Public health

News in brief: Heart drug could dampen MTX resistance; ARA updates patients advice on COVID-19; Hospital doctors bullied to discharge patients prematurely

Heart drug could dampen MTX resistance

A commonly used oral antiplatelet drug used in conjunction with MTX can improve RA disease severity, a proof of concept trial suggests.

In a letter published in Rheumatology New York cardiologist Prof. Jeffrey S. Berger noted that studies in mice suggested MTX resistance might be due to inadequately increased adenosine release.

Prof Berger and colleagues therefore tested the adenosine blocker ticagrelor in RA patients without clinical CV disease who met ACR criteria for RA and had a disease activity score-28 (DAS28) – ESR > 3.6, and 3) and were on stable doses of MTX monotherapy for a minimum of 12 weeks.

One month of ticagrelor therapy added to weekly MTX significantly improved RA disease severity, and reduced platelet aggregation and platelet activation while showing a trend towards increase in circulating adenosine, the results showed.

Prof Berger noted several limitations to the trial and said larger studies were needed to weigh the benefit versus risk of supporting a [potentially] unique indication for ticagrelor.

ARA updates advice for rheumatology patients  on COVID-19

The Australian Rheumatology Association has released updated advice on COVID-19 and vaccination recommendations for patients with Rheumatoid Arthritis, Systemic Lupus Erythematosus (SLE) and other autoimmune inflammatory rheumatic diseases (AIRD).

The latest advice reflects the latest evidence on risks of COVID-19 and the issues to be considered for vaccination since the previous advice was released  in October 2020.

For example, it notes that data from the COVID-19 Global Rheumatology Alliance has shown that the risk of COVID-19-related death was associated with higher disease activity, glucocorticoids/steroids at doses of >10mg daily, but not with methotrexate and TNF inhibitors.

“Therefore, the priority should be to maintain adequate disease control while minimising glucocorticoids/steroids,” the ARA advises.

In a separate patient information sheet the ARA advises that patients with AIRD have COVID-19 vaccination and notes that both the AstraZeneca (Oxford) vaccine and the Pfizer (Comirnaty) vaccine are suitable for rheumatology patients.

It also provides advice on timing and of doses of treatments such as rituximab and methotrexate in relation to vaccination.

Hospital doctors bullied to discharge patients prematurely

More than 60% of hospital doctors feel coerced to discharge patients before they are medically ready, according to a survey conducted by the SA Salaried Medical Officers Association.

Almost 40% of doctors said the pressure to discharge patients came from hospital executives and half said the early discharges negatively impacted on care, according to report In Daily.

The survey supports a “Time to Care” campaign by SASMOA which says that medical care is being compromised by lack of staff numbers to meet demand and lack of time to provide appropriate medical care for patients.

“Medical decisions should be made by doctors based on a medical assessment of patient need and not based on cutting costs,” the Association said.

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