Patient PrepRheum Podcast CreakyJoints Australia

In this episode, we’ll be talking about methotrexate and clarifying how it is used in rheumatology settings. Methotrexate is one of the main medications used to slow or stop the progression of autoimmune arthritis and reduce disease activity.

 

We’ll hear from Janine Fisher, a patient who has lived with rheumatoid arthritis for 31 years. Janine shares her journey with methotrexate, starting with her initial concerns about taking it. She has tried various other treatments over the years and now uses methotrexate successfully in combination with a biologic medication to manage her condition.

 

Rheumatologist, Dr Irwin Lim will explain why methotrexate is widely used as a front-line treatment for many forms of autoimmune arthritis. He will also explain how it can safely be used by most people and dispel the myths that have developed around it.
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Learn more about the medication Methotrexate in this short audio guide that accompanies Episode 4: Methotrexate - Management, Myths and Milestones. The guide gives an overview of Methotrexate and delves deeper into how the medication works, how it is used and its side effects.
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This is an audio guide about patient and doctor communication brought to you by CreakyJoints Australia.

Be sure to go to the CreakyJoints Australia website, and join for free to keep updated on all of our resources.

TRANSCRIPT

This is an audio guide about Patient and Doctor Communication, brought to you by Global Healthy Australia.Whilst many patients have had positive experiences working with their health team, there are still many of you who are unsatisfied with the quality of treatment and are frustrated by the ineffective communication experienced when approaching your GPs/ specialists...Here we would like to offer our top tips so Doctors and Patients can “Get on The Same Page”

PATIENTS 


Get your needs met, ask, ask and ask some more! 


This is about YOU, Doctors are here for you.
Be realistic - You won’t always get all the answers from a doctor, so seek advice so you know where to go next! 
This process is empowering in itself, there may be setbacks along the way but keep up a proactive mentality/approach and you will land in the right place/direction 
Get your needs met - if you are unsatisfied with your doctor, you are 100% entitled to ask your records to be transferred to a new one! It’s common practise and they won’t take it personally. 


Helpful ways to keep up effective communication and manage any hesitancy around discussion


If you feel nervous or have a particularly sensitive issue, bring a friend, a support person, social worker or someone you feel comfortable with to generate a feeling of safety and security when verbalising your issue.
If helpful, Jot down some points before hand so you have a reference point that will keep your discussion on the right track in case you get confused/lost/shy etc. Remember, you are not the first one who has come with the issue you have! 


Be accountable with record keeping 


Doctors need as much information as possible, the more you have the better you are treated. 


If you struggle with this make sure to stay as prepared and organised as possible. This is your best chance at getting the treatment and support you need! Be accountable.
DOCTORS 

It is essential that doctors have a proper understanding of their patients. 

Whilst this may seem obvious, this is not to minimise the health care communities efforts, it’s to address the feedback that there are some barriers that need to be addressed. 

Quality Communication 

Get clear on your patients value systems: Sometimes patients have a hard time verbalising their needs... 


Gain a clear understanding of the patient as a person, ask direct questions that get YOU clear on their needs.


What do they like to do with their time? 
What kind of lifestyle do they seek? 
What is getting in the way of your wants/needs/desires?
Pre appointment surveys may be helpful to identify your patients concerns and needs
Holistic Understanding: The condition goes beyond physical aspects, affecting emotional, social, spiritual and intellectual aspects of life.
Be conscious that there are topics patients struggle to discuss, so you may need to help encourage them on this, remind them its a safe, non-judgemental space. 


Broaden your list of resources/ information to offer up. You are a Hub of information for them. 


Every patient responds differently to therapy. Be well-versed/updated on the latest news/stats and new developments within Arthritis care. Broaden your pool of resources to suggest to your patients.
Get yourself acquainted with key players in the field, help to navigate getting across everything! You’ll be more prepared. 
Rosemary: “For sufferers, information is power. It’s one of the ways we cope with the condition”. 
People respond differently, be conscious of their personality types when making non-medical based suggestions. 


Always be meticulous with record keeping, patient history and handover to specialists 


“Something huge I think is missing is an automatic referral f

This is an audio guide about the approval and sale of therapeutic goods in Australia, brought to you by CreakyJoints Australia. 

Be sure to go to the CreakyJoints Australia website and join for free to keep updated on all of our resources.

TRANSCRIPT

This audio guide is about the approval and sale of therapeutic goods in Australia. It is brought to you by CreakyJoints Australia.

