NICE recommends drugs for blood clots and constipation

UK healthcare guidance body NICE has recommended drugs targeting blood clots and constipation.

It has reviewed its 2009 guidance on prasugrel (Efient, Eli Lilly and Co) and now recommends the drug in combination with aspirin for preventing blood clots in people who have had a heart attack or who have unstable angina (collectively called acute coronary syndromes) and who are also having a procedure to widen narrowed arteries in the heart (percutaneous coronary intervention).

Acute coronary syndromes are caused when a blood clot causes one of the large blood vessels that carry oxygen-rich blood to the heart to become narrowed or blocked. This reduces blood flow to the heart and the part of the heart affected can become permanently damaged.

Where the blood supply to the heart is blocked but there is no evidence of actual damage to the heart muscle, it is described as unstable angina. ST-segment-elevation myocardial infarction (STEMI) and Non-ST-segment-elevation myocardial infarction (NSTEMI) are types of heart attack that happen when the blockage in the blood vessel results in damage to the heart muscle.

Prasugrel is an anti-platelet drug that works by reducing or preventing the formation of blood clots, so that blood flow to the heart muscle can be maintained to prevent further damage.

Prof Carole Longson, director of the Centre for Health Technology Evaluation at NICE, commented: “This review assessed the clinical and cost effectiveness of prasugrel, noting that since the original guidance was published in 2009 NICE has also published guidance on the use of ticagrelor for the same indication, and the price of another drug, clopidogrel, has reduced as generic versions have become available. Taking these factors into consideration, we are now recommending prasugrel as an option for more people with acute coronary syndromes than our previous guidance.

“The Committee also heard from clinical experts that the faster action of prasugrel compared to clopidogrel could be an advantage for STEMI patients who need immediate percutaneous coronary intervention. The guidance also recommends prasugrel as an option for people with NSTEMI and unstable angina, with or without diabetes.”

It is estimated that there are approximately 82,000 MIs every year in England.

Lubiprostone for constipation

NICE has also published final guidance recommending lubiprostone (Amitiza, Sucampo Pharma Europe) for chronic idiopathic constipation in adults.

This common form of constipation affects people over a prolonged period and the cause is often unknown. Intense abdominal pain is a common symptom and severe cases can affect physical and mental health.

Lubiprostone works differently to current treatments, relieving symptoms by increasing the sliminess of the bowel lining. The new guidance is for adults who have tried at least two laxatives at the highest tolerated recommended doses for at least six months, but who have not seen an improvement in their symptoms.

Prof Longson said: “Chronic idiopathic constipation can be very distressing. Symptoms go beyond difficulty going to the lavatory and can be embarrassing for the person affected. It is a painful condition and those who suffer from it can experience a decreased quality of life.

“We are pleased to be able to recommend the drug in final guidance for use in the NHS.”

The guidance has been published on the NICE website. The NHS now has a legal duty to fund the treatment for eligible patients within the next three months.

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