Balancing risks and benefits difficult with both non-steroidals and antidepressants
Problems in balancing the benefits and risks of both non-steroidal anti-inflammatory drugs (NSAIDs) and antidepressants have been highlighted in two studies that emphasise difficulties in translating trial data to the general population (BMJ 2004;329:31 and 34).
Researchers compared the types of patients receiving NSAIDs in 219 clinical
trials and in practice. Patients over 75 years were excluded from most
trials and ethnicity was not usually reported. Trial participants were
mainly patients known to have benefited from NSAIDs and in whom the risk
of adverse events was small. Serious gastrointestinal events were poorly
reported, the researchers say. They add that some other serious adverse
events such as renal toxicity are not mentioned in any of the trials
they examined.
The “reality” as reflected by a medicines monitoring database
showed that 14 per cent of patients treated with NSAIDs were actually
over 75 years. Prescribing was also common for those at high risk of
gastrointestinal or renal problems who had been excluded from trials.The
authors conclude that evidence from trials might not be applied to everyone
likely to take a drug.
Looking at risk and benefit for antidepressants in the prevention of
suicide, another group of researchers from Bristol say that there is
no strong evidence that increases in antidepressant prescribing are linked
to recent reductions in population suicide rates. |
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