Who is afraid of biosimilars? Openness to biosimilars in an Australian cohort of patients with rheumatoid arthritis.

Biosimilars are increasingly adopted to improve affordability of biologics. An effective introduction of biosimilars requires an understanding of patient acceptance of these agents. We performed a cross-sectional study of 132 patients with rheumatoid arthritis prior to the introduction of biosimilar switching or prescribing in this cohort. Despite being unfamiliar with biosimilars, most patients are willing to accept biosimilar medicines if recommended by their rheumatologist. Patient concerns about biosimilar uptake mainly focus on concerns about its efficacy. There is a significant correlation between patient attitudes towards biosimilar and generic medicines.

Outcomes of patients admitted to hospital medical units with back pain.

BACKGROUND: Hospital admissions for patients with back pain are increasing. Despite their significant contribution to the healthcare burden, they remain largely unstudied. AIM: To investigate the management and clinical outcomes of patients with acute back pain admitted to hospital under general medicine units when compared to a rheumatology unit. METHODS: A 36-month retrospective, observational study on patients presenting to the emergency department with back pain who were subsequently admitted to one of three general medicine units (GM) or a rheumatology unit (RU). Differences in patient demographics, management and clinical outcomes were assessed using Chi-squared tests for categorical variables and Kruskall-Wallis tests for continuous variables. Multivariate associations of two primary outcomes, length of stay (LOS) and complications were examined using generalised estimating equations. RESULTS: Data from 712 admissions from 594 patients across the four inpatient units were used for this study. Common discharge diagnoses were musculoskeletal/non-specific back pain (41%), disc-related illness (22%), vertebral fracture (14%) and sciatica (14%). Non-English speaking background (NESB), age ≥ 80 years, disc-related disease, vertebral fracture and sciatica were statistically significantly associated with both increased LOS and complications. The presence of comorbidities was associated with more complications. GM admission was associated with a longer LOS and more complications than RU admission. CONCLUSION: Multiple factors associated with an increased LOS and complications were identified, including older patients and patients of NESB. Given the observed variations in back pain management between general and specialty units, strategies to standardise care should be considered.

Diagnostic accuracy of combined coronary angiography and adenosine stress myocardial perfusion imaging using 320-detector computed tomography: pilot study.

OBJECTIVES: To determine the diagnostic accuracy of combined 320-detector row computed tomography coronary angiography (CTA) and adenosine stress CT myocardial perfusion imaging (CTP) in detecting perfusion abnormalities caused by obstructive coronary artery disease (CAD). METHODS: Twenty patients with suspected CAD who underwent initial investigation with single-photon-emission computed tomography myocardial perfusion imaging (SPECT-MPI) were recruited and underwent prospectively-gated 320-detector CTA/CTP and invasive angiography. Two blinded cardiologists evaluated invasive angiography images quantitatively (QCA). A blinded nuclear physician analysed SPECT-MPI images for fixed and reversible perfusion defects. Two blinded cardiologists assessed CTA/CTP studies qualitatively. Vessels/territories with both >50 % stenosis on QCA and corresponding perfusion defect on SPECT-MPI were defined as ischaemic and formed the reference standard. RESULTS: All patients completed the CTA/CTP protocol with diagnostic image quality. Of 60 vessels/territories, 17 (28 %) were ischaemic according to QCA/SPECT-MPI criteria. Sensitivity, specificity, PPV, NPV and area under the ROC curve for CTA/CTP was 94 %, 98 %, 94 %, 98 % and 0.96 (P < 0.001) on a per-vessel/territory basis. Mean CTA/CTP radiation dose was 9.2 ± 7.4 mSv compared with 13.2 ± 2.2 mSv for SPECT-MPI (P < 0.001). CONCLUSIONS: Combined 320-detector CTA/CTP is accurate in identifying obstructive CAD causing perfusion abnormalities compared with combined QCA/SPECT-MPI, achieved with lower radiation dose than SPECT-MPI. KEY POINTS: • Advances in CT technology provides comprehensive anatomical and functional cardiac information. • Combined 320-detector CTA/adenosine-stress CTP is feasible with excellent image quality. • Combined CTA/CTP is accurate in identifying myocardial ischaemia compared with QCA/SPECT-MPI. • Combined CTA/CTP results in lower patient radiation exposure than SPECT-MPI. • CTA/CTP may become an established imaging technique for suspected CAD.