News in brief: TGA approves belumosudil for GVHD; Alloimmunisation common in Sickle Cell Disease patients; Specialty training colleges’ ‘dirty secret’

TGA approves belumosudil for GVHD

Australian graft-versus-host disease patients’ treatment horizon has just expanded with the first-in-class approval of belumosudil (Rholistiq).

The oral serine/threonine kinase inhibitor, developed by Kadmon (now owned by Sanofi), is indicated for the “treatment of patients 12 years and older with chronic graft-versus-host disease after failure of at least one prior line of systemic therapy”, according to the TGA’s website site.

It targets rho-associated coiled-coil-containing protein kinase-2 (ROCK2) to “reduce type 17 and follicular helper T cells via downregulation of  signal transducer and activator of transcription 3 (STAT3) and enhances regulatory T cells via upregulation of signal transducer and activator of transcription” — processes involved in chronic GVHD development — the ROCKstar Study suggests.

The drug was approved under the FDA’s Project Orbitis initiative designed to accelerate patient access to new oncology-related medicines across multiple countries.

Alloimmunisation common in Sickle Cell Disease patients

Many Australian Sickle Cell Disease (SCD) patients continue to receive large volumes of red blood cell  (RBC) transfusions, placing them at risk of alloimmunisation, a national survey has found.

Data from 314 SCD patients in the Australian Haemoglobinopathy Registry showed that one third of patients were regularly transfused (17% paediatric, 58% adult). Overall, 11% patients had RBC alloantibodies (7% paediatric, 17% adults), with more than one alloantibody was present in 1.6% paediatric and 9.9% adult patients.

Researchers from Monash University noted that transfusions routinely occurred in the outpatient setting at four-six week intervals, with 57% of adults receiving six or more RBC units at each episode.

The median number of RBCs transfused in the preceding 12 months was 43, according to the results presented at the ANZSBT meeting 2021..

Specialty training colleges’ ‘dirty secret’

Training colleges, consultants, and hospital executives have been blamed for enabling ongoing abuse and overwork of registrars, in an article about speciality training written by an anonymous junior doctor deploring what they describe as medicine’s ‘dirty secret’.

Published in mainstream newspapers this week, the article entitled ‘Distressed doctors don’t bend, so they break’ describes a training regime that encourages mental distress and suicide among registrars who are given a heavy workload and responsibilities but no support from senior doctors or management.

“They are the first to arrive at the hospital and the last to leave. You are told not to make waves, to keep your head down, to get through it. You are often working unsupervised with vast responsibilities and unsupportive distant supervisors. The less you complain, the more you’re willing to endure, the more attractive and hireable you become. Troublemakers do not get hired,” it says.

The article says the current approach by training colleges is flawed because “the focus has been on coping with abuse rather than ending abuse.’

“The medical fraternity needs to host a meaningful discussion about how to fix our training system to provide more support for doctors and improve their wellbeing. Workload is an issue but the crux of the problem is the lack of support from those in authority,” it concludes.

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