Rheumatoid arthritis

News in brief: Secukinumab on PBS for nr-axSpA; Cannabis not recommended for chronic pain; MTX action plans

Wednesday, 31 Mar 2021

 IL-17A inhibitor reimbursed for nr-axSpa

Secukinumab (Cosentyx) has been listed on the PBS for the treatment of adults with non-radiographic axial spondyloarthritis (nr-axSpA).

According to manufacturer, Novartis, secukinumab  is the first interleukin-17A (IL-17A) ) inhibitor to be to be reimbursed in Australia for the treatment of active nr-axSpA.

The PBS criteria state that to be eligible, patients must have objective signs of inflammation evidenced by elevated C-reactive protein (CRP) and MRI – and have had an inadequate response to, or are intolerant to, at least two NSAIDs, whilst completing an appropriate exercise program, for a period of three months.

In a statement released by Novartis, rheumatologist Dr Stephen Hall, an Adjunct Professor at Monash University said  that until now patients with nr-axSpA only had access to one class of biologic therapy.

“While current advanced therapies have transformed the management of nr-axSpA; around 30-40% of patients don’t achieve a good clinical response, either failing to respond or tolerate the treatment, only achieving a partial response or seeing the treatment lose efficacy over time,” he said.

Don’t use cannabis for chronic pain: expert groups

Expert groups representing pain specialists have recommended against medicinal cannabis for people with persistent non-cancer pain. Although cannabis products are now being made available by the TGA, there is a critical lack of evidence that cannabis provides a consistent benefit for any type of chronic non-cancer pain, according to the Faculty of Pain Medicine of the Australian and NZ College of Anaesthetists (ANZCA). In a Choosing Wisely recommendation the group says cannabidiol products formulations have not been shown in high quality randomised controlled trials to be effective for pain indications, while evidence of harms does exist, particularly in relation to sedative effects, interactions with other medications and neuropsychiatric effects.

“Given the above, the clinical use of cannabinoid products cannot be ethically recommended outside a properly established and registered clinical trial environment,” they state.

Methotrexate action plans for RA and PsA

Action plans to promote appropriate early use of low dose methotrexate in people with RA and PsA have been released by NPS MedicineWise. As part of the NPS program  for rheumatoid arthritis prescribing, the plans provide information on the facts and myths around methotrexate and how it can be used on a regular basis as background therapy to slow disease progression and reduce inflammation.

Patients are encouraged to use the action plan to discuss methotrexate with their rheumatologist and plan the best way to take their medicine.

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