News in brief: ILD therapy nintedanib recommended for PBS listing; Corticosteroids in doubt for elderly COVID patients; Patient communication suffers if physicians can’t mentally multitask

Tuesday, 19 Oct 2021

ILD therapy nintedanib recommended for PBS listing

Nintedanib (Ofev) capsules have been recommended for PBS listing for the treatment of patients with progressive fibrosing interstitial lung disease (PF-ILD).

At its September meeting the Pharmaceutical Benefits Advisory Committee (PBAC) recommended the listing of the drug produced by Boehringer Ingelheim, saying it was satisfied that nintedanib provided a significant improvement in effectiveness compared with best supportive care, for some patients with PF-ILD.

The PBAC said uncertainty around the cost-effectiveness of nintedanib could be adequately managed by a price reduction, and it was satisfied that the proposed Risk Sharing Arrangement would manage the financial risk of use outside the eligible patient population.

Corticosteroids in doubt for elderly COVID patients

Elderly COVID-19 patients who are critically ill are at higher risk of death if they are taking steroids as part of their treatment, according to an analysis published in the European Respiratory Journal

An international team of researchers, including Susannah Leaver, a Consultant in Intensive Care at St George’s University Hospitals NHS Foundation Trust in London, undertook a secondary analysis of data from the COVIP trial to examine the effects of corticosteroid therapy in this patient population. The COVIP study included 3,082 patients aged 70 years or older with proven COVID-19 and admitted to an intensive care unit in 35 different countries; 2,115 patients received corticosteroids as part of their treatment and 967 patients did not. The analysis found that 30-day mortality was significantly higher in the group treated with corticosteroids, at 53% compared to 42% in the no-corticosteroid group. At three months, the association “was even more pronounced”, the researchers noted, with data showing mortality rates of 60% versus 49%, respectively.

According to the authors, the results throw into question the practice of routinely treating elderly COVID-19 patients with corticosteroids. “While the immunosuppressive effect of steroids is undisputed and desirable in the context of severe COVID-19 treatment, the adverse effects of steroid treatment in elderly patients may outweigh the potential benefits,” they concluded.

Patient communication suffers if physicians can’t mentally multitask

Patient communication tends to be less satisfactory in specialties in which physicians must use diagnostic reasoning during patient encounters, an Australian study has found.

Physicians have more ‘cognitive busyness’ and must mentally multitask more than specialists such as surgeons whose encounters are more focused on procedures, according to according to Queensland researchers who analysed communication ratings for 67 doctors across various specialties.

They said their findings suggested that patient communication may be relegated to a secondary task and the news of an adverse finding may be less well accepted from physicians than from a procedural specialist who was not distracted by cognitive multitasking. Possible solutions included having separate consultations for making and conveying a diagnosis or taking a break during a consultation before delivering the diagnosis, they suggested in Internal Medicine Journal.

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