News in brief: Diroximel fumarate on PBS for RRMS; Age cut-off defined for Early Onset PD; Doubts about antiseizure medications in aSAH

4 Aug 2022

New treatment for RRMS listed on PBS

Diroximel fumarate (Vumerity), a next-generation oral fumarate treatment for relapsing-remitting MS has been listed on the PBS from 1 August.

Biogen Australia said in a statement that the new agent offers bioequivalent efficacy and safety to dimethyl fumarate but with greater tolerability and fewer gastrointestinal side effects.

In the phase 3 EVOLVE-MS-1 study, it has demonstrated less severe gastrointestinal events and fewer days of self-assessed gastrointestinal symptoms, fewer gastrointestinal adverse events, and lower discontinuation rates because of gastrointestinal adverse events than dimethyl fumarate.

Sydney neurologist Dr Todd Hardy said in the statement that as well as being better tolerated, the drug has a faster washout period which provides more flexibility for patients considering pregnancy.

“Living with MS can be relentless, challenging and debilitating, but access to Vumerity will hopefully help support people to embrace the opportunities life can present,” he said.

Age cut-off defined for Early Onset PD

The term Early Onset Parkinson Disease (EOPD) should be used in place of Young Onset Parkinson Disease (YOPD) for people with age at onset after the age of 21 years but before the usual age onset for PD, according to the Taskforce on EOPD.

In a review aimed at clarifying the nomenclature of EOPD/YOPD, the taskforce found that consensus was lacking and the reported maximal age for EOPD/YOPD has varied from 40 to 60 years, leading to lack of uniformity in published studies and difficulty in harmonisation of data.

They noted that there had been a shift from the use of YOPD towards EOPD in the literature, motivated by an attempt to avoid age-related stigmatization of patients.

They suggested that EOPD be adopted as the preferred nomenclature and that future research should adopt the standard of using 50 or 51 years as cut off. For age at onset, as already used by most countries.

Many studies suggest that changes in the oestrogen level can affect the predisposition to develop PD, making the average age at menopause of 50 years an important factor to consider when defining EOPD, they noted in the journal Movement Disorders.

“Considering the differential impact of the age at onset of PD on professional and social life, using 50 years as the upper cut off for the definition of EOPD seems reasonable,” they suggested.

Doubts about antiseizure medications in aSAH

An Australian study has raised questions about the routine use of antiseizure medication in patients with aneurysmal subarachnoid haemorrhage.

Results from the PROMOTE-SAH study conducted in eleven ICUs showed that about 40% of the 357 patients with aSAH received an anti-seizure medication, with most commonly used agent being levetiracetam.

The median length of anti-seizure medication administration was eight days, but varied from 4.5–12.5 days, according to findings published in the Journal of Clinical Neuroscience.

The study showed that anti-seizure medication was more commonly used in patients with higher grade aSAH but there was no significant association between death or disability at six month. There were also suggestions of inferior outcomes with anti-seizure medication use in lower aSAH grades

“This study highlights several important questions regarding the use of anti-seizure medication therapy in aSAH; namely whether routine anti-seizure medication prescription is warranted, in who, and for how long,” the authors said.

“The variability in prescribing patterns would suggest significant clinical heterogeneity in this area, implying that a well-designed randomised controlled trial is warranted. Critically, robust trial data are urgently needed to inform best practice guidelines, in addition to determining any potential harm associated with anti-seizure medication therapy in lower grade aSAH,” they concluded.

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