Before therapeutic goods (including medicines, biologicals, vaccines, medical devices and products such as vitamins) can be sold in Australia, they must be approved for sale by the Therapeutic Goods Administration (or “the TGA”). The TGA is a part of the Australian Government Department of Health.

Individuals or organisations, such as pharmaceutical companies, can apply for (or “sponsor”) a therapeutic good to be considered for sale in Australia by the TGA. Sponsors must also supply evidence of their product’s quality, safety and efficacy gathered through clinical trials. The submission is then evaluated by the TGA.

If approved, the product is added to the Australian Register of Therapeutic Goods as a “listed” or “registered” product according to its risk profile. No medicine is 100 per cent risk-free, but the risk is greater for some medicines. Therefore, they place more rigorous controls on higher risk “registered” medicines than lower risk “listed” medicines.

Listed products can be sold through supermarkets or pharmacies without a prescription, though not all are evaluated by the TGA for efficacy.

All registered products are always evaluated for efficacy before they go on sale. Some are available in pharmacies over the counter after consultation with a pharmacist. Prescription products are only available with a valid prescription from an approved health professional and can only be sold through pharmacies.

The Pharmaceutical Benefits Scheme (or “PBS”) heavily subsidises the cost of prescription products for all Australians with a Medicare card as well as some Australian visitors. For example, the actual cost of some medications for autoimmune arthritis is well over $1,000 but, through the PBS, consumers pay less than $50 for them at the pharmacy.

Sponsors can apply for registered products to be added to the PBS. These applications are considered by the Pharmaceutical Benefits Advisory Committee (or “the PBAC”). The PBAC is an independent body of health professionals and consumer representatives appointed by the Australian Government.

The PBAC meets at least three times a year to review the applications on their agenda. They assess relevant information from the sponsor, the TGA and public submissions before deciding if they should recommend products to the Minister for Health for inclusion on the PBS.

Public submissions can come from patients, carers, members of the public, health professionals or consumer groups and are a valued part of the process. They help the PBAC understand how the proposed product will benefit consumers. These perspectives may be quite different from those presented by the sponsor.

Products that are on the Australian Register of Therapeutic Goods but are not included on the PBS may still be sold in Australia but they are not subsidised by the Government.

If there is a product that you would benefit from that is not currently listed on the PBS, you can ask your healthcare professionals or relevant consumer groups to help you bring it to the attention of the PBAC. This could start the process of making the product available to you and others like you.

 
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This is an audio guide about biosimilar medications, brought to you by CreakyJoints Australia.

Be sure to go to CreakyJoints Australia website, and join for free to keep updated on all of our resources.

TRANSCRIPT

Audio Guide 1: Biosimilar Medications

 

This is an audio guide about biosimilar medications, brought to you by CreakyJoints Australia.

A biosimilar medication (also known as a “biosimilar”) is a very close duplicate of an original brand of biologic medication (or “biologic”). 

Biologic medications are developed from living cells and are used for a wide range of conditions including diabetes, chronic kidney failure and some types of cancer. They are often also prescribed to treat autoimmune conditions such as rheumatoid arthritis, psoriatic arthritis and Crohn’s disease.

You might already be using biologics such as etanercept (sold under the brand name Enbrel), infliximab (sold under the brand name Remicade) or adalimumab (sold under the brand name Humira) to help treat your condition.

Biologics have large complex molecular structures compared to tablet medications. (Picture a basketball next to a pea and you’ll get the idea.) As a result, they cannot be processed through the digestive system. Instead, they are injected or infused into the bloodstream.

Unlike the synthetically made generic versions of tablet-form medications (which are 100 per cent identical to the original brand-name medication), biosimilars are almost identical copies of biologics.

Biosimilars are made using the same research and materials as the original reference biologics they replicate. The manufacturing processes are also exactly the same. Biosimilars even have the same active ingredient name as their reference biologic, but they are sold under different brand names.

However, the end products can never be exactly the same as the original biologics, so they cannot be reproduced identically. Both biologics and biosimilars can even vary slightly between batches.

Does this mean biosimilars are safe?

Yes, they are. The very minor differences between a biosimilar and its reference biologic mean that the biosimilar has the same safety profile as the reference biologic. Both must go through the clinical trial process, although biosimilars can use some of the data from the clinical trials conducted for their reference biologic.

Biosimilars must also pass the same strict regulation processes of Australia’s Therapeutic Goods Administration. Biosimilars will not be approved if they don’t meet the same quality, efficacy and safety standards as their reference biologics.

