction in events. Recent analyses have indicated that aspirin may only produce a 12% reduction and perhaps this study was underpowered.
Action: This study adds some more weight to the conclusions reached by the Drug and Therapeutics Bulletin that the use of aspirin in the primary prevention of cardiovascular events is unjustified.
The Department of Health (DH) has published the results of a survey into the drinking habits of more than 2,000 English adults.
The survey found that 22% of respondents have drunk more alcohol than they planned because of peer pressure. 39% stated that they made up an excuse or lied to avoid another drink.
However, the survey also noted that these steps may be unnecessary because the survey also found that:
- Only 1% of respondents think less of people who refuse a drink or choose to drink less than them
- Just 4% expect their friends to keep up with them when drinking
- Only 2% admit to piling on the pressure for friends to drink more when they don’t want to
The DH has also issued the following advice to those wanting to drink less:
- Take it a day at a time: try and cut back a little every day. Each day you cut back is a success
- Make it a smaller one: you can still enjoy a drink but have less. Try bottled beer instead of a pint or a small glass of wine instead of a large
- Have a lower strength drink: manage how much you drink by swapping a strong strength beer or wine for one with a lower ABV [Alcohol By Volume]
- Take a break: have the odd day here and there when you don’t have a drink
Action: Clinicians may find this information useful when advising patients on strategies to reduce alcohol consumption. The results of this survey indicate that peer pressure to drink is more of an internal pressure than an external one.
