News in brief: Stronger advice on tocilizumab shortage; JIA risk with antibiotics in early life; Lupus related healthcare costs are substantial: study

Thursday, 30 Sep 2021

Stronger advice on tocilizumab shortage

The supply of tocilizumab (Actemra) has changed significantly with shortages expected until early 2022 due to global demand in response to the COVID-19 pandemic.

In particular, extremely limited stock of intravenous (IV) tocilizumab has led to updated recommendations to prescribers.

For example, rheumatologists are advised to change RA patients on IV tocilizumab to alternate treatments as soon as possible; consider reducing the frequency of SC tocilizumab dose where appropriate; and not to initiate new patients on tocilizumab, except where no alternatives or no suitable alternatives are available.

The Australian Rheumatology Association and the TGA have agreed the priority indications for IV tocilizumab are cytokine release syndrome, systemic juvenile idiopathic arthritis, and polyarticular juvenile idiopathic arthritis.

Priority indications for SC tocilizumab are systemic juvenile idiopathic arthritis, giant cell arteritis and polyarticular juvenile idiopathic arthritis.

For more details and to keep up to date with the situation, check out the joint statement.

JIA risk leads to call to avoid antibiotics in early life

Exposure to antibiotics early in life is associated with an increased risk of developing JIA.

Data from a Swedish birth cohort of 17,000 children has shown that the odds of developing JIA were three times higher in those exposed to antibiotics during the first 3 years of life compared to those not exposed (aOR 3.17).

The odds of JIA were also more than twice as high in those exposed to antibiotics during the first 5 years of life compared with those not exposed (aOR 2.18).

“Our findings suggest a causal link between antibiotics and the development of JIA, which supports the hypothesis that antibiotic-induced dysregulation of the microbiome may trigger or accelerate the development of the autoimmune disease JIA in genetically predisposed children,” the study said.

“Irrespective of mediating mechanisms, these results suggest that restrictive antibiotic policies during the first years of life should be advisable.”

Read more in Pediatric Rheumatology

Lupus related healthcare costs are substantial: study

The direct healthcare costs for adults with systemic lupus erythematosus (SLE) are “substantial” and remain high after diagnosis, largely because of primary care and prescription drugs, a UK study has found.

For the real-world observational retrospective study, published in Rheumatology Advances in Practice, researchers identified 802 patients with SLE between 2005 and 2017, of whom 46% had mild, 43% moderate and 11% severe disease. Patients were followed for three years before diagnosis until the earliest of the following events: the end of the study period, a patient leaving the database or date of their last visit, or death.

The researchers found that across all types of healthcare use there was “a pattern of increasing utilisation in the three years before diagnosis, with a peak during the year of diagnosis, after which healthcare utilisation remained fairly constant over 10 years of follow-up”, and also that primary care utilisation and prescription drugs represented the lion’s share of costs both before and after diagnosis.

Annual all-cause healthcare costs for SLE were shown to grow progressively in the three years before diagnosis to plateau in the first year after. Costs remained relatively steady through seven years of follow-up, but significantly climbed again up to 10 years or those who remained in the study.

The later increases seen from year 8 might be driven by costs linked with long-term SLE care and comorbid disease, said the authors of the analysis, which was supported by AstraZeneca.

Also of note, the findings showed that healthcare costs increased over time for patients with severe and moderate SLE but remained fairly stable for those with mild forms. This likely reflected “the extent of organ damage in these patients”, the researchers concluded, and as such, they suggested that future research should assess “whether earlier diagnosis and treatment may reduce disease severity and associated high healthcare costs”.

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