Is there a cost difference between biologics and biosimilars?

While biologics are planned and developed from the ground up, biosimilars are based on biologic structures that already exist. This means they are more cost-effective to produce than their reference biologic so they can be sold to the government at a lower price. 

Additionally, every time a new biosimilar is launched, the price the PBS pays for ALL equivalent medicines in the category drops. For example, if a new adalimumab biosimilar is approved, the price to the PBS of the reference biologic HUMIRA plus other approved adalimumab biosimilars all drop to the same lower price.

In the long run, that means less expensive medicine as the cost savings allow the government to invest in other medications and areas of the healthcare system.

There is no price difference for consumers between biologics and biosimilars as these are sold at the same fixed price through the Pharmaceutical Benefits Scheme (PBS). However, consumers benefit from the increased range of treatment options available to them.

How are biosimilars prescribed?

Only rheumatologists and clinical immunologists are authorised to prescribe biologics and biosimilars in Australia. If you have autoimmune arthritis you will most likely see a rheumatologist to access either of these medication types. 

There are several ways you may be

In our third episode, Naomi learns some top tips from fellow patient Sarah Clark abouthaving good communication with your doctor. Sarah tells of her rocky start with her initial diagnosis and early treatment until she found a specialist who really listened to her.  Rheumatologist, Dr David Liew shares some wonderful insights and what helps him provide the best care possible to his patients.

Amongst other committee positions, he served on the Council of Australian Therapeutic Advisory Groups' Expert Advisory Group for the Guiding Principles for the Governance of Biologics and Their Biosimilars in Australian Hospitals and maintains an academic interest in adverse drug reaction surveillance.

Dr David Liew ProfileDavid Liew is a rheumatologist and clinical pharmacologist at Austin Health in Melbourne and also leads the Medicines Optimisation Service there. He is also the deputy editor of Rheumatology Republic and a co-host of the Australian Prescriber Podcast.

Amongst other committee positions, he served on the Council of Australian Therapeutic Advisory Groups' Expert Advisory Group for the Guiding Principles for the Governance of Biologics and Their Biosimilars in Australian Hospitals and maintains an academic interest in adverse drug reaction surveillance.

HOST: Naomi Creek

PATIENT: Sarah Clark

DOCTOR: Dr David Liew

My GP helped me find a Rheumatologist at the Rheumatology ward in Wellington.

I just did not connect at all with him. He didn’t really listen to me, his approach was cold and clinical.

Hi, I’m Naomi Creek and welcome to our 3rd Episode of Patient Prep Rheum.

In this episode, we are diving into the art of communication between Patients, Doctors and the rest of your healthcare team. 

We know that many patients have a great line of communication with the members of their healthcare management team. However, we also know there are others out there who find themselves quite overwhelmed due to poor communication when they are just trying to find the best treatments for their often complex conditions. 

We believe effective conversations between doctors and patients are extremely important as this not only fosters positive relationships, it also helps to   greatly improve patient outcomes.

Sarah Clark, from New Zealand, lives with rheumatoid arthritis. She knows all too well the negative impact that poor communication between a patient and doctor can have on treatment.

My GP helped me find a Rheumatologist at the Rheumatology ward in Wellington.

I just did not connect at all with him. He didn’t really listen to me, his approach was cold and clinical.

My symptoms progressed rapidly, he did not really listen to that. Put me on anti-inflammatories, and said that that should deal with the symptoms which it did not.

I was flaring everywhere at this point, probably in every joint.

I just wasn’t getting anywhere with him.

It was by chance that Sarah”s rheumatologist was away on the day she had her appointment, so she saw a younger female rheumatologist, Rebecca, instead.

They connected instantly.

She was just really holistic in her approach and could clearly see from my lab results and how I presented in the clinic that my rheumatoid arthritis was 100% not under control.

She then started me on strong medications. In NZ it starts with anti-inflammatories, and then it works up tier by tier, so if you fail a medication you can go to the next tier of medications so quite swiftly she got me to try biologics and try humira and I was on methotrexate and still nothing was really helping so she got me on the infusions.

One of the major things for me is that she didn’t just sit there with their head in a piece of paper and a pen, they didn’t actually take notes while I was talking to them so they were engaging with me, making eye contact and it made me feel like I was having a conversation and they were responding to me.

Rheumatologist Dr. David Liew is aware that the relationship between a pat