News in brief: Colonoscopy fear is real; Thermal ablation reduces adenoma recurrence post-EMR; New version of Humira on PBS

Thursday, 8 Apr 2021

Colonoscopy wins the wooden spoon for popularity!

Patients with IBD have concerns about colonoscopy which are not easily dissuaded by the person recommending the procedure.

A New Zealand study of more than 100 patients with IBD found while colonoscopy was one of the most common investigations ordered, patients preferred anything else including blood tests, faecal tests and imaging studies.

Other potential tests such as saliva, urine and breath tests were also preferred options to colonoscopy.

Of concern, the study found explanations provided by a physician did not relieve patient concerns.

“Explanation of tests by a referring clinician played a significant role in respondents’ level of understanding across all tests, but did not necessarily affect their levels of comfort or worry. when receiving results across all tests.”

“These findings need to be considered by physicians when referring patients with IBD for investigations, with particular regards to patient’s test preference and allowing adequate test explanations with patients.”

Internal Medicine Journal

EMR-T should be universally employed for the management of LNPCPs

Thermal ablation of the defect margin after endoscopic mucosal resection (EMR-T) of large non-pedunculated colorectal polyps (LNPCPs) is safe and effective in reducing adenoma recurrence at surveillance colonoscopy.

In a prospective international cohort study of 1,000 LNPCPs ≥ 20mm, complete EMR-T significantly reduced residual or recurrent adenomas at first surveillance to a low 1.4% compared to 27.1% for incomplete EMR-T.

Reasons for an incomplete procedure were extensive post-EMR defect, intraprocedural adverse events, and technical issues such as unstable colonoscope position or difficult access.

The researchers, including senior investigator Professor Michael Bourke from Westmead Hospital, said EMR-T was an effective, safe, easy to perform and naturally cost-effective auxiliary modality to prevent recurrence.

They concluded that EMR-T should be considered as an integral component of high-quality EMR and employed universally for LNPCPs.


PBS lists new version of Humira and biosimilars

A reformulated ‘less painful’ version of Humira has been listed on the PBS, along with four adalimumab biosimilars.

AbbVie’s revised version of its best-selling anti-TNF drug has been available for some years in overseas markets and is documented as causing less pain and discomfort on injection than the original formula containing citrate.

With the new formulation comes a new autoinjector pen, a smaller 29-gauge needle and a reduced injection volume – all of which the company says will help reduce pain and discomfort for patients.

Queensland gastroenterologist Dr Jakob Begun, chair of GESA’s IBD faculty, said he expected the redesigned device would make it easier for his large patient cohort of adolescents and young adults to self-administer.

“For some patients the anxiety and pain is a major issue,” he said.

“And from the clinician’s standpoint, it makes it easier to make decisions if we know a drug is well tolerated by patients and with the new formulation its efficacy hasn’t changed at all.”

The biosimilars are: Amgevita (Amgen); Hadlima (Samsung Bioepsis); Hyrimoz (Sandoz) and Idacio (Fresnius Kabi).  Only Amgevita does not employ citrate as a stabilising buffer ingredient, according to TGA documents.

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