Tips to manage rheumatology patients on biologics

3 minute read

A new guide on biologics helps GPs navigate the complex area of these highly specialised drugs.

The Australian Rheumatology Association (ARA) has published a new GP guide to biologic and targeted synthetic disease-modifying anti-rheumatic drugs. 

The guide, available on the ARA website, provides information about assessment and pathology, risk of infection, potential adverse effects and considerations for special situations including pregnancy, impending surgery and malignancy.  

The guide advises giving covid, pneumococcal and annual flu vaccinations, and points out some patients may be eligible for extra vaccinations, including pneumococcal, meningococcal and influenza vaccinations due to their immunocompromised status. 

Before starting biologics and targeted synthetics, the guide suggests considering vaccinating patients against hepatitis A and B, varicella zoster, MMR and HPV. Patient should also be screened for latent tuberculosis and treated accordingly.  

Some live vaccines are contraindicated for use in patients taking biologics and targeted synthetics, including MMR, varicella zoster, BCG, oral rotavirus, yellow fever, oral typhoid and some childhood vaccines. 

There is an increased risk of infection associated with the drugs, and GPs could consider prescribing antibiotics at a lower threshold. Conventional disease modifying anti-rheumatic drugs and steroids can increase the immunosuppressive effect. 

The guide also recommends maintaining a lower threshold for clinical review in case of any deterioration in the patient’s condition, and withholding the drugs if the patient is too unwell for work or study, has a fever over 39C, has started antibiotics or has started antivirals for covid. 

There is information on reporting requirements if a patient discontinues the medication. As stated in the guide, these “medications fall under the category of PBS-funded specialised drugs, which means they have strict eligibility and continuation criteria”.  

The guide also outlines general management responsibilities for GPs who share care of these rheumatology patients including ensuring these patients undergo their appropriate cancer screening and regular cardiovascular risk review.  

“We hope GPs find this guide helpful, and encourage all GPs involved in the care of rheumatic disease patients to contact their patient’s treating rheumatologist if they have further questions,” said Dr Amy Kelly, chair of the ARA Clinical Resources Committee. 

“We hope that by working together we can all improve the outcomes for our rheumatic disease patients.” 

Biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) – A guide for GPs  

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