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Vienna, Austria, Thursday, 9th June, 2005. People with arthritis remain concerned and confused over the side-effects of their medication following the furore over COX-2 selective NSAIDs (painkillers), according to the results of a new European survey released today.[1]

Since the withdrawal of popular COX-2 selective NSAID used to treat arthritis, Vioxx® (rofecoxib), and the suspension of Bextra® (valdecoxib), after studies linked them to increased cardiovascular risk in long-term use, many patients now face a serious dilemma over alternative treatment options to manage their arthritis. All NSAIDs – which include aspirin and ibuprofen – carry a risk of upper gastrointestinal (GI) side-effects. For example, each year in the UK NSAIDs cause approximately 3,500 hospitalisations for, and 400 deaths from, ulcer bleeding in patients aged 60 years and above. [2]

Despite the well-publicised risks, more than 45 per cent (46.18 per cent) of those questioned said they had received little or no support on managing the side-effects of their treatment from their doctor. More than one in six people with arthritis (17.8 per cent) were still unaware of potential drug side-effects.

The survey findings support work by professional organisations who are calling for improved guidance on arthritis treatments, to help doctors address patient concerns.

Professor Greg Rubin, Chairman of the European Society for Primary Care Gastroenterology (ESPCG) and Professor of Primary Care at the University of Sunderland, UK, said: “These results reflect the fact that it is not only patients who are confused over the side-effects of non-selective and COX-2 selective NSAIDs – doctors have also received a huge amount of conflicting information on the drugs. This means that GPs face the serious task of counselling people with arthritis on the different treatment options, without themselves feeling totally confident of the best course of action. With this in mind, we have already begun formulating some sort of guidance to help GPs through this difficult time.”

Combining NSAID therapy with the proton pump inhibitor (PPI) Nexium® (esomeprazole) effectively resolves symptoms of heartburn and acid regurgitation,[3] as well as preventing peptic and gastric ulcers in at-risk patients, and healing gastric ulcers associated with continuous use of NSAIDs.[4],[5] A cost-effectiveness study recently determined that the combination of a non-selective NSAID plus a PPI is a more cost-effective treatment option than a COX-2 selective NSAID alone in preventing ulcer complications for many arthritic patients, particularly those at high risk of a GI or cardiovascular adverse event.[6]

However, the European survey of 626 arthritis sufferers found that only 25 per cent had been offered treatment to protect against the upper GI side-effects associated with the long-term use of their medication.

The key to managing NSAID-associated upper GI side-effects is controlling gastric acid secretion. NexiumÒ has been shown to provide consistently more effective control of gastric acidity than all other PPIs.[7],[8] It has also been shown to provide more effective gastric acid control than lansoprazole or pantoprazole in patients on NSAIDs, including COX-2 selective NSAIDs.[9] NexiumÒ works by deactivating the proton (acid) pumps that produce stomach acid, reducing the amount of acid that is in the stomach. NexiumÒ is only available on prescription. The most common side-effects with NexiumÒ are headache, diarrhoea, and abdominal pain, which occur in around one per cent of patients.


Notes to Editors

European Arthritis Patient (E-A-P) Survey

The E-A-P survey was conducted to investigate the level of awareness of side-effects of arthritis or rheumatism treatments amongst patients in Europe. The survey also sought to gain an insight into the professional advice and guidance being offered to these patients regarding their arthritis / rheumatism treatments.

The telephone survey involved 626 patients with arthritis or rheumatism in Austria (180 patients), Germany (103 patients), Ireland (141 patients) and Portugal (202 patients).

AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of prescription pharmaceuticals and the supply of healthcare services. It is one of the world's leading pharmaceutical companies with healthcare sales of over $21.4 billion and leading positions in sales of gastrointestinal, cardiovascular, respiratory, oncology and neuroscience products. AstraZeneca is listed in the Dow Jones Sustainability Index (Global) as well as the FTSE4Good Index.

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1. E-A-P (European Arthritis Patient) Survey.

[2]. Langman MJS. Ulcer complications associated with anti-inflammatory drug use. What is the extent of the disease burden? Pharmacoepidemiol Drug Safety 2001;10:13-19.

[3]. Hawkey CJ et al. Resolution of heartburn and acid regurgitation by esomeprazole in patients taking NSAIDs including COX-2-selective NSAIDs. Gastroenterology 2004;126 Suppl 2:A-2.

[4]. Goldstein JL et al. The comparative healing of gastric ulcers with esomeprazole versus ranitidine in patients taking either continuous COX-2 selective NSAIDs or nonselective NSAIDs. Gastroenterology 2004;126 Suppl 2:A-610.

[5]. Scheiman JM et al. Esomeprazole prevents gastric and duodenal ulcers in at-risk patients on continuous non-selective or COX-2-selective NSAID therapy. Gastroenterology 2004;126 Suppl 2:A-82.

[6]. Spiegel BM, et al. Minimizing complications from nonsteroidal antiinflammatory drugs: cost-effectiveness of competing strategies in varying risk groups. Arthritis Rheum 2005;53:185-97.

[7]. Miner P Jr et al. Gastric acid control with esomeprazole, lansoprazole, omeprazole, pantoprazole, and rabeprazole: a five-way crossover study. Am J Gastroenterol 2003;98:2616–20.

[8]. Röhss K et al. Esomeprazole 20 mg provides more effective intragastric acid control than maintenance-dose rabeprazole, lansoprazole or pantoprazole in healthy volunteers. Clin Drug Invest 2004;24:1–7.

[9]. Goldstein JL et al. Intragastric acid control in nonsteroidal anti-inflammatory drug (NSAID) users: comparison of esomeprazole, lansoprazole, and pantoprazole. Gastroenterology 2005;128 Suppl 2:A-241.

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