News in brief: Women with RRMS benefit most from natalizumab; COVID-19 vax booster doses to be recommended for some patients; Telehealth MBS items now available for inpatients

27 Sep 2021

Women with RRMS benefit most from natalizumab

Relapsing-remitting multiple sclerosis drug natalizumab appears effective in a range of patients, but new research shows it could best benefit women.

The study of 5,148 patients over median 25 months found women on natalizumab had fewer relapses (incidence rate ratio [IRR]: 0.76, 95% CI: 0.65–0.88) and higher probability of confirmed disability improvement (hazard ratio [HR]: 1.36, 95% CI: 1.10–1.66) versus those on fingolimod, the authors wrote CNS Drugs.

Patients aged ≤38 years (IRR: 0.64, 95% CI: 0.65–0.88), with disease duration ≤7 years (IRR: 0.63, 95% CI: 0.53–0.76), an EDSS score <4 (IRR: 0.75, 95% CI: 0.64–0.88), <6 (IRR: 0.80, 95% CI: 0.70–0.91) and ≥6 (IRR: 0.52, 95% CI: 0.31–0.86) and pre-baseline relapses (IRR: 0.74, 95% CI: 0.64–0.86) had similar success regarding on-treatment relapses over fingolimod.

Meanwhile, patients aged >38 years (HR: 1.34, 95% CI: 1.04–1.73), with disease duration >7 years (HR: 1.21; 95% CI: 1.01–1.46), EDSS scores <6 or ≥6 (HR: 1.93, 95% CI: 1.11–3.34), and with no new MRI lesion (HR: 1.73, 95% CI: 1.19–2.51) were also more likely to have confirmed disability improvement.

“Natalizumab has proved to be more effective than fingolimod in reducing disease activity in relapsing-remitting multiple sclerosis,” the authors wrote.

This study identified sub-groups who were particularly receptive to natalizumab.

COVID-19 vax booster doses needed for some patients: ATAGI

A third COVID-19 vaccine booster dose will soon be recommended for some Australians with immunocompromising conditions, according to the Australian Technical Advisory Group on Immunisation (ATAGI).

In advice released on 23 September, ATAGI said it anticipated that “a relatively small cohort of individuals, such as those with severely immunocompromising conditions, are likely to require a third dose as part of their primary course of vaccination to ensure optimal vaccine effectiveness.”

ATAGI added that boosters for other populations may be required in the future, and it was preparing recommendations to be released in the next few weeks.

Factors to be considered in recommendations for boosters include the duration of protection provided by additional doses, timing of booster doses to cover anticipated future peaks and the balance of efficacy and safety of third doses of mRNA vaccines, it said. ATAGI is also reviewing the types of vaccine to be used as boosters and the potential for newer  types such as the protein subunit vaccines variant vaccines as they become available.

In the meantime it said first and second dose coverage remained a priority for achieving protection in the current Delta outbreak.

Telehealth MBS items now available for inpatients

New MBS telehealth items have been introduced to cover in-hospital services for private admitted patients receiving specialist care where the doctor is unable to attend due to the COVID-19 pandemic.

Available from 15 September 2021, the 40 temporary items (valid until 31 December) for specialists cover video and phone consultations for a specialist who is located in COVID-19 hotspot, or in isolation or quarantine.

According to Medicare, private health insurance rebates and gapcover schemes do not apply for these telehealth attendances.

Out of pocket costs for the new items will count towards the patient’s Medicare Safety Nets (original and extended).

In its Factsheets, Medicare says MBS specialist telehealth items do not need to be bulk billed, although this is encouraged

“The fee structure for the new items aligns with equivalent face-to-face items and existing COVID-19 telehealth specialist items introduced from March 2020,” it says.

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