Published: 12 August, 2022
New article - Coeliac disease: Investigation and management
Coeliac disease affects approximately 1 in 100 people. However, it is often unrecognised as symptoms can be vague and non-specific and are not always related to the gastrointestinal tract. Laboratory investigations are the first step in making a diagnosis; this is often followed by confirmation with duodenal biopsy, but diagnosis based on strongly suggestive serology is increasingly common, particularly in children. Strict adherence to a gluten-free diet is the only treatment for coeliac disease. In most people this will result in complete resolution of symptoms, prevent further damage to the small intestinal mucosa and reduce the risk of long-term adverse health outcomes.
Read the full article here, along with a personal account from a general practitioner recently diagnosed with coeliac disease.
Come meet BPAC at the Christchurch CME conference
If you are in Christchurch this weekend for the CME conference, come on down and have a chat to our colleagues on the BPAC stand. They would love to talk to you about our educational resources, as well as some of the other exciting products in development by the wider team. Pick yourself up a sneaky copy of a special conference edition BPJ or the diabetes toolbox!
For those of you who can’t make the conference, you can read more about the new SmartCare tools here.
AstraZeneca COVID-19 vaccine soon no longer available
The AstraZeneca COVID-19 vaccine, Vaxzevria, is being phased out. The last day people can get vaccinated with Vaxzevria is 4 September, 2022. It will no longer be available in New Zealand after this date; the vaccine stock expires the following day.
The Novavax COVID-19, Nuvaxovid, is a non-mRNA option for people who are not able to, or do not wish to, receive the Pfizer COVID-19 vaccine.
Change to funded shingles vaccine
The funded shingles (herpes zoster) vaccine is changing from Zostavax to Shingrix as the supplier is discontinuing this vaccine. Shingrix is already listed on the Pharmaceutical Schedule, but will only be made available for people receiving a funded vaccine once stock of Zostavax has run out; this is anticipated to be in August or September, 2022.
There is no change to the eligibility criteria for funded treatment, but the dosing schedule is different: Shingrix is given as two doses, two to six months apart for people aged 65 years (the second dose can be given if the patient was aged 65 years when they received their first dose). The catch-up programme for people aged >65 years is no longer in place.
The change in vaccine will be welcome news for many healthcare professionals who have been waiting for Shingrix, which is a significantly more effective vaccine, to be funded.
Read more about shingles vaccine
Zostavax contains live attenuated herpes zoster vaccine, the same as that contained in the chicken pox (varicella) vaccine, but 14-fold more units of virus per dose. Shingrix is an adjuvanted recombinant vaccine, meaning that it does not contain the live attenuated virus, but instead contains a small fraction of the virus that cannot replicate but can boost immunogenicity. Shingrix is therefore safe to administer in people who are immunocompromised.
Shingrix is a more effective vaccine than Zostavax: a 2019 meta-analysis of 24 studies including over 88,000 participants showed that people aged 60 years or over who received live attenuated zoster vaccine had a 51% reduction in the relative risk of shingles compared to placebo vaccine. However, those who received the recombinant vaccine had a 92% reduction in the relative risk of shingles compared to placebo. Immunity is more long-lasting with Shingrix than Zostavax and it is also more effective in older age groups.
N.B. Shingrix is recommended, but not funded (except for people aged 65 years), for all adults aged 50 years or over and people aged over 18 years who are at increased risk, e.g. immunocompromised.
Read more about Shingrix vaccination from IMAC here and a previous comparison between vaccines here.
Laxatives in short supply
There are a number of supply issues currently affecting laxatives:
- Laxsol (dosusate sodium with sennosides) is in short supply due to manufacturing issues and is now being dispensed monthly.
- The manufacturing issue has also affected supply of Coloxyl (docusate sodium) 50 mg and 120 mg tablets; stocks are running low
- Bisacodyl 5 mg tablets supplied by AFT are no longer available. Viatris, the new supplier, is expected to have stock available shortly.
