News in brief: Biosimilar switching letters cause concern; MBS item for EMR removal of very large sessile colorectal polyps; Screen for obsessive eating in GI disorders

12 Oct 2021

Biosimilar switching letters cause concern

Pharmacists have raised concerns about some gastroenterologists who they claim are giving patients proforma letters supplied by Abbvie insisting that the originator Humira brand of adalimumab is dispensed rather than biosimilars.

According to a report in The Australian, pharmacists said they felt it was inappropriate for doctors to use letter templates saying the prescriber had determined that brand substitution was not clinically appropriate for the patient and that no other brand of adalimumab should be dispensed in place of Humira.

However the paper quoted Dr Britt Christensen, Head of the Inflammatory Bowel Disease Unit at The Royal Melbourne and chair of GESA’s IBD executive committee saying that doctors were not comfortable with patients switching back and forth between Humira and biosimilars. “Patients can go to different pharmacies and they could end up on four different types of medication,” she said.

Dr Susanna Proudman,  a rheumatologist at the Royal Adelaide Hospital, said patients needed consistency and specialists “may argue the clinical decision about what drug is prescribed should be the drug that is dispensed – and if that is not happening, some form of correspondence is entered into that may be justified.”


New MBS item for EMR removal of very large sessile colorectal polyps

A new MBS item 32230 is being introduced from 1 November for the removal of very large (≥25mm) sessile colorectal polyps by endoscopic mucosal resection (EMR). Reimbursement was recommended by the Medicare Services Advisory Committee in 2020 in response to an application from GESA, with the committee noting that EMR is the current standard of care, and has advantages such as reduced mortality and length of stay compared with surgical resection. However MSAC rejected the prosed fee of $1750 and instead recommended a reimbursement of $750 per procedure.


Screen for obsessive eating in GI disorders

Disordered eating is common in patients with disorders of gut-brain interaction (DGBI) and it may be difficult to know whether a patient’s primary underlying diagnosis is that of an eating disorder or gastroenterological disorder, a review by Australian clinicians has found

The prevalence of disordered eating ranged from 13–55% in a literature review that included 17 studies of patients with conditions such as IBD, coeliac disease and DGBI. The prevalence was higher in patients with DGBI than in those with organic gastrointestinal disorders. Disordered eating was associated with female sex, younger age, gastrointestinal symptom severity, anxiety and depression, and lower quality of life.

The study authors, from Melbourne University and St Vincent’s Hospital Department of Gastroenterology said eating disorders could easily develop in people with bowel disease if they were encouraged to have heightened awareness of symptoms and dietary intake, and the condition could impair uptake of treatment

“Screening and identification of disordered eating is crucial to ensure treatment includes appropriate monitoring, psychological intervention, and avoids overly restrictive diets where possible,” they concluded in Neurogastroenterology and Motility.

 

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