PATIENTS SELF-PRESCRIBE ‘CANCER-PREVENTING’ ASPIRIN AS PHARMACY SALES SOAR
From the FMS Global News Desk of Jeanne Hambleton 3 August 2014 By Caroline Price Pulse Today
Exclusive Pharmacies have reported big hikes in aspirin sales in the past week after UK academics called for people in late-middle age to start taking daily doses of the drug to prevent stomach and bowel cancer, Pulse has learnt.
Health retailer Superdrug reported a doubling in the amount of low-dose aspirin sold last week in its stores, recording a 229% increase in sales on the preceding week.
The figures came as UK experts claimed the benefits of taking a low dose of aspirin daily to prevent stomach and bowel cancer outweigh any risks for most people aged 50-65.
The researchers had warned there were still some doubts regarding the evidence – in particular over what dose should be taken and for how long – and advised people to consult their GP before choosing to self-prescribe aspirin.
But one Superdrug store in Bolton last week reported a massive 500% increase in sales after the announcement, a finding reflected by a big jump in national sales of 75 mg aspirin across Superdrug stores nationally compared with the previous week – and a 400% increase in the London region.
A spokesperson for Superdrug told Pulse: ‘Aspirin sales were up 229% nationally week on week, on aspirin 75mg last week in comparison to the week before. In London sales were up 400% week-on-week.’
Elsewhere independent chain LloydsPharmacy told Pulse they had noticed a smaller but still marked increase in sales nationally, with a 27% increase in the volume of sales compared with the same week last year, and a 36% increase in volume compared with the preceding week.
Boots declined to share information on its aspirin sales while Day Lewis, Morrisons and Whitworth said they had not seen a big change in the overall pattern of sales.
GP leaders stressed there is still not enough evidence to recommend anyone takes aspirin routinely for cancer prevention – but said it was more appropriate for the public to consult their local pharmacist about the pros and cons, rather than visiting over-stretched GPs.
Dr Andrew Green, chair of the GPC clinical and prescribing subcommittee, said: ‘I would be encouraging people to have a chat with their pharmacist about it rather than their GP. Whether someone should be taking aspirin or not is well within the pharmacists’ competence.’
He added: ‘The advice from a GP I would suggest is at the moment is we don’t have enough evidence to recommend it for everybody. If a patient wants to disregard that and take it then they should still get some advice – but the pharmacist can advise them if there is anything in their past medical history or their current prescriptions that means they shouldn’t take aspirin.’
Dr Richard West agreed that while people should get advice before deciding to take aspirin, consulting a GP may not be necessary.
Dr West said: ‘It’s a difficult balance – there are undoubtedly some risks from taking it and therefore it is worth discussing it with an appropriate healthcare professional beforehand.
‘However, as we know general practice is under a lot of pressure at the moment and therefore if a pharmacist felt capable of giving that advice then I think that would be perfectly appropriate.’
A spokesperson for the Royal Pharmaceutical Society said: ‘Pharmacists are well practiced in dealing with requests for treatments following a big media story. The links between cancer prevention and aspirin are not new but as yet haven’t lead to a change in indication or licence of aspirin.
‘Although aspirin is often portrayed as a wonder drug, it can cause serious harms, especially in people with pre-existing conditions such as stomach ulcers.’
ASPIRIN FOR PRIMARY PREVENTION IN DIABETES ‘SHOULD BE RESTRICTED’
From the FMS Global News Desk of Jeanne Hambleton 9 May 2013 By Caroline Price Pulse Today
Daily low-dose aspirin treatment does not prevent cardiovascular events or death in people with type 2 diabetes and no previous cardiovascular disease (CVD), and may even increase the risk of coronary heart disease (CHD) in female patients, shows a large cohort study.
Researchers analysed the outcomes of 18,646 men and women with type 2 diabetes and no CVD history, aged between 30 and 80 years, over an average of four years beginning in 2006, using data from the Swedish National Diabetes Registry. In all, 4,608 patients received low-dose (75 mg/day) aspirin treatment while 14,038 patients received no aspirin treatment, giving 69,743 aspirin person-years and 102,754 non-aspirin person-years of follow-up.
Aspirin treatment was not associated with any benefit in terms of cardiovascular outcomes or mortality, after propensity score and multivariable adjustment. Aspirin-treated and non-aspirin-treated groups had equivocal risks of the outcomes non-fatal or fatal CVD, fatal CVD, fatal CHD, non-fatal or fatal stroke, fatal stroke and total mortality.
Patients who received aspirin had a significant 19% increased risk of non-fatal or fatal CHD; further analysis stratifying the group by gender showed this was driven by a significant 41% increased risk in women, while there was no increased risk in men. Women also had a 28% increased risk of fatal or non-fatal CVD.
There was also a borderline significant 41% increase in risk of non-fatal or fatal total haemorrhage with aspirin, but this association became weaker when broken down by gender.
Risks of cerebral or ventricular bleeding did not differ between groups, but aspirin use was associated with a significant 64% increased risk of ventricular ulcer, driven by a 2.3-fold increased in women, while no increased risk was found in men.
