Latest news and product developments

An analysis of the UK General Practice Research Database has found that both glitazones increase the risk of fracture more than two‐fold (Arch Intern Med 2008;168:820‐5).

Compared with nonusers, the odds ratio for fracture (mostly hip and wrist) was 2.59 for pioglitazone and 2.38 for rosiglitazone. The risk increased with dose but was unrelated to age and sex.

Antipsychotics should be prescribed for patients with dementia only as a last resort at times of severe distress or critical need, the All‐Party Parliamentary Group on Dementia has concluded.

Its inquiry (available at www.alzheimers.org.uk) found that antipsychotics are being prescribed for patients with mild behavioural symptoms and for prolonged periods despite the limited benefits they offer and the risk of serious adverse effects such as stroke. Contributory factors include lack of training for staff, inadequate leadership and exclusion of family and friends from decisions about treatment.

High‐dose atorvastatin (Lipitor) reduces cardiovascular events in patients with chronic kidney disease (CKD) more than a low dose — despite similar reductions in LDL‐C (J Am Coll Cardiol 2008;51:1448‐54).

A post hoc subgroup analysis of the Treating‐to‐New‐Targets study involving 10 001 patients with CHD, with or without CKD, found that atorvastatin 10 and 80mg per day reduced LDLC and triglycerides to similar levels; there was no change in HDL‐C. After a median follow‐up of five years, the incidence of cardiovascular events in patients with CKD was 9.3 per cent at 80mg per day and 13.4 per cent at 10mg per day (number needed to treat to prevent one event, NNT, 24). In patients with no CKD, the corresponding figures were 7.9 vs 9.2 per cent (NNT 74).

There was no difference in all‐cause mortality; adverse events were more frequent at the higher dose.

An economic analysis of COX‐2 selective NSAIDs has concluded that they are not more cost effective than older agents plus a proton pump inhibitor (PPI) in the treatment of osteoarthritis and rheumatoid arthritis (Health Technology Assessment 2008;12:No. 11).

The analysis concluded that selective and nonselective NSAIDs were similarly effective but selective agents were associated with a lower risk of upper GI events and a higher risk of cardiovascular events. However, the available evidence includes only low numbers of events and further studies are needed.

Compared with ibuprofen or diclofenac plus a PPI, the COX‐2 selective NSAIDs look ‘generally unattractive from a cost effectiveness point of view’, even in high‐risk patients with a history of peptic ulcer. There were insufficient data to allow a reliable comparison within the COX‐2s.

Naftidrofuryl increases pain‐free walking distance (PFWD) in patients with intermittent claudication, a new Cochrane review has shown (Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD001368. DOI: 10.1002/ 14651858.CD001368.pub3; also see page 49 in this issue). The meta‐analysis of six trials involving a total of 1083 patients found that, compared with placebo, naftidrofuryl increased PFWD by over a third with a proportion successfully treated of 20 per cent (NNT 4.5).

To clarify any confusion following our recent news item (Perindopril brand switch, 19 April issue, page 12), Servier has asked us to reiterate that the new formulations Coversyl Arginine 2.5, 5 and 10mg are equivalent to 2, 4 and 8mg of the discontinued Coversyl formulation. Coversyl Arginine contains perindopril arginine, a salt that offers greater stability and a longer shelf‐life. Prescriptions for the Coversyl brand of perindopril must in future be written as Coversyl Arginine in its revised strengths.

Coversyl Plus has also been replaced by Coversyl Arginine Plus and the same revised dosages apply. Generic formulations of perindopril remain unaffected. Copyright © 2008 Wiley Interface Ltd