Dr Sanjay Ramakrishnan.
Biologic therapies will change the game for countless Australia patients with COPD, but respiratory physicians must now take on an active advocacy role to make sure they meet their potential, the Australian COPD Symposium has been told.
Dr Sanjay Ramakrishnan, an academic respiratory physician at the University of Western Australia, told the inaugural Lung Foundation Australia symposium in Melbourne that the TGA approval and subsequent PBAC recommendation for dupilumab and mepolizumab would have “dramatic impacts” for patients with uncontrolled eosinophilic COPD.
“The first new therapies in 30 years are coming, with dramatic impacts for people who are eligible,” he said.
In March, the PBAC recommended both biologics for PBS listing in adults with blood eosinophils of at least 300 cells per microlitre who continued to experience exacerbations after 12 months of triple inhaled therapy. Dr Ramakrishnan said the recommendation, granted after just the first submission, reflected broad recognition of the burden of COPD.
“This is a big problem, and health economists see it. It’s not something marginal,” he said.
But a PBAC recommendation does not guarantee a PBS listing, and Dr Ramakrishnan urged clinicians to make the case directly to Minister for Health Mark Butler.
“Just because the PBAC has said yes, doesn’t mean the minister is going to say yes,” he said. “Does the minister even know about COPD? Are we in his face? His electorate has one in thirteen people over the age of 40 with COPD — that’s a lot of voters.”
He also argued Australia’s updated COPD stepwise management guidelines needed to give stronger backing to eosinophil testing. The June guidelines state that eosinophil counts above 300 should be considered as an indication for ICS therapy “if available,” but Dr Ramakrishnan pushed back on that framing.
“It is not an ‘if available’ test — it is a ‘must-do’ test,” he said, noting eosinophil counts are collected as part of a standard full blood count and are affordable for all COPD patients.
He also warned that stepwise treatment pathways requiring patients to progress through monotherapy, then dual therapy, then triple therapy before accessing biologics risked “building inertia” into the system and delaying access.
Dr Ramakrishnan said patients already receiving the biologics were reporting meaningful gains. One of his own patients, he said, had been unable to attend the symposium because she was overseas, something that would have been impossible before starting treatment.
“The advocacy work is not done. We need to do everything in our power, and the guideline needs to shout for us,” he said.