Changes to the Australian Pharmaceutical Benefit Scheme restrictions for biological disease-modifying antirheumatic drugs have influenced the use of leflunomide
Date
2017
Authors
Hopkins, A.
Vitry, A.
O'Doherty, C.
Proudman, S.
Wiese, M.
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International Journal of Rheumatic Diseases, 2017; 20(11):1795-1797
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Introduction Methotrexate is the ‘anchor’ of rheumatoid arthritis (RA) treatment and leflunomide is commonly added in resistant disease, or where methotrexate is contraindicated.[1] In Australia, biological disease-modifying anti-rheumatic drugs (bDMARDs) are considered when response to conventional DMARD therapy is inadequate.[1, 2] They are expensive and criteria have been developed to restrict their use on the Australian Commonwealth Government subsidised Pharmaceutical Benefits Scheme (PBS). Prior to 2010, to qualify for bDMARDs, a patient must have been treated for at least 12 weeks with: (i) weekly methotrexate; (ii) combination therapy with methotrexate and at least two other DMARDs; and (iii) received treatment with leflunomide or cyclosporine.[2] In August 2010, these restrictions were modified so they could be accessed by patients who failed to respond to 6 months of therapy, which must include at least 3 months of methotrexate (unless contraindicated) and 3 months of hydroxychloroquine, leflunomide or sulfasalazine.[2] We aimed to assess the influence of these changes on the use and expenditure on leflunomide and bDMARDs.
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Copyright 2015 Asia Pacific League of Associations for Rheumatology and Wiley Publishing