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Published: 7 October, 2022


No new patients should be started on dulaglutide: global supply issue

A global supply issue is affecting stock of dulaglutide (Trulicity), an injected GLP-1 receptor agonist for people with type 2 diabetes, and supply pressures are likely to continue through to early next year. Pharmac has asked health professionals to “strongly consider” not starting new patients on dulaglutide so that existing stock can be prioritised for those who are already taking the medicine.

Empagliflozin (with or without metformin), an oral SGLT-2 inhibitor, is the primary funded alternative treatment for patients who meet the Special Authority criteria. Other funded alternatives for people with type 2 diabetes include vildagliptin, metformin, sulphonylureas and insulin.

bpacnz has published a Diabetes Special Edition Best Practice Journal – Diabetes Toolbox. This suite of resources covers all aspects of management for people with type 2 diabetes, including lifestyle interventions, oral glucose-lowering medicines, e.g. empagliflozin, vildagliptin, initiating insulin and monitoring for complications. Individual articles can be found here.

Consultation to fund adrenaline auto-injectors

Pharmac is seeking feedback on a proposal to fund adrenaline auto-injectors (e.g. EpiPen) for people at risk of anaphylaxis. Submissions are due by 11 October.

Currently, people at risk of anaphylaxis can purchase adrenaline auto-injectors at a pharmacy without a prescription. However, the cost, alongside a short expiration date (efficacy may be compromised in expired products), can be significant barriers to access.

N.B. This consultation also includes a proposal to fund nusinersen (Spinraza) for the treatment of people with spinal muscular atrophy.

COVID-19 mortality in New Zealand: analysis released

Manatū Hauora, The Ministry of Health, has published a report on COVID-19 mortality in New Zealand. The analysis was undertaken by the Public Health Agency to identify and quantify inequities in COVID-19 mortality in New Zealand, particularly for Māori and Pacific peoples, and to examine factors that may influence this risk.

The analysis included 1,797 people whose death had been attributed to COVID-19 between 1 January and 26 August, 2022. Age was found to be the most significant predictor of mortality from COVID-19. Other risk factors included:

  • Māori and Pacific ethnicity. Māori and Pacific peoples had 2.0 and 2.5 times greater risk of COVID-19 mortality, respectively, compared to European/Other.
  • Low socioeconomic status. The most deprived 20% of people in New Zealand had 3.0 times the risk of COVID-19 mortality compared to the least deprived 20%.
  • Pre-existing health conditions. People with one or more co-morbidities (particularly those aged under 60 years) had a 6.3 times greater risk of COVID-19 mortality compared to people without co-morbidities.

Being vaccinated provided significant protection for all ethnicities; two or more doses of a COVID-19 vaccine reduced the risk of death by 62% compared to fewer than two doses.

Read the full report here. There is also an associated press release detailing some of the key findings.

Immunisation reminders

ACC to cover injuries during labour or childbirth

From 1 October, 2022, birthing parents who are injured during labour or childbirth are eligible for support from ACC. Data show that up to 80% of birthing parents experience an injury during labour or childbirth. Previously, the definition of injury in the Accident Compensation Act 2001, specified the application of force or resistance that was external to the body; obstetric injuries were judged to be due to an internal force and therefore did not meet the requirements for cover. This has meant that only injuries that occurred as a result of treatment during childbirth were covered by ACC. It is estimated up to 28,000 birthing parents will benefit from this change, each year.

A defined list of birth injuries that are covered has been developed by ACC, including uterine prolapse, obstetric fistula and genital tears. People who experience significant morbidity or long-term complications following an injury during labour or childbirth, will be able to access compensation, support and rehabilitation services.

NZF updates for October

Significant changes to the NZF in the October, 2022, release include:

You can also read about any significant changes to the NZFC, here.

In brief: Medicine updates

Citalopram brand change

A new brand of citalopram, Celepram, has been listed to replace the current brand PMS citalopram that is being discontinued due to the supplier leaving the market. It is expected that patients will have to be changed to the new brand by December. Read more about this decision here.

New strength of perindopril available

Following Medsafe approval, an 8 mg tablet of perindopril is now available, fully funded. Perindopril is also available and funded in 2 mg and 4 mg tablet strengths. Read more about prescribing ACE inhibitors here.

Paper of the Week: How general practitioners in New Zealand treat patients with a first or new episode of depression

A recent qualitative study published in the Journal of Family Medicine and Primary Care has examined how general practitioners in the Auckland region treat patients presenting with a first or new episode of depression.

General practitioners were interviewed about their approach and a wide variety of management options were reported; physical activity and antidepressants were the most common. Despite evidence suggesting behaviour activation (re-engaging with activities) is an effective treatment for depression, it was recommended by less than half of all clinicians interviewed.

The initial consultation when a patient presents with depression is important as treatment decisions at this time can have long-term consequences. The first consultation may also be the only opportunity to discuss appropriate treatments with a patient, as the follow-up rate after a diagnosis of depression is often low. Consider how you approach the first consultation with a patient with depression, and what determines your decisions for recommending different management options.

Moir F, Roskvist R, Arroll B, et al. Treatment of depression in the first primary care consultation: A qualitative study. J Family Med Prim Care (2022).

For further reading, also see: “Depression or distress? Examining SSRI prescribing in primary care.” Bpacnz.

This Bulletin is supported by the South Link Education Trust

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