News in brief: Lasting problems with cobalt toxicity beyond recalls; Young arthritis patients have good antibody responses to coronavirus; Value in prescribing biologics program extends to plaque psoriasis

Lasting problems with cobalt toxicity beyond recalls

Millions of people with implanted cobalt-chrome prostheses are still at risk of developing cobalt toxicity despite product recalls.

A single-centre US study of 241 patients with a suspected hip, knee or shoulder replacement containing cobalt-chrome found 57% of the group had cobalturia (≥ 1 ppb) with a mean cobalt level of 12.6 ppb.

A subgroup of 37 patients designated extreme-risk implantations with metal-on-metal hip replacements and resurfacings had mean urinary cobalt levels of 54.1 ppb and mean blood levels of 14.8 ppb.

The study said millions of people with nonrecalled extreme-risk or high-risk implantations were likely not monitored and likely to be experiencing cobalturia.

“Clinicians might consider obtaining a screening of cobalt levels in urine for their patients with a replaced joint presenting with encephalopathy or cardiomyopathy because cobalt might be a remediable aetiology.”

JAMA Network Open

Young arthritis patients have good antibody responses to coronavirus

Children and adolescents with inflammatory rheumatic diseases such as juvenile idiopathic arthritis show reassuringly robust antibody responses against coronaviruses, UK researchers have found.

A study of sera from 118 children and adolescents with JIA and 79 with juvenile dermatomyositis (JDM) or juvenile systemic lupus erythematosus (JSLE) , showed that they mounted a strong antibody response to seasonal human coronaviruses comparable to those of healthy children.

The children and adolescents with rheumatic conditions had preexisting IgG antibodies to coronavirus spike proteins cross-reacted with SARS-CoV-2 spike protein. There was smaller or no IgM antibody responses to nucleoproteins, according to researchers  from Centre for Adolescent Rheumatology Versus Arthritis at University College London (UCL).

“Despite adaptive immune dysfunction and immunosuppressive treatment, paediatric and adolescent JIA, JDM and JSLE patients can maintain antibody responses to coronaviruses that are comparable to or stronger than those of healthier peers,” the researchers concluded.

“Our findings suggest that inflammatory rheumatic diseases do not impede humoral immunity to the seasonal [coronavirus] in this age group and may even enhance it,” they added in the journal Med.

Value in prescribing biologics program extends to plaque psoriasis

The government backed program to ensure better value prescribing of high-cost biologics has been extended to the management of plaque psoriasis.

A new NPS MedicineWise-led collaboration between the Targeted Therapies Alliance, Psoriasis Australia and the Australasian College of Dermatologists will provide resources such as decision aids and practitioner education visits to promote strategies such as use of low-dose methotrexate the of the Value in Prescribing – Biological Disease Modifying Anti-Rheumatic Drugs (bDMARDs) Program.

A recent PBAC review of nine PBS-listed biologics for chronic plaque psoriasis (etanercept, infliximab, adalimumab, ustekinuma, secukinumab, ixekizumab, guselkumab and tildrakizumab) estimated that costs could be $112 million a year by 2025 for about 6000 patients who take up treatment.

NPS MedicineWise spokesperson Jonathan Dartnell told the limbic that the bDMARDs program was funded to support optimising the use of biologics.

“But in order to optimise use of biologics it is really about optimising the different lines of therapy – the topical treatments which are the first line and then the treatments which come after that.”

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