3 April, 2017 
1. REDUCING HEPATITIS C IN AUSTRALIA

Australia has the potential to eradicate hepatitis C in the next 10–15 years, according to Associate Professor Simone Strasser, gastroenterologist at Royal Prince Alfred Hospital in Sydney.  

Writing in the latest edition of Australian Prescriber, Professor Strasser says that the new oral antiviral treatments for hepatitis C are so effective and well tolerated that 95% of patients will be cured with a short course of treatment.

As these new treatments are available on the Pharmaceutical Benefits Scheme (PBS), and have a very wide prescriber base that includes GPs, new cases of hepatitis will become rare. Consequently liver disease, liver failure, liver cancer and liver transplantation will decrease.

This outcome can only be achieved if all people with chronic hepatitis C are diagnosed, assessed, treated and followed up appropriately, says Professor Strasser. To be cured, it is important for patients to take their medicines every day for the full course of treatment.

“It is essential that all medical practitioners, particularly GPs, have the skills to diagnose patients with hepatitis C and either manage them with specialist support if needed, or refer them for specialist care.”

It is estimated that 82% of the 227,000 people living with hepatitis C in Australia have been diagnosed.  However, many of them have either not been informed of their diagnosis or are not aware of the implications of chronic viral hepatitis.

Before 2016, less than one in four Australians with chronic hepatitis C had been treated and approximately one in five was undiagnosed. Because hepatitis C is a major cause of chronic liver disease, cirrhosis and liver cancer, it is essential that all people with chronic infection are identified so that treatment can be provided.

“Anyone at risk of contracting a blood-borne infection should be tested for hepatitis C, as should anyone with evidence of chronic liver disease or abnormal liver enzymes”, says Professor Strasser.   

“Approximately 80% of those infected are injecting drug users, and so should be a major focus for testing. Other important groups include migrants from high-prevalence countries or regions such as Egypt, Pakistan, Mediterranean and eastern European countries, Africa and Asia.”

To read the full article and others visit nps.org.au/australianprescriber.

3 April, 2017 
2. RHEUMATIC FEVER RATES HIGH AMONG ABORIGINAL AND TORRES STRAIT ISLANDERS

Acute rheumatic fever and rheumatic heart disease are rare in affluent societies yet high rates persist among Aboriginal and Torres Strait Islander populations, especially those living in rural or remote settings.

Estimates for rheumatic heart disease in Australian children range from less than one per 1000 population in low-risk children, to 33 per 1000 in parts of the Northern Territory.  Maori and Pacific Islanders and immigrants from developing countries are also likely to be at elevated risk.

In the latest edition of Australian Prescriber, this important problem in remote indigenous Australian communities is discussed by Associate Professor Anna Ralph, senior clinical research fellow from Menzies School of Health Research, Charles Darwin University, and colleagues from RHDAustralia. 

Rheumatic fever occurs in response to an infection caused by Group A streptococci. This infection is more common in disadvantaged communities where there are overcrowded living conditions. Repeated infections lead to rheumatic heart disease, which has high death rates.

“Many healthcare providers working with at-risk populations, have little experience with acute rheumatic fever and rheumatic heart disease, and might not know of the many resources available to guide diagnosis and management,”     says Associate Professor Ralph. “It is important that they and patients are aware of the current evidence for treatment and recent changes in guidelines.” 

Rheumatic fever is notifiable to public health units in Australian states and territories which have rheumatic heart disease control programs such as Western Australia, Northern Territory, Queensland, South Australia and New South Wales.  The control programs are a vital resource in managing the disease by providing education and support to clinicians and patients through online training, videos and diagnostic tools.  

The recommended treatment to prevent recurrences and development of rheumatic heart disease is an injection of penicillin every 28 days.

“Children embarking on the daunting prospect of at least 10 years of penicillin injections require sensitive, culturally appropriate engagement with healthcare systems and use of strategies to minimise the pain of injections, “ says Associate Professor Ralph.  Adherence resources including smartphone applications, calendars, reminder cards and incentive programs are offered at some clinics”.

To read the full article and others visit nps.org.au/australianprescriber.

3 April, 2017
3. EARLY TREATMENT KEY TO SUCCESS IN RHEUMATOID ARTHRITIS

The cause of rheumatoid arthritis might still be unknown, but an understanding of its pathological processes has advanced greatly in the last 20 years.

In the April issue of Australian Prescriber, Dr Tom Wilsdon, clinical pharmacology registrar at Flinders Medical Centre, and Professor Catherine Hill from the School of Medicine, University of Adelaide write that these advances have markedly changed the way the disease is managed and as a result have improved outcomes for patients.

Rheumatoid arthritis is a chronic autoimmune condition affecting joints.  Its onset is usually in people aged 35–60 years, however the majority of patients in Australia are over 65. 

Without treatment, the underlying inflammatory process can lead to joint destruction, pain, deformity, disability and also heart disease.  Newer treatments for rheumatoid arthritis modify the course of the disease. They reduce inflammation and pain, and prevent further joint damage. 

The authors say patients with suspected rheumatoid arthritis should be referred for treatment promptly as early intervention can achieve better results for patients over the long term.

“Within three months of onset there is a ‘window of opportunity’ as early treatment is more likely to induce remission and slow down progression of the condition.  Delaying treatment beyond three months causes more joint destruction and a higher chance of requiring long-term treatment.”

To read the full article and others visit nps.org.au/Australian prescriber.

