CSM adviser stands down over latest HRT warnings
An adviser to the Committee on Safety of Medicines has stood down from his position on an expert working group following the committee's latest recommendations on hormone replacement therapy (HRT).
Professor David Purdie, a consultant to the Edinburgh Osteoporosis Centre,
disagrees with CSM advice that HRT should no
longer be recommended as
first-line therapy for the prevention of osteoporosis (PJ, 6 December,
p768). He told The Journal: “I took the view that HRT should be
retained as first-line treatment for younger women. But I did not persuade
the committee.”
The CSM recommendation states that HRT should be an option only for women
who are unresponsive or intolerant of other osteoporosis prevention therapies,
or for women in whom such therapies are contraindicated. The advice is
based on a review of recent studies looking at the long-term risks and
benefits of HRT. The studies provide increasing evidence that long-term
HRT use is associated with an increased risk of certain cancers. The
review concludes:
• The risk:benefit ratio of HRT is favourable for treatment of menopausal
symptoms (the minimum effective dose should be used for the shortest
duration)
• The risk:benefit ratio of HRT is unfavourable for prevention of osteoporosis
as first-line use
• In healthy women without symptoms, the risk:benefit ratio of HRT is
generally unfavourable
The conclusions and CSM advice apply to all conventional oestrogen-only
and combined (oestrogen plus progestogen) HRT products licensed for the
prevention of osteoporosis.
In a letter to health care professionals, including prescribing advisers,
community pharmacists and medical information pharmacists, Professor
Gordon Duff, chairman of the CSM, said: “This new advice does not
necessitate any urgent changes but women currently receiving HRT as long-term
prophylaxis should have their treatment reviewed at the next appointment.”
A spokeswoman for the Department of Health told The Journal that there
were no plans to withdraw the CSM advice following Professor Purdie’s
resignation. |
