News in brief: PBS listing for rheumatology drugs; Opioid prescribing falls after doctors sent warning letters; Rheumatologist calls to curb spinal imaging

PBAC positive recommendations for rheumatology drugs

PBS listings have been recommended for upadacitinib (Rinvoq) for the treatment of ankylosing spondylitis (AS) and psoriatic arthritis (PsA). The Pharmaceutical Benefits Advisory Committee (PBAC) made the recommendations that the drug’s price is minimised to the lowest cost biologic DMARD for the indications.

At the March meeting the PBAC also recommended PBS listing of ustekinumab for the treatment of paediatric patients with severe chronic plaque psoriasis, saying it was satisfied that ustekinumab provided a significant improvement in efficacy over etanercept for some patients.

In other decisions, the PBAC recommended PBS listing for a biosimilar brand of teriparatide (Terrosa) for the same osteoporosis indications as the reference brand Forteo. It also recommended the listing of ciclosporin (Ikervis) for the treatment of severe keratitis with dry eye disease.

Rheumatologist calls to curb spinal imaging

New Australian research has highlighted the need to reduce unnecessary lumbar spine imaging for low back pain, according to Professor Flavia Cicuttini, Head of the Musculoskeletal Unit in the Department of Epidemiology and Preventive Medicine at Monash University and Head, Rheumatology at The Alfred hospital in Melbourne.

A study of 13,458 women in their 30s found that the rate of lumbar spine CT scans increased nearly 25 fold from 1996 to 2015 while MRIs increased 16 fold. Almost 39% of found that underwent some form of lumbar spine imaging over the 20 years.

“This is at odds with the current recommendations for the management of low back pain which advise that routine use of imaging be avoided except to exclude significant alternative ‘red flag’ diagnoses such as cancer, fractures and auto-immune diseases and focus on high-quality education, encouragement to return to normal activity and physical exercise,” Professor Cuttini told the Australian and New Zealand College of Anaesthetists’ (ANZCA) Faculty of Pain Medicine (FPM) symposium in Melbourne.

“What we found was that people who tended to be more depressed and anxious were the ones most likely to have a lot of tests. It may be that doctors feel pressured to do these investigations in these patients, despite the clinical guidelines,” she said.

Opioid prescribing falls after doctors sent warning letters

A controversial Department of Health initiative has had modest success in curbing opioid use by sending warning  letters to high prescribing GPs. In June 2018, letters were sent to 4,679 GPs in the top 20% of prescribers of opioids. Their prescribing rate over the following 12 months fell 4% compared with a control group of 1,178 similarly high prescribers of opioids, who did not receive the letter. The intervention had significant effect on reducing prescribing of oxycodone – by 5.6% – but the impact was not seen among GPs in rural and regional areas. The developers of the program said it supported guidelines against the use of opioids for non-cancer chronic pain.

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