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EDITOR [email protected] | ADVERTISING
[email protected] 12 JUNE 2015
HUGO WILCKEN
Recommendations for managing health and pregnancy in women with
systemic lupus erythematosus and antiphospholipid syndrome have
been presented at the European League Against Rheumatism annual
congress in Rome.
Developed by an international expert panel, the evidence-based
recommendations cover family planning, assisted reproduction,
pregnancy and menopause in women with either or both of the
conditions.
“APS and SLE disproportionately affect women, typically starting
when they are at their most fertile, and leaving women at risk of
reduced fertility and pregnancy complications,” says lead author Dr
Laura Andreoli,
a rheumatologist from the University of Brescia in Italy.
“Women often develop these conditions before they have had the
chance to have children or complete their family; physicians must
ensure optimal management includes best-practice measures to reduce
these risks from the onset of disease and throughout
pregnancy.”
Patients planning a pregnancy should be assessed for disease
activity, serology, hypertension and drug use, with an emphasis on
hydroxychloroquine and antiplatelet/anticoagulant therapy, the
guidelines say.
Other key recommendations are:• Women with SLE and/or
APS may be candidates for contraception based on their
disease activity and thrombotic risk, in particular the presence
of antiphospholipid antibodies;
• Fertility preservation methods, including
gonadotropin-releasing hormone (GnRH) analogues should be
considered before using alkylating agents;
• Assisted reproduction techniques can be safely used in
patients with stable or inactive disease, provided preventive
measures are offered to limit the risk of flare and/or
thrombosis;
• Disease activity, serological markers and renal function
parameters are useful to monitor for obstetrical adverse outcomes
and disease flares during pregnancy.
• Fetal monitoring is similar to high-risk pregnancies in the
general
population, with fetal ECG indicated for suspected dysrhythmia,
particularly in patients with positive anti-RO and/or anti-La;
• Cancer screening should be similar to the general population,
with particular vigilance for cervical pre-malignancies if exposed
to immunosuppressive therapy;
• HPV vaccination should be considered in women with stable or
inactive disease;
• Hydroxychloroquine, glucocorticoids (oral or IV),
azathioprine, cyclosporine-A, tacrolimus and IV immunoglobulin can
be used to prevent or manage SLE flares during pregnancy.
For this abstract, click here.What do you think?Click here to
comment
New family planning guidelines for SLE and APS
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Experience Success1†
Experience Success1^ÂCR 20 achieved by 59% of RA patients at 6
months.1
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commenthttp://www.6minutes.com.au/getmedia/72475118-dc7a-441c-8dbc-9b30b082f3ed/Enbrel-Full-PI-June.aspxhttp://www.6minutes.com.au/rheumatologyupdate/home
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EDITOR [email protected] | ADVERTISING
[email protected] 12 JUNE 2015
Rheumatologists head for RomeCLARE PAIN
While patients with arthritis might have difficulty scaling the
seven hills of Rome, their physicians are out in force, presenting
a wealth of research at the European League against Rheumatism
(EULAR) 2015 Conference.
The perennial question of whether vitamin D helps in
osteoarthritis is addressed by a two-year Australian trial of 413
knee OA patients with low 25-hydroxy vitamin D, randomised to
either a monthly capsule of 50,000 IU D3 or placebo.
The answer seems to be no, with no statistically significant
changes in total knee pain WOMAC scores, or in MRI-assessed knee
tibial cartilage volume.
The persistence of treatment with various biologics prescribed
for RA is examined in an Australian Medicare database study, led by
Roche in conjunction with the Royal Hobart Hospital.
Median time to stopping
treatment was 39 months for tocilizumab, 32 months for
abatacept, 21 months for subcutaneous anti-TNFs and 3 months for
infliximab. Eighty
percent of patients taking tocilizumab as second-line therapy
were still taking the biologic at one year, compared with 45% of
people taking abatacept and 49% of people
on subcutaneous anti-TNFs.If a patient has OA-related
knee pain, which joints are the next ones likely to become sore?
According to a Tasmanian study, such patients are at increased risk
of shoulder pain some four years down the track.
“Spread of joint pain over time is not random, with shoulders
the most common painful joint following knees,” say the authors.
Having leg muscle weakness seems to be key to the spread of pain to
the shoulders, the authors add.For these abstracts and more, click
here.What do you think?Click here to comment
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TO PRODUCT INFORMATION. References: 1. ENBREL Approved Product
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zer Australia Pty Limited, 38–42 Wharf Road, West Ryde NSW 2114. ®
Registered trademark Pfi zer. www.pfi zer.com.au. P10393 May 2015
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Early RA (
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EDITOR [email protected] | ADVERTISING
[email protected] 12 JUNE 2015
Too much screen time affects boys’ bonesCLARE PAIN
Teenage boys who spend lots of time in front of the television
or computer screen are at risk of poorer bone health, research has
found.
A study carried out in Norway found the same does not apply to
girls, which it suggests can be explained by their different body
fat distribution.