Furthermore, the effects of aspirin on these endpoints were similar in patients with high estimated CV risk (five-year risk 15% or higher) and those with low estimated CV risk (five-year risk below 15%).
What this means for GPs.
The results support current guidance from the European Society of Cardiology and the European Association for the Study of Diabetes that do not recommend primary prevention with aspirin in patients with diabetes, but conflict with the NICE type 2 diabetes guidelines, which recommend primary prevention with 75 mg/day aspirin in patients aged 50 years or older if their blood pressure is below 145/90 mm/Hg and in patients younger than 50 who have another significant cardiovascular risk factor.
The authors conclude: ‘The present study shows no association between aspirin use and beneficial effects on risks of CVD or mortality in patients with diabetes and no previous CVD and supports the trend towards a more restrictive use of aspirin in these patients, also underlined by the increased risk of ventricular ulcer associated with aspirin.’
GPS TOLD TO REVIEW ASPIRIN USE IN PATIENTS WITH ATRIAL FIBRILLATION
From the FMS Global News Desk of Jeanne Hambleton 18 June 2014 By Caroline Price Pulse Today
GPs are to be tasked with reviewing all their patients with atrial fibrillation who are taking aspirin, under final NICE guidance published today that recommends anticoagulant therapy as the only option for stroke prevention in these patients.
The new guidance means GPs will need to start advising patients with atrial fibrillation who are on aspirin to stop taking it, and encourage them to take warfarin or one of the newer oral anticoagulants.
NICE said just over a fifth of the UK population with atrial fibrillation – around 200,000 patients – are currently on aspirin, many of whom should be able to be switched onto anticoagulation therapy of some sort.
GP leaders have warned that practices do not have the capacity to proactively call in patients, and suggested that changing management of this number of patients could only be achieved through incentive schemes such as enhanced services or the QOF.
But NICE advisors and CCG cardiology leads have claimed that GPs can do the reviews opportunistically over the coming year.
The final publication comes after it emerged the GPC had raised serious concerns over the complexity of the draft guidance – and warned CCGs would need to consider developing enhanced services to support GPs in delivering it.
Dr Andrew Green, chair of the GPC’s clinical and prescribing subcommittee, told Pulse GPs should feel they can refer patients on if they are not able to deal with all the changes as part of annual reviews.
Dr Green said: ‘I would expect GPs as part of their normal work to consider whether [atrial fibrillation] patients not on anticoagulation should be, in the light of the new guidance. If they should be, then the choice is between anticoagulation with warfarin or one of the newer agents, and if GPs do not feel they have the expertise or resources to do this properly, they have a duty to refer to someone who can.’
He added: ‘Commissioners need to predict this activity and may want to commission a service specifically for this which is more cost-effective than a traditional out-patient referral.’
Local GP leaders told Pulse practices would not take a systematic approach to reviewing and updating patients’ medications unless the work was specifically funded.
Dr Peter Scott, a GP in Solihull and chair of the GPC in West Midlands, said: ‘It’s not going to happen unless it’s resourced and incentivised as part of a DES or LES, or through the QOF – until then I don’t think a systematic approach to this will happen.’
But Dr Matthew Fay, a GP in Shipley, Yorkshire, and member of the NICE guidelines development group, acknowledged the workload concerns and said GPs should be advised to review patients opportunistically.
Dr Fay said: ‘I think it’s perfectly acceptable [to review patients opportunistically]. A lot of these patients who are at risk in this situation we will be reviewing because of their hypertension and other comorbidities, and those patients on aspirin should have that discussed at the next presentation.’
He added: ‘I think anticoagulation is an intimidating topic for clinicians – both in primary and secondary care. I would suggest one person in each practice one clinician is involved with the management of the anticoagulated patients – whether that’s keeping a check on them during the warfarin clinic or being the person who initiates the novel oral anticoagulants.
‘If GPs feel uncomfortable with [managing anticoagulation] then they should be approaching the CCG executive to say, “we need a service to provide expert support for this”. The CCG may choose to come up with an enhanced service – but then whoever is providing the service needs to make sure they are well versed in use of the latest anticoagulants.’
The new guidance says GPs must use the CHA2DS2-VASc score to assess patients’ stroke risk and advise any patients with a score of at least one (men) or two (women) to go onto anticoagulation therapy with warfarin, or another vitamin K antagonist, or with one of the novel oral anticoagulants (NOACs) dabigatran, apixaban or rivaroxaban.
It adds that aspirin should no longer be prescribed solely for stroke prevention to patients with atrial fibrillation.
The HAS-BLED score should be used to assess patients’ risk of bleeding as part of the decision over which anticoagulant to choose.
In the only major revision to the draft guidance, aspirin is no longer to be considered even as part of dual antiplatelet therapy for patients at particularly high bleeding risk, as this combination has now also been ruled out.
BENEFITS OF ASPIRIN A DAY FOR CANCER PREVENTION IN MIDDLE-AGED PEOPLE ‘OUTWEIGH HARMS
This story was published a few days ago