Infliximab PBS restrictions to be lifted for UC patients

The Pharmaceutical Benefits Advisory Committee has approved a request from gastroenterologists to allow patients treated with PBS-subsidised infliximab under the acute severe ulcerative colitis (ASUC) listing to subsequently transition to PBS-subsidised infliximab for the treatment of moderate to severe ulcerative colitis (MSUC) without having to demonstrate prior failure to alternative treatments.

After reviewing evidence from the from the Australian IBD Consensus Working Group, the PBAC considered it is reasonable that ASUC patients who respond to PBS-subsidised infliximab for the treatment of ASUC to not have to demonstrate failure with pretreatment with a 5-aminosalicylate oral preparation and one of azathioprine, 6- mercaptopurine or oral steroids in the four months prior to transition to PBS-subsidised infliximab for MSUC.

At its May meeting, the PBAC also noted an advice from the Drug Utilisation Sub-Committee (DUSC) that around 15% of patients that initiated PBS-subsidised infliximab for ASUC went on to receive PBS-subsidised infliximab for MSUC.

IBD rare in Indigenous Australians 

The impact of poverty in infancy could be the environmental trigger that, paradoxically, conditions the gut microbe against subsequent digestive disease in adulthood – an observational hypothesis, which could account for the very low prevalence of IBD in Indigenous Australian populations, suggests Professor Isidor Segal.

The esteemed gastroenterology expert’s previous work in South Africa on the social determinants of health led to ground breaking papers on the trajectory of gastrointestinal disease in people living in Soweto.

In a letter to the editor of Internal Medicine Journal Professor Segal says while Australia has one of the highest rates of IBD in the world the condition is rarely found in Indigenous Australians – a situation similar to that in South Africa.

Pointing to other research he also notes that the gut microbial profiles of Indigenous Australians are ‘highly abundant in Provotella species and lactic acid producing bacteria’ and other enzymes that would lead to a higher expression of anti-inflammatory cytokines.

Read more.

Hospitalised patients face sleep disruption due to noise

Almost half of hospital inpatients have their sleep disrupted, with noise being the main culprit, Australian research shows.

A study involving 60 patients at Melbourne’s Box Hill hospital found that sleep was disturbed in 45% of patients, with the problem common to those in shared rooms and those in single rooms distance from the nursing station.

Lighting levels were appropriately low across all the ward locations studied, whereas sound levels were higher in the shared and single rooms group compared to a ‘control’ setting of a sleep laboratory. Noise was also rated as the greatest environmental disturbance by 70% of ward patients compared to 10% in the sleep laboratory.

Operational interruptions were also a major factor in disrupted sleep, with patients experiencing an average of around six per night, according to the findings published in Sleep and Breathing.