Researchers looked at how much time 15- to 18-year-olds say they
spend sitting in front of screens at the weekend, with between four
and six hours being the most common amount of time in the 1000
students questioned.
This is followed by more than six hours in boys, but between two
and four hours in girls.
The school pupils’ bone mineral density was analysed along with
their height, weight and details of their lifestyles.
The team found that while girls in the four- to six-hour
category had the highest bone mineral density, the amount of time
spent in front of screens had a negative effect on
the bone mineral density of boys.“Our study suggests
persisting
associations of screen-based sedentary activities on bone health
in adolescence,” the Tromsø-based researchers say.
“This detrimental association should therefore be regarded as of
public health importance and
followed closely, since improvement of peak bone mass is
possible.”
While time spent in front of the TV and computer games was
linked to lower levels of physical activity, one in five (20 per
cent) of the girls and a quarter (26 per cent) of the boys who said
they spent more than four hours a day in front of a screen at
the weekend also spent more than fours hours a week doing
sport.
Researchers add that it is possible students either under or
over-reported their screen times because of social pressures or
gender differences.
They say girls tend to perform several activities at once -
spending time in front of the TV or computer screen as well as on
their phones or carrying out other tasks, such as hobbies or
crafts.
Meanwhile male adolescents are less likely to report spending
lots of time on the phone, texting and instant messaging, and it
might therefore have been easier for boys to give a precise amount
of time spent in front of a screen.
The study, which was led by the UiT The Arctic University of
Norway, is published in the online journal BMJ Open.Leisure time
computer use and adolescent bone health—findings from the Tromsø
Study, Fit Futures: a cross-sectional studyWhat do you think?Click
here to comment
Patient group concerned about biosimilarsCLARE PAIN
Patients are nervous about the introduction of biosimilars and
need to be well-informed by their treating physicians, according to
a presentation given at EULAR 2015 by the Committee for People with
Arthritis/Rheumatism (PARE).
With the original biologics now starting to reach the end of
their patent periods, biosimilars are being developed which are
intended to be “highly similar” to the original biologics, says
Diana Skingle, Chair of the PARE Standing Committee.
The problem is, that, with the complex molecules involved and
the equally complex production processes required to produce them,
it is virtually impossible for a biosimilar to be identical to the
original biologic medicine – which is known as the ‘reference
medicine’, she explains.
Even the reference medicines themselves have a degree of natural
variability, and biosimilars will also exhibit natural variability,
she says.
The European Union has led the world in setting up a legal
framework and regulatory pathway for biosimilars with the first
biosimilar being approved by the European commission in 2006, so
they are not new, she adds.
“There is an opportunity for these biosimilars to be available
at a lower cost than the original medicines, possibly making them
more widely accessible to patients
and offering more treatment options to physicians. The PARE
Committee welcomes these new possibilities.”
But there are patient concerns: one being that pressure may be
put on clinicians by health providers and insurers to prescribe the
newer cheaper biologics on the basis of cost.
Another concern is the European Medical Agency’s statement that
“some studies that have been
carried out with the reference medicine may not need to be
reproduced” for the biosimilar. This may mean that biologics are
approved after only very short or limited trials, she suggests
Pharmacovigilance is of particular concern, she remarks, and the
EU has said that, for biosimilars, the brand name should be used,
to enable “clear identification and traceability to support adverse
drug reaction reporting…”
Many patients are also concerned that physicians may switch them
between the reference product and a biosimilar without their
consent, says Ms Skingle.
“As for all medicines, patients need to be able to make
fully-informed decisions about whether to take a biologic or a
biosimilar,” she says.Biosimilars: What do patients need to
consider? What do you think?Click here to comment
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EDITOR [email protected] | ADVERTISING
[email protected] 12 JUNE 2015
Experience Success1†
PBS Information: Authority required for the treatment of adults
with severe active rheumatoid arthritis, active ankylosing
spondylitis, severe active psoriatic arthritis and severe chronic
plaque psoriasis.
Authority required for the treatment of patients under 18 years
with severe chronic plaque psoriasis. Private and public hospital
authority required for the treatment of severe active juvenile
idiopathic arthritis.
This product is not listed on the PBS for the treatment of
non-radiographic axial spondyloarthritis.Refer to PBS Schedule for
full information.
PLEASE REFER TO THE PRODUCT INFORMATION BEFORE PRESCRIBING.
CLICK HERE FOR ACCESS TO PRODUCT INFORMATION. References: 1. ENBREL
Approved Product Information. 2. Emery P, et al. Ann Rheum Dis
2012; 71:989-92. Pfi zer Australia Pty Limited, 38–42 Wharf Road,
West Ryde NSW 2114. ® Registered trademark Pfi zer. Medical
Information: 1800 675 229. www.pfi zer.com.au. P10393 May 2015
PFE0052/RU3
*Post-hoc analysis. ¥ DAS28 remission 70% vs. 48% in
patients
