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Prescribing
Did PJ misreport NICE guidance?
From Mr N. J. Staunton,
MRPharmS
A recent PJ news
feature covered the Health Select Committee’s
report on the pharmaceutical industry (PJ, 30 April, p514). I enjoyed
reading this concise report of the lengthy select committee paper. The
report included good advice from the well respected National Prescribing
Centre, which directed criticism at both pharmaceutical companies and
the media for misrepresenting information on drugs.
I was therefore rather surprised to read a news
item in the PJ just four
weeks later which seems to misrepresent recent National Institute for
Health and Clinical Excellence guidance (PJ, 28 May, p641). The PJ news
headline states “NICE restricts clopidogrel and dipyridamole”.
NICE guidance actually clearly differentiates between clopidogrel and
dipyridamole in combination with aspirin and says: “The combination
of modified-release (MR) dipyridamole and aspirin is recommended for
people who have had an ischaemic stroke or a transient ischaemic attack
for a period of two years from the most recent event.” In contrast,
NICE states: “Clopidogrel alone (within its licensed indications)
is recommended for people who are intolerant of low-dose aspirin and
either have experienced an occlusive vascular event or have symptomatic
peripheral arterial disease.”1
NICE actually goes on to estimate an increase in sales of MR dipyridamole
and aspirin from £2.6m in 2003 to anything between £10.1
and £11.9m in the first year, with a decrease in sales of clopidogrel
from £86.8m in 2003 to between £7.6m and £25.2m (although
NICE does point out that it is not clear exactly how much of the £86.8m
is spent on which indications).
Might I respectfully suggest that the PJ takes its own advice and reports
objectively and accurately on important issues such as NICE guidance
in future?
Noel Staunton
Isle of Wight
Reference
1. National Institute for Health and Clinical Excellence. Guidance
on vascular disease — clopidogrel and dipyridamole No 90 — May
2005. National Institute for Clinical Excellence, 2005.
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The guidance to which Mr Staunton refers relates to the prevention
of occlusive vascular events and makes recommendations about use of
clopidogrel
and modified-release dipyridamole. Clopigogrel (Plavix) is licensed
for prevention of atherothrombotic events in patients suffering from
myocardial
infarction, ischaemic stroke or established arterial disease. MR dipyridamole
is licensed for secondary prevention of ischaemic stroke and transient
ischaemic attacks either alone (Persantin Retard) or in conjunction
with aspirin (Asasantin Retard). NICE restricts use of clopidogrel to
only
those patients who cannot tolerate aspirin. It also restricts the use
of MR dipyridamole to use with aspirin and also for a period of two
years post event. The Scottish Medicines Consortium, an organisation
with functions
similar to those of NICE, uses the term “restricted use” whenever
it makes recommendations that limit use compared with the licensed indications
for a drug
— EDITOR
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