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Medicines optimisation: improving safety and reducing treatment burden among people taking non-steroidal anti-inflammatory drugs or disease modifying anti-rheumatic drugs

Principal Investigator: Dr Simon Fraser

Team members: Dr Simon Fraser (Associate Professor of Public Health. School of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital), Professor Chris Edwards (Professor of Rheumatology, Southampton and Associate Director of the NIHR Clinical Research Facility) Dr Chris Holroyd (Consultant Rheumatologist, University Hospital Southampton NHS Foundation Trust), Dr Kinda Ibrahim (Senior Research Fellow, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust), Dr Ravina Barrett (Pharmacist, University of Portsmouth), Dr Clare Howard (Chief Pharmacist, Medicines Optimisation, Wessex AHSN), Dr Mary O’Brien (NHS England, NHS Rightcare), Dr David Culliford (Senior Medical Statistician, Health Sciences, University of Southampton), Professor Paul Roderick (Professor of Public Health, Primary Care and Population Sciences, University of Southampton), Professor James Batchelor (Director Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton), Dr Matthew Stammers (Senior Endoscopy Fellow, University Hospital Southampton and Clinical Informatics Research Fellow at Clinical Informatics Research Unit)

Start: 1 October 2019 Ends: 30 September 2021

Project Partners: University Hospital Southampton NHS Foundation Trust, NHS England (NHS Rightcare), University of Portsmouth, University of Southampton, Academic Health Sciences Network (AHSN) Wessex.

 

Lay summary
Painful conditions associated with age (such as arthritis) are common in the UK and safe pain relief options for older people are limited. Anti-inflammatory drugs such as ibuprofen are widely used – both bought from the pharmacy and prescribed by doctors, but they have significant risks, such as bleeding from the stomach and kidney damage.  Older people and those with certain long-term medical conditions are at higher risk of experiencing bad effects from these drugs.

Another issue concerns people who are taking one of a group of medications call ‘disease-modifying anti-rheumatic drugs’ (DMARDs). These drugs are often used for rheumatoid arthritis and work by slowing its progression, reducing the likelihood of severe joint damage and other related health problems. They are also used for inflammatory bowel diseases, such as Crohn’s disease. Methotrexate is one of the most commonly used DMARD in arthritis and azathioprine is one of the most commonly used in inflammatory bowel disease. Anti-TNF drugs are an important group of so called ‘biological agents’ – another type of DMARD. DMARDs are powerful drugs that require regular blood tests to check for adverse effects, such as liver problems, and guidelines advise how often these tests should be done. However, for most people, these blood tests are almost never abnormal, and could potentially be safely done less frequently. In addition, some people with inflammatory arthritis have an excellent response to DMARDs.  Stopping DMARDs can lead to flare ups of disease, but the amount of therapy used may be tapered successfully to reduce dose-dependent adverse events and costs.

In one part of this research we will use an anonymous database of about half a million people from GP practices in Hampshire to identify how many people are prescribed anti-inflammatory drugs, particularly those who may be at high risk of complications by being older or having other conditions. The aim is to help doctors transfer high risk patients to other pain relief options.

In another part, we will use the same dataset and also data from people who have attended University Hospital Southampton NHS Foundation Trust who take methotrexate, azathioprine and anti-TNF drugs. We will look at their blood results to see if some people might not need blood tests so frequently. Patients may be understandably nervous that problems could be missed if the blood check is not done so often, so we plan future research asking patients and doctors whether such reduction in checks would be acceptable.

We will also investigate the possibility of successful dose reduction strategies for anti-TNF drugs. Specifically, we will identify which kinds of patients tend to succeed in being able to reduce the dose.

This research has potential to reduce the burden on patients and on the NHS by reducing the frequency of blood tests and/or medication burden for some people and avoiding hospital admissions for anti-inflammatory drug complications.

Through connections our team has already, the results of this research will be shared with relevant doctors, nurses and patient groups across Wessex so it makes a difference locally. It will also be published in academic journals and presented at conferences.