News in brief: Upadacitinib now on PBS for severe atopic dermatitis; Psoriasis flares after COVID-19 vaccination; Consultants must act on junior doctor wage theft

1 Feb 2022

Upadacitinib now on PBS for severe atopic dermatitis

From 1 February the JAK1 inhibitor upadacitinib (Rinvoq) is listed on the PBS for the treatment of moderate to severe atopic dermatitis in adults and adolescents 12 years and older.

The 15mg and 30mg tablets, marketed by Abbvie, were recommended for listing by the Pharmaceutical Benefits Advisory Committee (PBAC) in July 2021 on the basis that upadacitinib provides an overall clinical benefit similar to the comparator, dupilumab. The PBAC also accepted that the response to treatment may be faster with upadacitinib.

Minister for Health and Aged Care, Greg Hunt, said this listing will benefit around 3,600 Australians a year, who would otherwise have to pay more than $27,000 per year treatment.

Psoriasis flares after COVID-19 vaccination

Psoriasis flares may result from vaccination even in well-managed disease, according to Sydney dermatologists who advise closer monitoring following each vaccination dose.

In a case report, Dr Natalie Teh of the University of NSW describes three psoriatic flares in close succession that occurred in an 80-year old man after receiving his doses of AstraZeneca COVID-19 vaccine and flu vaccine.

The first psoriatic flare occurred with trunk, head, and limb involvement (PASI 11.4) and responded to oral prednisolone and betamethasone dipropionate 0.05% ointment. A second flare occurred 26 days after the first, which also responded to the same corticosteroid regimen. A more severe flare occurred eleven days after the second AZ dose (PASI 15.2) necessitating wet dressings in hospital for two days and at home for a further five days. The eruption then abated.

In her report, Dr Teh says the combination of AZ and pre-activation of natural killer (NK) cells from the influenza vaccine may have contributed to each exacerbation.

Consultants must act on junior doctor wage theft

Hospital consultants are being urged to help stop public hospital ‘wage theft’ from junior doctors.

An article in MJA Insight says that doctors-in-training are deterred from claiming overtime for fear of being labelled inefficient, incompetent or greedy. Since claims must be signed off by a consultant who usually act as a referee for the junior doctor’s reappointment, these senior clinicians are in a key position to help prevent the chronic underpayment of doctors-in-training, writes Dr Leanne Rowe. They must also support junior staff access to entitlements such extra shift allowances, on call penalties, breaks and training periods, she says.

“Senior consultants must urgently re-examine how they manage legitimate claims for the basic pay entitlements by subordinates, as well as notifying public hospital management of the need for adequate funding for payroll,” she writes.

“Continuing to expect junior doctors to perform significant additional volunteer hours in the presence of many other serious occupational health and safety issues is not only grossly unjust – it’s criminal,” she concludes.

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