Two novel treatments to be trialled for CRPS

An Australian trial is to investigate the efficacy of memantine and a rehabilitation program using Graded Motor Imagery in the treatment of Complex Regional Pain Syndrome (CRPS).

The MEMOIR trial, led by Professor James McAuley, of NeuRAand University of New South Wales, is recruiting 160 patients as part of an RCT to assess the effect of the interventions on pain intensity and pain interference compared to placebo and standard care for CRPS.

Memantine is currently approved in Australia for the treatment of moderately severe Alzheimer’s disease, but not for CRPS. Graded Motor Imagery uses patient education and a combination of brain-directed movement activities such as laterality tasks, imagined movements, mirror therapy and functional rehabilitation tasks.

SMA treatments reviewed by PBAC

The Pharmaceutical Benefirs Advisory Committee says a review of treatments for spinal muscular atrophy (SMA) is unlikely to change its recommendations for PBS listings, although it provided useful information about emerging longer term data for nusinersen and onasemnogene abeparvovec (ONA) in paediatric patients. The PBAC said the literature review showed that the clinical management of SMA was increasingly based around SMN2 copy number(s) rather than just a focus on age of symptom onset or SMA type classification.

However at its May meeting it deferred for a second time an application from Novartis to have the gene replacement therapy ONA listed on the PBS. The committee maintained its initial deferral from November 2020, saying there were still some of concerns with the subsidy proposal from sponsor Novartis.

It noted the proposed population had been revised down from patients aged less than 2 years of age to those less than 9 months, with 1-3 copies of the SMN2 gene.

It also considered the request for inclusion of patients with 3 copies of SMN2 was not adequately supported, and at the requested price ONA was unlikely to be cost-effective in these patients.

Noise the main reason for sleep disruption in hospitals

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.