However, their use has been linked to more lengthy and severe withdrawal symptoms<\/a> in long-term users of antidepressants, blindness and other ophthalmic complications<\/a>, and associated with greater rates of gastrointestinal events and dysaesthesia<\/a> and telogen effluvium and androgenic alopecia<\/a>.<\/p>\n In addition, the TGA has issued a safety alert regarding the potential risk of suicidal thoughts<\/a> in people who use these products, there are ongoing concerns about ensuring equitable access<\/a> to the new-generation weight loss drugs and many women of reproductive age are not concurrently using contraceptives, risking unplanned pregnancies<\/a>.<\/p>\n Finally, the World Health Organization has released its first set of guidelines on using GLP-1 medications for the management of obesity<\/a>, leading some to wonder whether this will influence the federal government and PBAC\u2019s decision regarding the inclusion of GLP-1 medications on the PBS. And with an oral GLP-1 set to be reviewed by the TGA<\/a> in the near future, you don\u2019t need a crystal ball to tell that there will be plenty more GLP-1 related content from TMR in 2026.<\/p>\n After reviewing all these stories, I can\u2019t help but think that this exchange sums things up rather nicely:<\/p>\n Australian experts caution FDA\u2019s decision on potential autism treatment<\/p>\n The US Food and Drug Administration made a somewhat surprising announcement in September, updating the indication for the drug leucovorin to include the treatment of cerebral folate deficiency<\/a>, a condition often seen in children with autism spectrum disorder.<\/p>\n Leucovorin is chemically similar to vitamin B9, or folate. In Australia it is used to reduce toxicity and counteract the effects of folic acid antagonists like methotrexate in cytotoxic therapy (e.g., chemotherapy). The FDA\u2019s press release claims it used published case reports and mechanistic data to inform its decision.<\/p>\n \u201cMy understanding is that the hypothesis is that autism is caused by low levels of folic acid or folate, and that this drug could somehow change those levels and therefore lead to better outcomes,\u201d said Professor David Trembath, head of Autism Research and senior principal research fellow at CliniKids, The Kids Research Institute Australia, following the announcement.<\/p>\n \u201cI\u2019ve seen some preliminary research and suggestions of some small positive effects, but it\u2019s far from a clear and large effect, if there is one. We need to tread cautiously with this.\u201d<\/p>\n The Department of Health and Human Services stopped short of recommending leucovorin for all people with ASD, however.<\/p>\n \u201cWhile promising, it is important to note that leucovorin is not a cure for ASD and may only lead to improvements in speech-related deficits for a subset of children with ASD,\u201d the organisation said in a statement.<\/p>\n \u201cFurthermore, this treatment must be administered under close medical supervision and in conjunction with other non-pharmacological approaches for children with ASD (e.g., behavioural therapy).\u201d<\/p>\n The move, announced by US president Donald Trump and HHS secretary Robert F Kennedy Jr, raised eyebrows on Australian shores.<\/p>\n \u201cLeucovorin (folinic acid) has been promoted as a \u2018treatment\u2019 for autism, but the evidence is weak\u2026 right now, the science does not come close to the standard needed to recommend leucovorin in the clinical management of autism,\u201d said Professor Andrew Whitehouse, Angela Wright Bennett Professor of Autism Research at The Kids Research Institute Australia.<\/p>\n \u201cThere are also some studies suggesting negative side effects. More work is needed to be certain about the correct dose and timing, particularly when given in pregnancy and early childhood, before being taken up as a treatment for the community,\u201d added Professor Adam Guastella, Michael Crouch Chair in Child and Youth Mental Health at Children\u2019s Hospital Westmead Clinical School and the University of Sydney.<\/p>\n \u201cThe suggestion of using leucovorin to \u2018treat\u2019 autism is worrying,\u201d said Professor Dawn Adams, endowed chair in Autism Research in the Olga Tennison Autism Research Centre at La Trobe University.<\/p>\n \u201cFirstly, because the research in this area is poor quality and not at the level that we would expect when making recommendations for approvals. It is also worrying because such statements impact how people understand and perceive autism.<\/p>\n \u201cAutism is not something that needs treating or to be cured, it\u2019s a neurodevelopmental difference. When we frame it as a condition that needs \u2018fixing\u2019, we risk adding to the stigma autistic people already face.\u201d<\/p>\n This wasn\u2019t the first, and won\u2019t be the last, time that the Trump\/RKF Jr stick their noses into healthcare. But remember that it\u2019s not the white coat that makes someone a doctor.<\/p>\n Au revoir, blue puffer<\/p>\n The iconic blue puffer is no more.<\/p>\n Short-acting beta agonists (SABA), historically the first choice for relieving asthma symptoms, were given the flick in September<\/a> when the National Asthma Council updated the Australian Asthma Handbook.<\/p>\n The new Handbook recommends that anti-inflammatory reliever (AIR) therapy or maintenance-and-reliever therapy (MART) should be used in people over the age of 12 with asthma as they are safer and more effective alternatives. Crucially (and unlike the blue puffers), they target the underlying pathology of asthma rather than simply relieving symptoms.