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Published: 3 September, 2021


Contents

Dulaglutide now funded for people with type 2 diabetes

As of 1 September, 2021, dulaglutide (Trulicity), a glucagon-like peptide-1 (GLP-1) receptor agonist, is available fully funded with Special Authority approval for people with type 2 diabetes who are at high risk of cardiovascular or renal complications. PHARMAC announced the decision to fund dulaglutide, along with empagliflozin (a sodium glucose co-transport 2 [SGLT-2] inhibitor), in December, 2020. Empagliflozin was funded from 1 February, 2021; funding of dulaglutide was delayed until it received Medsafe approval, which was granted on 14 August, 2021.

Dulaglutide is administered as a once-weekly subcutaneous injection. Treatment is associated with reductions in cardiovascular and renal complications of type 2 diabetes and weight loss. Dulaglutide is funded for people with HbA1c levels > 53 mmol/mol who are at high risk of, or with established, cardiovascular disease, diabetic kidney disease, heart failure or who are of Māori or Pacific ethnicity. Dual treatment with dulaglutide and empagliflozin is not funded. The Special Authority criteria for prescribing dulaglutide are available here.

For further information on the place of dulaglutide in type 2 diabetes management, see: https://bpac.org.nz/2021/diabetes.aspx

For information on prescribing dulaglutide, refer to the NZF: https://nzf.org.nz/nzf_71107


Be aware of rare adverse effects with empagliflozin

In the latest issue of Prescriber Update (September, 2021), Medsafe reminds clinicians to be alert for two rare, but serious, adverse effects associated with empagliflozin, a SLGT-2 inhibitor used in the treatment of people with type 2 diabetes: diabetic ketoacidosis (three reports in New Zealand up to 30 June, 2021) and Fournier's gangrene (two reports).


Reminder: COVID-19 vaccination and the risk of myocarditis

Earlier this week the Ministry of Health issued a press release concerning a death of a person possibly due to myocarditis following vaccination with the Pfizer COVID-19 vaccine. The case has been referred to the Coroner and the cause of death has not yet been determined. The COVID-19 Vaccine Independent Safety Monitoring Board (CV-ISMB) considered that the myocarditis was probably due to vaccination, but note that other clinical factors may have also contributed.

We included an item in Bulletin 30 about the risk of myocarditis and pericarditis with COVID-19 vaccination; primary care health professionals should ensure they are aware of this adverse effect and are familiar with the possible presenting symptoms and management. Medsafe advise that cases are most likely within the first four days post vaccination but can occur up to 14 days later. It appears that the risk is higher after the second dose of vaccination although it may also occur after the first dose. Younger males are at higher risk but do not discount symptoms in females or other age groups. The benefits of vaccination continue to outweigh these risks.


Primary Care Update Series poll: have your say about future topics

The bpacnz Primary Care Update Series is a comprehensive multimedia resource that keeps subscribers up to date on the management of conditions commonly seen in primary care. The series now includes eight topics, covering the management of ten different conditions across two body systems (cardiovascular and musculoskeletal), with informative commentary from a variety of clinical experts. We are now planning our next topics for the Update Series, and we want to hear from you about what you would like us to cover: click here to vote on the options and have your say.


New Zealand Formulary updates for September

Significant changes to the NZF in the September, 2021, release include new monographs for a range of vitamins, mineral supplements and vitabdeck used to prevent vitamin deficiency in people with fat malabsorption conditions such as cystic fibrosis. Similar changes apply to the New Zealand Formulary for Children (NZFC) but also include an updated dosing regimen for chloramphenicol eyedrops in children aged under two years.


PHARMAC seeking feedback on funding biosimilar adalimumab

PHARMAC has released a proposal to award Principal Supply Status to Amgevita (a biosimilar form of adalimumab) from 1 September 2022. This would result in Amgevita becoming the main funded brand of adalimumab available in New Zealand. To provide feedback on the consultation, click the link above for an email address or to submit online. Feedback should be received by 5pm on Wednesday, 22 September 2021.


Medicines Monitoring: skin reactions with pregabalin

As part of the Medicines Monitoring Scheme, Medsafe is encouraging health care professionals to make a report to the Centre for Adverse Reactions Monitoring (CARM) if they observe any dermatological adverse effects in people taking pregabalin. The potential association between the use of pregabalin and development of bullous dermatitis and exfoliating skin reactions is being investigated.


Paper of the week: Medicine and the Machine – talking about pandemics and the anti-science movement

In a now regular departure from paper of the week (we may need to rename this section!), we present a podcast from the Medicine and the Machine series by Medscape. In this episode Dr Peter Hotez, infectious diseases expert, discusses the global COVID-19 pandemic, the role of anti-science rhetoric in the evolution of this pandemic and anti-vaccination stances in general, and the important role of clinicians in "speaking up for science".

"When people talked about COVID-19 being an extraordinary event, I said no, it was actually more of a culminating event of lots of unravelling of different aspects of global health. What caused the unravelling were things that none of us were ever taught to think about during our medical or scientific training: war, political collapse, climate change, and, of course, this aggressive antiscience movement and urbanization. It's also a wake-up call about how we need to re-envision medical education to train physicians to think more broadly than we do now."

Listen to the podcast or read the transcript here: https://www.medscape.com/viewarticle/948991


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