Inhaled heparin trialled for COVID-19
A pilot study has shown that inhaled nebulised unfractionated heparin (UFH) iis safe in the treatment of hospitalised patients with COVID-19 and has provided suggestions that it may be effective in improving oxygen levels.
The international study led by Dr Frank van Haren, of Saint George Hospital, Sydney involved 98 patients with COVID-19 on stable prophylactic or therapeutic systemic anticoagulant therapy who were treated with inhaled nebulised UFH for a mean of six days. Patients showed an increase in activated partial thromboplastin time (APTT) levels but it remained within the normal range and was not considered clinically significant.
Two patients on therapeutic anticoagulation had serious adverse events: bleeding gastric ulcer requiring transfusion and thigh haematoma. Minor bleeding occurred in 16 patients, 13 of whom were on therapeutic anticoagulation. An exploratory efficacy outcome of oxygen saturation/FiO2 ratio and the FiO2 worsened before and improved after commencement of inhaled UFH.
Writing in the British Journal of Clinical Pharmacology the study authors said the results supported promising findings seen with UFH in other preliminary studies and showed an urgent need for prospective controlled studies of nebulised UFH in patients with COVID-19 pneumonia
PBAC approvals for haematology therapies
A positive recommendation for PBS listing have been made by the Pharmaceutical Benefits Advisory Committee (PBAC) for treatments for gemtuzumab (Mylotarg) for the treatment of acute myeloid leukaemia (AML)
The PBAC recommended the listing of gemtuzumab ozogamicin, in combination with standard intensive chemotherapy (an anthracycline and cytarabine), for the treatment of patients with previously untreated, de novo CD33-positve AML except acute promyelocytic leukaemia, who have favourable/intermediate/unknown cytogenetic risk (where the unknown risk is due to inconclusive test results).
At its November 2021 meeting the PBAC also recommended a PBS listing of siltuximab (Sylvant) for the treatment of idiopathic multicentric Castleman disease (iMCD).
Other recommendations included listing of a new 600mg tablet of imatinib (Imatab) in addition to the existing PBS listed imatinib 100 mg and 400 mg tablets for conditions including chronic myeloid leukaemia (CML); Philadelphia chromosome positive acute lymphoblastic leukaemia (Ph+ ALL) and myelodysplastic or myeloproliferative disorder (MDS/MPD).
A new biosimilar brand of rituximab (Ruxience) was recommended for listing under the same conditions as the biosimilar brands currently listed on the PBS (Riximyo and Truxima) for non-Hodgkin’s lymphoma (NHL) and chronic lymphocytic leukaemia (CLL);
The PBAC also recommended that the written authority requirement be changed to telephone/electronic for first continuing treatment with eltrombopag and romiplostim in patients with idiopathic thrombocytopenic purpura (ITP). However it did not support such a change for initial treatment.
New guidelines on fungal infections for haematologists
Australasian guidelines for the management of invasive fungal disease and use of antifungal agents in the haematology/oncology setting have been updated for the first time in seven years.
Highlights of the new consensus guidelines, backed by professional groups such as HSANZ and ALLG, include updates on antifungal prophylaxis and an expanded scope to provide more detailed coverage of common and emerging fungi such as Aspergillus and Candida species, and other fungi such as Cryptococcus, Mucorales and rare yeasts.
The new guidelines, published in the Internal Medicine Journal, also have a greater focus on the principles of antifungal stewardship.