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13-02-2013 | Article

High diclofenac use questioned

Abstract

PLoS Med 2013; 10: e1001388

Diclofenac accounts for almost a third of prescriptions for non-steroidal anti-inflammatory drugs (NSAIDs) in England, despite its known association with increased cardiovascular risk, researchers report.

A study of data from 15 countries worldwide shows that despite information about this risk being known for several years, little action has been taken to reduce prescribing rates.

"There has been a slow decline in prescription numbers in England, Australia, and Canada since 2006 but it remains popular in all three countries, particularly in England where it is the single most-prescribed NSAID," say authors Patricia McGettigan, from Barts and The London School of Medicine and Dentistry, and David Henry, from the University of Toronto in Ontario, Canada.

Yet the researchers point out that diclofenac is associated with around the same magnitude of cardiovascular risk as rofecoxib, which was withdrawn from markets 8 years ago owing to cardiovascular toxicity.

From reviewing meta-analyses of NSAID trials, the team found that relative risks of serious cardiovascular events with use of rofecoxib (versus non-use) ranged from 1.27 to 1.45, while for diclofenac they ranged from 1.38 to 1.63. Naproxen had the lowest risk, with five of the six meta-analyses finding it risk-neutral.

According to the World Health Organization, diclofenac is included on the essential medicine lists (EMLs) of 74 countries, and was the most commonly used NSAID in the 15 countries studied, the authors say in PLoS Medicine.

They call for diclofenac to be removed from EMLs in favour of alternative drugs: "Lower risk NSAIDs, including naproxen and low-dose ibuprofen, are widely available and are equally efficacious," write McGettigan and Henry. Furthermore, they add: "Both are available as generics."

Medical News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Caroline Price, Senior medwireNews Reporter