- Konsyl-D and the alternative product, Macro Organic Psyllium Husk, are both out of stock; re-supply of Konsyl-D is expected in October
For further information on managing constipation, click here
Locorten-Vioform ear drops out of stock again
We reported in Bulletin 53 that the long-term supply issue affecting flumetasone pivalate (Locorten-Vioform) ear drops had been resolved and the medicine was expected back in stock. Unfortunately, it appears that there was an issue with this stock and these ear drops are still not available. There is no indication when they will be back in stock.
For further information on managing otitis media, including CSOM, click here
Ongoing supply issues with oestradiol patches
The supply issues that have affected the availability of oestradiol patches for the past two years are still unresolved. As of 10th August, the 25 mcg Estradot patch is in stock (availability may differ by location). The 75 mcg and 100 mcg patches are in limited supply, and the 50 mcg patches are expected to be resupplied in late August. Climara 50 mcg patches were available to cover stock shortages but supplies have now run out. The stock situation is subject to frequent change; check NZF for up-to-date information or contact your local pharmacy prior to issuing a prescription for a patient.
For further information on menopausal hormone therapy, click here.
Dispersible roxithromycin tablets discontinued
The manufacturer of Rulide D, a 50 mg dispersible roxithromycin tablet, has discontinued supply; stock is likely to already be exhausted. There is no alternative brand available. Roxithromycin tablets (non-dispersible) are not affected by this issue. There is no liquid formulation of roxithromycin available, so this change means that roxithromycin is not a suitable treatment for children and adults* who are unable to swallow tablets. Roxithromycin may be prescribed to children as a second-line treatment for pneumonia, GAS sore throat or other susceptible infections.
* Funding of roxithromycin dispersible tablets is restricted to children aged under 12 years
Interim policy statement on health
Those of you who are keenly following the roll-out of health reforms in New Zealand may be interested in the recently published Interim Government Policy Statement on Health 2022-2024. This document sets out what the government expects the health system to deliver and achieve in the short term, and how this will be measured. The policy also sets expectations for each of the new health entities, with the collective aim of improving health outcomes for patients and their families/whānau: pae ora (healthy futures).
- Achieving equity in health outcomes – working towards equity in health and wellbeing, recognising the rights and obligations of under-served communities
- Keeping people well in their communities – identifying and addressing variations in healthcare, prioritising culturally appropriate community health services
- Ensuring a financially sustainable health system – maintain existing priorities and programmes, continuity of care
- Embedding Te Tiriti o Waitangi across the health system – strengthened Māori leadership and decision-making, kaupapa Māori and whānau-centred services
- Developing the health workforce of the future – sustainable and representative workforce, delivery of culturally appropriate services
- Laying the foundations for the success of the future health system – a new culture and ethos founded on Te Tiriti, working in partnership with communities
Paper of the Week: New study casts doubt on serotonin theory of depression
Researchers who conducted a systematic umbrella review (including existing systematic reviews and meta-analyses) of the evidence that lowered serotonin levels cause, or are associated with, depression found that there is no consistent evidence to support this theory. The authors concluded that: “...the huge research effort based on the serotonin hypothesis has not produced convincing evidence of a biochemical basis to depression...We suggest it is time to acknowledge that the serotonin theory of depression is not empirically substantiated.”
Expert commentary on the results of this study, however, reveal that this finding may not be as straightforward as it seems. The problem is that depression is not caused by one single factor, i.e. serotonin deficit, and that a study that aims to test whether serotonin levels are a factor in entire cohorts of people with depression will not be able to detect those patients for whom this may be a contributing factor. The premise of the main therapeutic group of medicines for treating depression is based on altering serotonin levels, but just because this may not be the reason for a person’s depression, doesn’t mean that the medicine won’t work. One commentator summarises this well: “Many of us know that taking paracetamol can be helpful for headaches and I don’t think anyone believes that headaches are caused by not enough paracetamol in the brain. The same logic applies to depression and medicines used to treat depression. There is consistent evidence that antidepressant medicines can be helpful in the treatment of depression and can be life-saving.”
Moncrieff J, Cooper R, Stockmann, et al. The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry (2022). https://doi.org/10.1038/s41380-022-01661-0
This Bulletin is supported by the South Link Education Trust
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