3 April, 2017 
1. REDUCING HEPATITIS C IN AUSTRALIA

Australia has the potential to eradicate hepatitis C in the next 10–15 years, according to Associate Professor Simone Strasser, gastroenterologist at Royal Prince Alfred Hospital in Sydney.  

Writing in the latest edition of Australian Prescriber, Professor Strasser says that the new oral antiviral treatments for hepatitis C are so effective and well tolerated that 95% of patients will be cured with a short course of treatment.

These new treatments are available on the Pharmaceutical Benefits Scheme (PBS), thanks to the great amount of research done using solutions like https://lnhlifesciences.org/liver-endothelial-cells. They have a very wide prescriber base that includes GPs, new cases of hepatitis will become rare. Consequently liver disease, liver failure, liver cancer and liver transplantation will decrease.

This outcome can only be achieved if all people with chronic hepatitis C are diagnosed, assessed, treated and followed up appropriately, says Professor Strasser. To be cured, it is important for patients to take their medicines every day for the full course of treatment.

“It is essential that all medical practitioners, particularly GPs, have the skills to diagnose patients with hepatitis C and either manage them with specialist support if needed, or refer them for specialist care.”

It is estimated that 82% of the 227,000 people living with hepatitis C in Australia have been diagnosed.  However, many of them have either not been informed of their diagnosis or are not aware of the implications of chronic viral hepatitis.

Before 2016, less than one in four Australians with chronic hepatitis C had been treated and approximately one in five was undiagnosed. Because hepatitis C is a major cause of chronic liver disease, cirrhosis and liver cancer, it is essential that all people with chronic infection are identified so that treatment can be provided.

“Anyone at risk of contracting a blood-borne infection should be tested for hepatitis C, as should anyone with evidence of chronic liver disease or abnormal liver enzymes”, says Professor Strasser.   

“Approximately 80% of those infected are injecting drug users, and so should be a major focus for testing. Other important groups include migrants from high-prevalence countries or regions such as Egypt, Pakistan, Mediterranean and eastern European countries, Africa and Asia.”

To read the full article and others visit nps.org.au/australianprescriber.

3 April, 2017 
2. RHEUMATIC FEVER RATES HIGH AMONG ABORIGINAL AND TORRES STRAIT ISLANDERS

Acute rheumatic fever and rheumatic heart disease are rare in affluent societies yet high rates persist among Aboriginal and Torres Strait Islander populations, especially those living in rural or remote settings.

Estimates for rheumatic heart disease in Australian children range from less than one per 1000 population in low-risk children, to 33 per 1000 in parts of the Northern Territory.  Maori and Pacific Islanders and immigrants from developing countries are also likely to be at elevated risk.

In the latest edition of Australian Prescriber, this important problem in remote indigenous Australian communities is discussed by Associate Professor Anna Ralph, senior clinical research fellow from Menzies School of Health Research, Charles Darwin University, and colleagues from RHDAustralia. 

Rheumatic fever occurs in response to an infection caused by Group A streptococci. This infection is more common in disadvantaged communities where there are overcrowded living conditions. Repeated infections lead to rheumatic heart disease, which has high death rates.

“Many healthcare providers working with at-risk populations, have little experience with acute rheumatic fever and rheumatic heart disease, and might not know of the many resources available to guide diagnosis and management,”     says Associate Professor Ralph. “It is important that they and patients are aware of the current evidence for treatment and recent changes in guidelines.” 

Rheumatic fever is notifiable to public health units in Australian states and territories which have rheumatic heart disease control programs such as Western Australia, Northern Territory, Queensland, South Australia and New South Wales.  The control programs are a vital resource in managing the disease by providing education and support to clinicians and patients through online training, videos and diagnostic tools.  

The recommended treatment to prevent recurrences and development of rheumatic heart disease is an injection of penicillin every 28 days.

“Children embarking on the daunting prospect of at least 10 years of penicillin injections require sensitive, culturally appropriate engagement with healthcare systems and use of strategies to minimise the pain of injections, “ says Associate Professor Ralph.  Adherence resources including smartphone applications, calendars, reminder cards and incentive programs are offered at some clinics”.

To read the full article and others visit nps.org.au/australianprescriber.

3 April, 2017
3. EARLY TREATMENT KEY TO SUCCESS IN RHEUMATOID ARTHRITIS

The cause of rheumatoid arthritis might still be unknown, but an understanding of its pathological processes has advanced greatly in the last 20 years.

In the April issue of Australian Prescriber, Dr Tom Wilsdon, clinical pharmacology registrar at Flinders Medical Centre, and Professor Catherine Hill from the School of Medicine, University of Adelaide write that these advances have markedly changed the way the disease is managed and as a result have improved outcomes for patients.

Rheumatoid arthritis is a chronic autoimmune condition affecting joints.  Its onset is usually in people aged 35–60 years, however the majority of patients in Australia are over 65. 

Without treatment, the underlying inflammatory process can lead to joint destruction, pain, deformity, disability and also heart disease.  Newer treatments for rheumatoid arthritis modify the course of the disease. They reduce inflammation and pain, and prevent further joint damage. 

The authors say patients with suspected rheumatoid arthritis should be referred for treatment promptly as early intervention can achieve better results for patients over the long term.

“Within three months of onset there is a ‘window of opportunity’ as early treatment is more likely to induce remission and slow down progression of the condition.  Delaying treatment beyond three months causes more joint destruction and a higher chance of requiring long-term treatment.”

To read the full article and others visit nps.org.au/Australian prescriber.