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Greater access to ‘life changing’ asthma drugs on PBS


Anastasia Tsirtsakis


2/06/2020 3:56:55 PM

Patients with mild and severe forms of asthma now have wider access to effective treatment, helping to curb anxiety amid the pandemic.

Woman with asthma.
Asthmatics who require oral steroids on a regular basis may benefit from mepolizumab.

One in nine Australians are affected by asthma, with mortality rates higher for people living in remote or lower socioeconomic areas.
 
Now access to effective treatments has been expanded under the Pharmaceutical Benefits Scheme (PBS), in effect from 1 June.
 
For patients with mild asthma, aged 12 years and over, GPs can prescribe the anti-inflammatory reliever budesonide and formoterol (sold as Symbicort), to help prevent and control symptoms.
 
Previously only available for patients with more severe forms of asthma, it will be available in two strengths of inhaler, Symbicort Turbuhaler 200/6 and Symbicort Rapihaler 100/3.
 
Expected to benefit more than 170,000 patients annually, Professor Amanda Barnard, a rural GP and Chair of the Guidelines Committee at the National Asthma Council Australia, welcomed the expanded listing.
 
‘Very few adults and adolescents with asthma can maintain good asthma control relying solely on a short-acting reliever,’ she said.
 
‘Nearly all adults with asthma will have better health outcomes and quality of life through use of a preventer that contains an inhaled corticosteroid, which addresses the underlying lung inflammation.
 
‘However, it’s important to note that short-acting relievers such as salbutamol remain an essential rescue medicine for their role in management of acute asthma and community first aid. They still provide safe relief of symptoms when used with a regular inhaled corticosteroid preventer.’
 
Meanwhile for patients with severe eosinophilic asthma, the PBS expansion includes a mepolizumab (sold as Nucala) pre-filled, self-administered auto-injector pen, allowing people to self-administer their treatment at home.
 
Without the subsidy, the treatment costs more than $20,000 per year.
 
Professor Philip Thompson, a respiratory physician, told newsGP he has witnessed how life changing the biologic treatment can be for patients firsthand.  
 
‘You get quite dramatic improvements, to the point where you wouldn’t recognise our patients as having severe asthma. So it is quite a miracle transition that occurs,’ he said.
 
‘Before this approach to therapy, these people’s lives just revolved around their health problems. Everything was driven by what was happening to their asthma and a lot of morbidity from having to use so many drugs. So it really is transforming.’
 
For patients in rural and remote areas, having the option to self-administer treatment at home is likely to have significant benefits, as they often need to travel long distances for treatment every four weeks, or otherwise organise a GP or nurse to come to them – an arrangement that isn’t always foolproof.
 
At the Lung Health Clinic in Western Australia, Professor Thompson and his colleagues surveyed 70 patients with severe asthma over 12 months about the prospect of self-injecting and found more than 95% were on board. For the few that expressed apprehension over giving themselves an injection, Professor Thompson said this anxiety can be eased through education and training. 
 
‘We’ve now got about 20 people taking it and from the very first injection, which they do in front of us, you can see they find it extraordinarily easy to use; they’re not daunted, they’re not challenged,’ he said.
 
‘It’s all over and done with very quickly and they’re full of enthusiasm about the whole idea of liberating themselves from being on a long leash from the doctor or the nurse.’
 
Once a specialist deems the patient is competent at administering the treatment, the patient nominates a pharmacist for their monthly supply.
 
Patients are then required to see their specialist again once every six months to obtain a new script. To continue receiving the treatment, the prescribing doctor is required to show evidence that the patient is responding well.
 
Those starting on the drug for the first time will still be required to see their specialist in clinic regularly to monitor for any adverse effects, as well as their transition off other therapies for their asthma.

Professor-Phil-Thompson-Article.jpgRespiratory physician Professor Philip Thompson says it is important GPs keep in contact with asthma patients on long-term therapy.
 
The PBS expansion to include an at-home option for Nucala was initially not due until September, but the Department of Health brought the date forward in response to the COVID-19 pandemic.
 
‘It’s nice to have a good news story,’ Professor Thompson said.
 
‘We’re freeing up that patient group, but also the people who are very anxious about coronavirus [and] the fear of attending a clinical practice where they might catch infection.’
 
Dr Kerry Hancock, Chair of the RACGP Respiratory Medicine Specific Interests network, says her patients with severe asthma have ‘felt incredibly vulnerable’ over the past few months.
 
‘I had patients who did not go outside their front door for six weeks and they were very scared,’ she told newsGP.
 
‘Across our practice, we had three patients on biologics and we touched base with all of them to make sure that they were able to access their biologic administration.
 
‘Of course, if they had access to an auto-injector, they could have been doing that themselves, which would have minimised the risk of exposure to other people.’
 
One of the main concerns, Professor Thompson says, is how well patients will stick to their schedules. He says it is important for clinicians to keep in contact with their patients, a process made easier through telehealth.
 
‘Even in the best of situations, people that always remember may get a bit slack because they’re feeling so good,’ he said.
 
‘But they’re the issues for any long-term therapy, we just need to make sure that we keep in contact with patients. Talk to them, ask them a few pertinent questions about how their asthma is travelling.’
 
To ensure the drug is working, periodic blood tests to check eosinophil levels remain low is advised, as is checking lung performance.
 
While most GPs often see only a minority of patients with severe asthma, Professor Thompson says it is important they are aware of new emerging therapies to assess patients who may benefit from a referral to a specialist.
 
‘There may be people sitting at home or seeing their GP where the mutual view is, “Well, this is how it is, I can’t be any better”. But that may not be the case for some of those patients – every so often there’s a revolutionary approach that might make a difference,’ he said.
 
‘Any asthmatic who’s needing to be on oral steroids on a regular basis would be worth checking with a specialist as to whether these drugs would be helpful.’
 
Dr Hancock agrees.
 
‘My understanding is that a lot of my colleagues are not aware that these biological agents are available for our patients who have severe asthma,’ she said.
 
‘As GPs we do have to be thinking when we’re seeing our patients with severe asthma, “Okay, is this a patient who might benefit from the introduction of a biologic agent such as mepolizumab? Do they meet the criteria? Have they had an exacerbation? Do they have a raised eosinophil count? Okay let’s refer them on to the severe asthma clinic at our local tertiary institution, or wherever it may be”.
 
‘As time goes by GPs will learn more and more about them.’
 
For further guidance, GPs can access previewed changes to the Australian Asthma Handbook on the National Asthma Council Australia website.  
 
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