PLUS: Image-based prescribing ends but still no ePrescribing for some; flu-rona twice as deadly as covid; anifrolumab promising for lupus nephritis; and new research on bari for OA.
Paediatric rheumatologists, allied health partners, patient support groups and others have welcomed the interim report and recommendations for the parliamentary inquiry into childhood rheumatic diseases.
Plus:
- Still no electronic prescribing for widely used practice management software
- Flu-rona twice as deadly as covid
- Anifrolumab shows early promise for lupus nephritis
- Watch this space: baricitinib for inflammatory OA
Childhood Rheumatic Diseases inquiry: interim report and recommendations tabled
The House of Representatives Standing Committee on Health, Aged Care and Sport has tabled an interim report for the Inquiry into childhood rheumatic diseases.
Among the recommendations are:
- an eight-year program of secure funding for training, with the aim of tripling the number of paediatric rheumatologists by 2030
- establishing multi-disciplinary centres to support expansion of allied health and specialist nursing services for paediatric rheumatology
- improving access to disease altering medications
- providing more education on childhood rheumatic diseases to GPs and the wider medical profession
- establishing a ‘hub and spoke’ model of care with outreach clinics for rural, regional and remote areas.
“The Australian Paediatric Rheumatology Group welcomes the Committee’s recommendations released today and urges the Australian Government to invest in implementing the recommendations to make a brighter future for these children and prevent pain and long-term disability now and for the generations to come, ” the APRG said in a press release.
An incredibly significant day for children with Rheumatic Diseases in Australia with the release of the report of the Inquiry into childhood rheumatic diseases.
— Jane Munro (@DrJaneMunro) March 31, 2022
Thanks to everyone for their mammoth work on this and to chairs MPs Freelander & Zimmerman.https://t.co/zGxiAwDRpX pic.twitter.com/1ntMOSVm1U
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Still no electronic prescribing for widely used practice management software
With image-based prescribing coming to an end on 31 March, and electronic prescribing currently unavailable in several practice management software systems – including Genie and Clintel – many specialists will need to implement alternative measures for their patients.
When prescribers can’t get a prescription to a patient, they can email, fax or phone the prescription through to the pharmacist, provided the original prescription is sent to the pharmacist – as per the situation before image-based prescribing was introduced due to covid.
While rules vary from state to state, the applicable time period for getting the hard copy prescription to the pharmacy is generally within 24 hours for schedule 8 medicines, and up to seven days for other medicines. In Victoria and WA these remote-prescribing measures are for emergency situations only.
According to Genie, ePrescribing is expected to be available mid-year for Genie and Gentu, while Clintel told Rheumatology Republic that a June upgrade of CareRight will include ePrescribing. Clinic to Cloud is currently non-compliant according to the ADHA’s conformance register. They have not advised when ePrescription functionality can be expected.
Flu-rona – twice as deadly as covid
Coinfection with covid and influenza is associated with a four-times greater risk of needing mechanical ventilation, and more than two-times greater risk of death, research suggests.
A research letter published in The Lancet presents the results of an observational study of nearly 7000 adults with SARS-CoV-2 infection admitted to hospital in the UK between February 2020, and December 2021 and who were tested for other respiratory viruses.
Of these, 583 patients had respiratory coinfections, and researchers found that those coinfected with influenza were just over four times more likely to be ventilated, and 2.3 times more likely to die than those admitted just with covid after adjusting for factors including age, sex, and comorbidities.
They didn’t see a significant effect of coinfection with adenoviruses or respiratory syncytial viruses.
The authors said the findings emphasised the importance not only of vaccinating against both covid and influenza, but also of in-hospital testing of covid patients for coinfection with influenza to identify patients who might be at greater risk of severe disease.
Anifrolumab shows early promise for lupus nephritis
Anifrolumab shows promise as a useful and safe treatment for patients with lupus nephritis, according to a 12-month trial. However, the improvements were numerical only and larger studies are required.
Positive results for patients with SLE in the TULIP trials contributed to FDA approval for that indication last year. But patients with severe, active lupus nephritis were excluded from those trials, so an additional study, TULIP-LN, set out to evaluate it in this patient group.
The phase-2 placebo-controlled, randomised trial tested two dosing regimens of anifrolumab – so-called basic and intensified regimens. The primary endpoint was change in baseline 24-hour urine protein–creatinine ratio (UPCR) at week 52 for combined anifrolumab versus placebo groups, and the secondary endpoint was complete renal response (CRR) at week 52.
The intensified regimen was required to achieve clinical efficacy, and was numerically superior to placebo for several clinically relevant endpoints, providing researchers with learnings for future trials.
Ann Rheum Dis 2022, online 10 March
Watch this space: baricitinib for inflammatory osteoarthritis
A small proof-of-concept study has had encouraging results for baricitinib as a treatment for patients with inflammatory knee OA, according to correspondence published in Rheumatology.
The open-label study, which took place in China, enrolled 13 people with knee OA refractory to NSAIDs. Participants took 2mg of baricitinib per day for 12 weeks, with 11 of the 13 meeting OMERACT-OARSI response criteria at week 12. The remaining two patients withdrew at week 4 due to lack of response.
“To our knowledge, this is the first study to evaluate baricitinib in inflammation dominant OA patients,” said the authors. “Our data demonstrate that baricitinib is effective and relatively fast-acting and may be a promising therapeutic option for patients with inflammatory knee OA refractory to NSAIDs.”
