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PBS ‘limiting’ treatment of ankylosing spondylitis

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ANKYLOSING spondylitis patients may be missing out on the dramatic benefits offered by tumour necrosis factor (TNF) inhibitors because of overly restrictive PBS requirements, an expert says.

Almost 90% of patients responded well when treated with the drugs and 60% had a

dramatic response

, according to a study of 30 people attending the newly established spondylitis clinic at Melbourne

s Austin Health. The study provided the strongest Australian evidence to date on the drugs

effectiveness in ankylosing spondylitis, said Dr Lionel Schachna, who runs the clinic.

However, many people who would benefit were missing out on the new drugs, Dr Schachna told the Australian Rheumatology Association conference in Melbourne recently.

He estimated about one-quarter of patients likely to respond to TNF inhibitors were not eligible under the PBS, either because they had not tested positive for the human leukocyte antigen B27 (HLA-B27) or did not have elevated inflammatory markers (eryt

hrocyte sedimentation rate and C-reactive protein), criteria he believed were more relevant to rheumatoid arthritis than ankylosing spondylitis.

He said treatment was also compromised by delays in diagnosis, with the average time from onset of symptoms to diagnosis being 5-7 years.

Ankylosing spondylitis should be considered when a patient did not respond to traditional treatments for mechanical back pain, such as physiotherapy, Dr Schachna said.

Until now, we really haven

t had any good medication for ankylosing spondylitis,

he said.

Now that we have a treatment it is important to pick people up earlier.

Patients in the study typically responded very quickly to treatment, Dr Schachna said. Within weeks they had minimal pain and stiffness, were sleeping better and had reduced their use of other medications.

The common experience is that, after their first infusion, they wake up and it is a brand new day for them.


 

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