<\/p>\n Just using SABA therapy posed additional risks, according to Professor Nick Zwar, chair of the NAC Guidelines Committee.<\/p>\n \u201cIt\u2019s been shown that you can have an exacerbation, and sometimes that can be quite a severe exacerbation, and your risk of getting that is higher if you\u2019re on SABA alone.<\/p>\n \u201cWe really are also trying to avoid people needing to have courses of oral steroids. So it\u2019s another way of avoiding a course of oral steroid, to be on an anti-inflammatory reliever therapy.\u201d<\/p>\n Low-dose budesonide\u2013formoterol is now the preferred first line option for adolescents and adults with asthma, although Professor Zwar highlighted there was still a role for SABA in children with mild asthma and other patients on low-dose inhaled corticosteroids as maintenance therapy.<\/p>\n First concrete genetic clues for fibromyalgia identified<\/p>\n Fibromyalgia is a common chronic pain syndrome that can have a significant negative impact on someone\u2019s quality of life. However, its underlying aetiology is poorly understood, leading researchers and clinicians to quibble over exactly how to classify and treat it. But earlier this year a large international study took a closer look at the genetic mechanisms that are linked to the condition.<\/p>\n The study, which analysed genetic data from more than 2.5 million people (including over 50,000 with fibromyalgia), identified 26 different risk loci<\/a> for the condition. The strongest genetic association was found for a variant of the HTT gene, which causes Huntington\u2019s disease when mutated, with other key loci including the GPR52 gene (which regulates HTT), as well as CAMKV,\u00a0DCC,\u00a0DRD2\/NCAM1,\u00a0MDGA2 and\u00a0CELF4.<\/p>\n Collectively, these genes are known to play a role in brain development, neuronal signalling and pain processing \u2013 suggesting that fibromyalgia is a brain-based disorder characterised by dysregulated neural communication, rather than inflammation or peripheral damage.<\/p>\n In addition, some of the 26 loci overlapped with two other poorly characterised disorders: long covid (BPTF) and ME\/CFS (OLFM4 and RABGAP1L\/GPR52).<\/p>\n \u201cSuch shared genetic architecture, rooted in central nervous system function, could predispose individuals to a spectrum of conditions characterized by sensory and\/or affective dysregulation, which may manifest clinically as fibromyalgia, irritable bowel syndrome, post-traumatic stress disorder or a constellation of other disorders, depending on other genetic and environmental factors,\u201d the researchers noted.<\/p>\n While the findings were only published as a preprint, they offer \u201cthe first robust genetic evidence defining fibromyalgia as a central nervous system disorder\u2026 establishing a biological framework for its complex pathophysiology and extensive clinical comorbidities,\u201d the wrote.<\/p>\n How to speedrun a uterus transplant to giving birth, Australian-style<\/p>\n In 2023 Coffs Harbour woman Kirsty Bryant became the first woman to receive a uterus transplant on Australian soil<\/a> after her mother, Michelle Hayton, donated the organ in question.<\/p>\n The transplant, which was performed over two surgeries, was completed without any major complications, although Ms Bryant experienced significant blood loss in the 24 hours after surgery, while her mother developed a serious infection and lack of sensation in her bladder.<\/p>\n Dr Rebecca Deans, a Sydney-based paediatric and adolescent gynaecologist and fertility specialist who served as the lead surgeon on Ms Bryant\u2019s transplant, felt Kirsty had a good chance of falling pregnant within 12 months after menstruation started roughly a month after surgery.<\/p>\n Fast forward to this year, and a new paper in the Medical Journal of Australia<\/a> reveals that Ms Bryant fell pregnant 112 days after the uterus transplant following the transfer of a frozen blastocyst 15 weeks post-surgery. This sets a new record for the shortest time to pregnancy post-transplant.<\/p>\n \u201cShe got pregnant straight away and had very few issues within pregnancy. She delivered at 37 weeks, everything went really well. So that\u2019s really wonderful, because you\u2019re always a bit anxious the first time you do something. So I was quite relieved that it all went so well,\u201d Dr Deans told TMR earlier this year, before explaining that the quick turnaround time was due to reducing the amount of time Ms Bryant spent on immunosuppressive therapy after surgery.<\/p>\n \u201cThere\u2019s emerging evidence around optimising, because in the first studies, they would wait a full year before they started doing embryo transfers in case of rejection. But I think now that chance of rejection drops right off after about three months, and she had done really quite well at that time and it timed in with her return of period.<\/p>\n \u201cSome of the older immunosuppression protocols, you can\u2019t get pregnant for a bit longer, and we\u2019re using more low-risk ones, but you still want to be quite certain there\u2019s no rejection.\u201d<\/p>\n Ms Bryant\u2019s son was 15 months old and reportedly meeting all developmental milestones at the time of publication. Ms Bryant underwent a hysterectomy after her son was born, when post-delivery biopsies showed signs of ongoing organ rejection.<\/p>\n Yoga \u2013 not all it\u2019s cracked up to be<\/p>\n Minimising the risk of falls in older people is certainly a worthwhile endeavour, but it turns out there are some methods that are more helpful in others.