News in brief: Temporary PBS listings for RA and JIA medications; AMA ‘secession’ move slammed; Doctors eligible for COVID-19 boosters

Temporary PBS listings for RA and JIA medications

To help patients switching from tocilizumab during the period of shortages, the PBS has made temporary listing changes to allow prescribers to request up to 24 weeks of alternative treatments for severe inflammatory arthritis

The health department says the changes will provide prescribers and patients with increased time to demonstrate response to the new therapy, and will also avoid inaccurate recording of the switch from tocilizumab as a treatment failure.

The new temporary listings have been applied to medicines currently PBS listed for the treatment of severe active rheumatoid arthritis (abatacept, adalimumab, baricitinib, certolizumab, etanercept, golimumab, infliximab, rituximab, tofacitinib, and upadacitinib) and for the treatment of severe active juvenile idiopathic arthritis (adalimumab and etanercept).

The listings, which cover initial treatment and first continuing treatment , will be in place from 1 November 2021 until the shortage of tocilizumab has been resolved.

“Once the shortage has resolved, prescribers will be able to transfer their patients back to therapy with tocilizumab should they choose to do so,” the TGA advises.

“Temporary listings are planned that will enable patients to transfer back to tocilizumab, that avoid inaccurate categorisation and recording of the switch back to tocilizumab from alternative treatment, as a treatment failure with Services Australia.”

There are no alternative bDMARDs listed on the PBS for the treatment of systemic JIA or GCA, and so prescribers are advised check the TGA website for advice on conservation of stock of tocilizumab for these patients.

AMA ‘secession’ move slammed

A move by AMA Victoria to offer cheaper ‘Associate’ membership that does not include membership of the Federal AMA has been condemned by some senior figures as effectively seceding from the national medical union.

The state branch is offering a ‘low cost membership option’ that is 40% cheaper than the full annual membership rates of $1582, and which provides the benefits and services of the AMA Victoria branch.

AMA Victoria told the ABC it had simply created an “additional membership category which offers doctors more choice, flexibility and pricing transparency”.

However Dr Stephen Parnis, a former AMA Victoria President and Vice President of the Federal AMA said the move would undermine the authority of the Federal AMA and also irreparably diminish the resources and policy strength of the AMA at state level

The move was also opposed by Federal AMA president Dr Omar Khorshid, who urged doctors to maintain their full membership while the Federal body sought to resolve its issues with the Victorian arm.

ATAGI advises COVID-19 boosters for doctors

Doctors and other healthcare staff at increased occupational risk of COVID-19 are among the high priority groups to receive booster doses of COVID-19 vaccine, according to new recommendations from the Australian Technical Advisory Group on Immunisation (ATAGI).

In advice released on 27 October, ATAGI said an additional vaccine dose after the primary vaccine course was warranted for people with risk factors for severe COVID-19 and/or those at increased occupational risk of COVID-19.

For people at increased occupational risk of COVID-19, ATAGI states that a booster dose is expected to reduce their likelihood of SARS-CoV-2 infection and associated occupation-related impacts, “acknowledging that infection will be mostly mild in these individuals due to prior vaccination and younger age. Booster doses may also reduce the potential for infected individuals to transmit SARS-CoV-2, although evidence for this is currently limited.”

“To facilitate implementation of the national COVID-19 vaccine booster program, ATAGI supports the use of a single booster dose for those who completed their primary COVID-19 vaccine course ≥6 months ago. This will initially include, but not be limited to, the groups above who were prioritised in the rollout of the vaccine program from early 2021,” it said

Pfizer (Comirnaty) vaccine is recommended as a single booster dose, irrespective of the primary COVID-19 vaccine used. Although not preferred, AstraZeneca (Vaxzevria) can also be used as a booster dose for people who received it for their first two doses, and also for people who had a significant adverse reaction after a previous mRNA vaccine dose.

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