News in brief: Methoxsalen listed on PBS for cGVHD; Male doctors choose beards over N95 mask fit; Extended use of DAPT common after PCI

Methoxsalen listed on PBS for cGVHD

Methoxsalen (Uvadex) will be available on PBS from 1 March 2022 for the treatment of chronic graft versus host disease (cGVHD).

The drug was recommended by the PBAC for an Authority Required (STREAMLINED) listing for the treatment of patients with steroid dependent or steroid intolerant or steroid refractory cGVHD, as part of treatment with integrated, closed system extracorporeal photopheresis (ECP).  According to the PBAC, ECP is a leukapheresis-based, immunomodulatory therapy in which a patient’s leukocytes are collected and treated ex vivo with methoxsalen and UVA light and then returned to the patient.

The PBS listing is concurrent with two new MBS items for the use of ECP in combination with  methoxsalen to treat this cGVHD, as recommended by the Medical Services Advisory Committee.

Around 180 patients a year are expected to access the drug, which usually costs more than $9,200 per course of treatment,

Male doctors not shaving for N95 masks

Almost half the male hospital staff required to wear a P2/N95 respirator during the COVID-19 pandemic have beards or facial hair that would potentially render them ineffective, an audit carried out in a Victorian tertiary centre has found.

Despite successfully completing fit testing with a clean shaven face in the preceding year, 45% of the 110 male staff working in three critical areas of a hospital (ICU, ED and operating theatres) were observed to have beards or to not be clean shaven in the face seal zone of their respirators.

Writing in the journal Infection, Disease and Health, the study authors said it was imperative that clinical staff were clean shaven in the face seal zone of their respirators so they are fit-for-purpose and ready to respond during periods of significant community transmission of COVID-19.

“Health care organisations allowing employees to have facial hair where N95 protection is required may be breaching their duty of care under OHS laws,” they wrote.

Male staff “experiencing a loss of identity or significant skin irritation with daily shaving should be supported so that their respiratory protection is optimised, not only to protect themselves from harm, but also to safeguard those they work with and care for,” they added.

Extended use of DAPT common after PCI

Unwarranted extended use of dual antiplatelet therapy  (DAPT) after percutaneous coronary intervention (PCI) may be placing patients at risk of bleeding complications, a study from Queensland suggests.

While clinical guidelines define 12 months or less of DAPT as standard therapy post-PCI a study conducted at the Princess Alexandra Hospital, Brisbane found that two thirds of patients were still taking DAPT beyond a year.

The study reviewed data for 105 patients admitted for PCI who were subsequently readmitted at least 12 months later. It found that 70 patients (66%) were still taking DAPT on readmission.

In one third of these cases DAPT duration patients was compliant with the recommendations of guidelines or treating cardiologist, with 10%  and 57% being shorter and longer than recommendations of guidelines or treating cardiologist respectively, according to findings published in Pharmacy Practice and Research.

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