Tablet Press
The prescribing newsletter for GPs, nurses and pharmacists in
Northamptonshire Primary Care Trust
Issue 31
April 2009
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Rosuvastatin in the prevention of VTE – secondary outcome analysis of the JUPITER trial
This study (NEJM, published early online on 29 March 2009) has generated considerable interest from the
media in the last couple of days (for example see http://www.dailymail.co.uk/health/article-1165774/Statins-cut-
deep-vein-thrombosis-threat-long-haul-passengers.html).
Patients may be asking about this as a consequence of the publicity – so what’s the real story?
The trial initially examined the question of whether treatment with 20 mg of rosuvastatin daily, as compared
with placebo, would reduce the rate of first major cardiovascular events. The occurrence of venous
thromboembolism was a protocol-specified secondary end point of the trial.
The Daily Mail quotes a risk reduction of up to 43%; this is of course a Relative Risk Reduction. The Absolute
Risk Reduction is much smaller (as ARRs always are) with a NNT over one year of about 700 to prevent one
additional case of DVT.
There are of course, also a lot of other unanswered questions – Where would you use a statin for this
indication? How long do you need to take it - is it really an alternative to LMWH or warfarin? What about the
harms? So we are some way off from recommending this to patients.
The NPC plan to blog this study shortly – see http://www.npci.org.uk/blog/
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MHRA Drug safety update
The MHRA and CHM have published the March edition of
Drug Safety Update. This issue focuses on two
drugs used for ADHD
— providing updated guidance on the safe and effective use of methylphenidate and
details on the risk of psychotic or manic symptoms with atomoxetine. Drug safety advice is also given on the
use of antipsychotics in elderly patients with dementia, the risk of severe pancreatitis and renal failure with
exenatide
▼ and atypical stress factures with bisphosphonates.
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Adcal D3 for pre-eclampsia
Prescribers will by now be aware that the PCT is not supporting the prescribing of Omacor and Adcal D3 to
reduce pre-term birth (see previous email correspondence to GPs) as there currently does not appear to be
sufficient evidence to support this. However, Adcal D3 may still be recommended by obstetricians for pre-
eclampsia and this indication IS supported by the evidence and is therefore supported by the PCT.
Calcium supplementation during pregnancy for preventing hypertensive disorders and related
problems (review) by the Cochrane Collaboration.
12 studies were reviewed. The risk of high blood pressure was reduced with calcium supplementation rather
than placebo (11 trials with 14,946 women, relative risk 0.7, 95% confidence interval 0.57 to 0.86).
There was also a reduction in the risk of pre-eclampsia associated with calcium supplementation (12 trials,
15,206 women, RR 0.48, 95% CI 0.33 to 0.69).
The effect was greatest for high-risk women (5 trials, 587 women, RR 0.22, 95% CI 0.12 to 0.42) and those
with low baseline calcium intake (7 trials, 10,154 women, RR 0.36, 95% CI 0.18 to 0.7).
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Near Patient Testing for 5-ASAs
A couple of queries have been received regarding why sulfasalazine prescribing and monitoring carries a NPT
fee whereas other aminosalicylates do not.
Sulfasalazine requires greater monitoring because of the sulphonamide component of the molecule, which is
cleaved in the gut. In the newer aminosalicylates (like balsalazide and mesalazine), the sulphonamide-related
side-effects of sulfasalazine are avoided (although 5-aminosalicylic acid alone can still cause side-effects).
NPAG agreed that the monitoring required for the newer drugs was therefore no more onerous than say, that
for ACE inhibitors or statins, and that these drugs therefore do not need shared care protocols (i.e. are not
amber 1 drugs). The gastroenterologists supported this view.
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Community HPV clinics
Girls requesting the HPV vaccine from their GP can be signposted to the PCT’s HPV helpline number which is
01604 678 052 or alternatively they can e-mail xxx@xxxxxxxxx.xxx.xx
This edition is also available on HNN (Health Network Northants)
http://nww.northants.nhs.uk/Display/Dynamic.jsp?topid=14070&lhsid=514&oid=2854¤tid=2854
Disclaimer
Information in this newsletter is believed to be accurate and true. Northamptonshire PCT and its employees accept no liability for loss of any
nature, to persons, organisations or institutions that may arise as a result of any errors or omissions.
Contact No 01536 480446