<\/p>\n In September, researchers from the University of Sydney found that Iyengar yoga \u2013 one of the more popular types of yoga in the country that utilises bricks and straps to provide stability and control in a variety of different postures \u2013 was associated with a 33% increase in the rate of falls among older people<\/a>, compared to a more relaxing kind of yoga where people stay seated.<\/p>\n Thankfully, the greater number of falls did not translate to a greater number of injuries.<\/p>\n It turns out that while participants in the Iyengar yoga group became more active than people in the relaxing yoga group, this may have created a situation where these individuals were hoisted by their own petard.<\/p>\n \u201cThe improved mobility goal attainment and confidence in balance might have encouraged participants to engage in a wider range of physical activities and at greater intensity, potentially exposing them to higher fall-risk situations,\u201d the researchers wrote in The Lancet Healthy Longevity.<\/p>\n \u201cThis observation might also help explain our subgroup analysis finding that participants with no history of falls and higher levels of physical activity had higher fall rates than their less active counterparts after the intervention.\u201d<\/p>\n Unsurprisingly, the authors did not recommend Iyengar yoga-based exercise programs as a means of preventing the risk of falls in people over the age of 60.<\/p>\n Back to the drawing board, I guess.\u00a0<\/p>\n Cost plays a role in changes to prescriber bag contents<\/p>\n In November, PBAC recommended that the covid antivirals molnupiravir and nirmatrelvir-ritonavir be removed from Australia\u2019s prescriber bags<\/a>, citing an \u201cevolving clinical landscape\u201d. The emergency covid treatments, which were only added to the prescriber bags in late 2022, cost around $2200 for each course.<\/p>\n But it\u2019s not all bad news, with ceftriaxone added for the emergency treatment of sepsis, and endorsed midwives getting extended prescribing rights for benzathine benzylpenicillin and adrenaline to support maternal, neonatal and immunisation care.<\/p>\n Dr Michael Tam, RACGP Expert Committee member, felt the changes were appropriate.<\/p>\n \u201cAs a GP and clinician, it\u2019s always good to have extra access to provide medicines at the same time. But I think, from the perspective of someone who\u2019s a custodian of the health system, if you think of it that way, I\u2019m not surprised they were removed.<\/p>\n \u201cThe medicines are very expensive. If you look at the total budget and total annual budget for the doctor\u2019s bag, the vast majority of it is actually just in the cost of these two medicines, the antivirals.<\/p>\n \u201cThe range of medicines which are funded through a doctor\u2019s bag is quite small, and there are some medicines I think, particularly some of the anti-nausea type medicines potentially for children, so ondansetron for instance, where it will be really useful for that to be available.\u201d<\/p>\n What to look for in a skincare product<\/p>\n The skincare market has become increasingly competitive and complicated \u2013 leaving many clinicians and consumers confused about what products will actually work, and which products are a waste of money.<\/p>\n But American research, released in July this year, recommended 24 ingredients to treat common skin conditions<\/a> such as fine lines and wrinkles, acne, dark spots, redness and dry skin.<\/p>\n Retinoids, azelaic acid, glycolic acid and mineral sunscreen were among the products that were given the thumbs up.<\/p>\n \u201cThis is the first time experts have come together nationally to cut through the overwhelming number of skin care options,\u201d said Dr Murad Alam, professor of dermatology at Northwestern University Feinberg School of Medicine. \u201cWe wanted to help both doctors and everyday users understand which ingredients are backed by the most expert support.\u201d<\/p>\n Other products were viewed less favourably.<\/p>\n \u201cFor instance, while ingredients containing DNA repair enzymes, growth factors and peptides are ubiquitous in over-the-counter formulations, the studies supporting their utility for common cosmetic indications may be perceived as insufficient or preliminary,\u201d the authors wrote in the Journal of the American Academy of Dermatology.<\/p>\n \u201c[And] when treating acne, topicals such as mandelic acid and polyhydroxyl acid are more expensive and less likely to be covered by insurance than vitamin A derivatives. Additionally, most of the conditions addressed in this study are considered aesthetic and therefore associated treatments are generally not covered by payers, so the out-of-pocket cost is important to consider.\u201d<\/p>\n Something to keep in mind the next time you reach for a moisturiser or acne cream!<\/p>\n Clinical Update\u00a0for 2025 will be coming to a close next week. We look forward to seeing you back here in 2026. If you have any story ideas or burning issues you think we should follow up, get in touch with us by email.<\/p>\n Wishing you all a safe, healthy and happy holiday season!<\/p>\n Amanda Sheppeard \u2013 editor, Specialist Titles and Clinical Update Lincoln Tracy\u2013 deputy editor, Specialist Titles and Clinical Update![\"\"](\"https:\/\/www.newsbeep.com\/au\/wp-content\/uploads\/2025\/12\/blue-puffer.jpg\")
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amanda@medicalrepublic.com.au<\/a><\/p>\n
lincoln@medicalrepublic.com.au<\/a><\/p>\n