News briefs

Home palliative care doubles as need increases overall in Australia

The number of Medicare‐subsidised palliative care services received by Australians in their own home almost doubled between 2015–16 and 2019–20, according to a report from the Australian Institute of Health and Welfare (AIHW). The report, Palliative care services in Australia, shows home visits for palliative care specialist services increased by an average of 18% annually over the 5‐year period, with a total of 2240 patients receiving home visits in 2019–20. However, most palliative care services continue to be received in a hospital or surgery, with these services increasing by 12% over the same 5‐year period. The report also includes updated information on palliative care services provided in hospital, and for people living in residential aged care. Prior to the COVID‐19 pandemic, almost 83 500 palliative care‐related hospitalisations were recorded in 2018–19, an increase of 29% between 2014–15 and 2018–19. Of the 244 300 people living in permanent residential aged care in 2019–20, 3200 (1.3%) were appraised as needing palliative care services. Of these, almost one in three (27%) had been diagnosed with cancer. The types of cancer most commonly reported were lung (18%) and prostate cancer (14%). These data only reflect whether a resident was appraised as needing palliative care, rather than whether they actually received the services. Information on actual service provision is a significant gap in the national data. Furthermore, national reporting on the need for palliative care in residential aged care is likely to be an underestimate, as available data are based on a funding instrument, rather than providing a comprehensive, diagnostic assessment.

https://pp.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia/contents/summary

Methotrexate users have reduced immune response to mRNA COVID‐19 vaccine

Up to one‐third of patients taking methotrexate — a common treatment for immune‐mediated inflammatory diseases (IMID) such as rheumatoid arthritis, psoriasis and psoriatic arthritis — failed to achieve an adequate immune response to mRNA COVID‐19 vaccines in a small study published in the Annals of the Rheumatic Diseases. While mRNA COVID‐19 vaccines have been shown to produce an effective immune response in over 90% of healthy adults in clinical trials, it is unknown whether the immune response is as robust in patients with IMID who may also be taking immunomodulatory medications. The authors assessed the immune response to the mRNA Pfizer–BioNTech COVID‐19 vaccine in 82 patients with IMID (mainly psoriasis, psoriatic arthritis and rheumatoid arthritis) receiving methotrexate or an alternative immunomodulator (mainly tumour necrosis factor inhibitors and other biologics) at two centres: New York University Langone Health and FAU Erlangen‐Nuremberg and Universitatsklinikum Erlangen in Germany. The study found that the Pfizer–BioNTech vaccine induced adequate antibody levels in up to one‐third fewer patients receiving methotrexate compared with healthy participants and patients with IMID on the other immunomodulatory drugs. Adequate antibody levels were produced in over 90% of the 208 healthy participants and 37 patients taking biologic or non‐methotrexate oral treatments but in only 62% of the 45 patients taking methotrexate. Furthermore, while the vaccination induced activated CD8+ T cell responses in healthy participants and patients with IMID not taking methotrexate, this same induction was not seen in patients taking methotrexate. T cells are another part of the body’s immune defence system. This is an observational study, and as such, cannot establish causality.

https://ard.bmj.com/content/early/2021/05/18/annrheumdis-2021-220597