News in brief: IV abatacept supplies restored; 3 ways to reduce carbon footprint from diagnostic imaging; Genetic scores predict joint replacements 

11 May 2022

IV abatacept supplies restored

Shortages of the bDMARD abatacept are now being resolved and health professionals can resume normal prescribing of Orencia IV infusion, the ARA advises.

In a statement released by the TGA, the regulator notes that the supply of subcutaneous presentations of abatacept products is also improving but it will remain constrained throughout the first half of 2022, the regulator says.

In light of the improvements in the supply situation, the ARA has provided updated advice to the TGA that rheumatologists should not initiate new patients on subcutaneous abatacept, but can resume initiating new patients on IV abatacept.

To help manage limited supplies, the Serious Scarcity Substitution Instrument (SSSI) has been extended until 30 June 2022. This allows pharmacists to offer adult patients whichever subcutaneous presentation is available at the pharmacy without the need for a new script, the TGA said in a 10 May statement.

“There is no additional process to obtain supply of IV abatacept for patients. The process to facilitate ordering of subcutaneous abatacept for patients who meet the ARA’s guidelines is still in place. For each individual patient who is to remain on subcutaneous abatacept, prescribers must complete a patient eligibility form to enable pharmacists to order stock,” it said.

3 ways to reduce carbon footprint from diagnostic imaging

Clinicians can help reduce the healthcare carbon footprint by adopting a three-pronged strategy to make more efficient use diagnostic imaging, according to Australian researchers.

Diagnostic imaging and pathology testing account for almost 10% of the carbon footprint, with MRI and CT scans accounting for a high proportion of it,  a Melbourne University study found.

The carbon emissions from an MRI are equivalent to driving a car for 145km, while a CT scan carbon emission are equal to driving 76 km, the findings in Lancet Regional Health showed.

Much of the large carbon footprint was due to electricity use by scanners, and in particular, their standby power use, said the researchers, who recommended that clinicians and administrators make efforts to reduce unnecessary imaging or by changing imaging to a lower carbon modality.

Other carbon reduction tips include turning scanners off when they are not required rather than leaving them in standby and ensuring existing scanners have high utilisation rates, they suggested.

Genetic scores predict risk of future hip or knee replacements 

Polygenic risk scores (PRSs) could help clinicians identify patients most likely to need a future knee or hip replacement and initiate preventative measures, Australian researchers say.

Their study of 12,093, ≥ 70-year-old individuals of European genetic decent found participants were 1.44 and 1.88 times more likely to have a knee or hip replacement, respectively, if their PRS scores were between 81% and 100%.

Scores were based on 10 and 37 significant single nucleotide polymorphisms linked to total knee or hip replacement risk in a 2021 meta-analysis of genome-wide association studies on advanced osteoarthritis.

Of assessed participants, 12% and 11% had knee and hip replacements, respectively, with PRSs associated with knee or hip replacement risk (odds ratio [OR]: 1.13, 95% CI: 1.07–1.20 and OR: 1.23, 95% CI: 1.16–1.30).

Associations were “stronger for PRSs and hip replacement risk in females than in males and similar in sensitivity analyses examining joint replacements before and during the trial separately”, the authors wrote in Arthritis & Rheumatology.

“Genetic scores, such as the one we developed, do not change over a person’s life, ” senior author Professor Flavia Cicuttini, Head of the Musculoskeletal Unit at Monash University and Head of Rheumatology at Alfred Hospital said in a statement.

They “have the potential to improve prevention of severe knee and hip osteoarthritis by providing a [personalised] approach and identifying individuals who may benefit from early intervention,” the paper concluded.

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