12 NEWS
When to prescribe LAGEVRIO as the preferred * COVID-19 oral antiviral on the PBS? 1, 2
1 2 3
12 NEWS
31 OCTOBER 2025 ausdoc. com. au
Calculator predicts liver disease
Bella Rough A SIMPLE calculator based on com- |
compensated and decompensated cirrhosis, hepatocellular carcinoma, liver |
count, AST and ALT— was 79 % accurate in assessing fibrosis risk, they said. |
CORE a fixed specificity of 86 % had a sensitivity of 73 %. |
mon biomarkers predicts patients’ risk |
transplant and liver-related mortality. |
The researchers said, at every level |
FIB-4 was originally used to detect |
of liver cirrhosis or related complica- |
Researchers from Sweden’ s Kar- |
of sensitivity, CORE had a better spec- |
advanced fibrosis in patients with |
tions with 88 % accuracy, a BMJ study |
olinska Institutet developed CORE |
ificity than FIB-4 and that, at every |
concurrent HIV and hepatitis before |
has found. |
|
|
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based on three decades of Swedish |
level of specificity, CORE had a higher |
becoming standard practice for liver |
The Cirrhosis Outcome Risk Esti- |
data, covering 480,000 people, and |
sensitivity than FIB-4. |
disease, the researchers said. |
mator( CORE) analyses age, sex and |
validated it on UK and Finnish data. |
For example, using FIB-4 with a |
However, principal investigator |
three common liver enzymes( AST, |
Their results showed that CORE |
cut-off value of 1.30 yielded a sensi- |
Professor Hannes Hagström said FIB-4 |
ALT and GGT) to estimate the risk of |
could correctly differentiate between |
tivity of 53 % and a specificity of 86 %, |
was“ not suited for the general popu- |
major adverse liver outcomes( MALO) |
individuals who would or would not |
whereas using a CORE cut-off with a |
lation and is less effective at predicting |
|
over 10 years in patients without a history of liver disease.
MALO is a composite outcome of
|
develop MALO in 88 % of cases. In comparison, the Fibrosis-4( FIB-
4) index— analysing age, platelet
|
fixed sensitivity of 53 % yielded a specificity of 96 %, the researchers said.
Using a cut-off value that gave
|
the future risk of severe liver disease”. BMJ 2025; 29 Sep. CORE calculator: core-model. com |
GP stabbed by patient, police say
Staff writer A PATIENT has stabbed a GP during a consultation at a practice, police allege.
The 85-year-old doctor was working at a GP practice on Pitt Street, in the centre of Sydney, last month before a patient allegedly attacked him at around 7pm.
Emergency services, called to respond to an assault, found the GP with serious injuries, including a stab wound to the neck, NSW Police said.
The patient, who was arrested at the scene, was taken to hospital for assessment and placed under police guard.
Emergency services found the GP with a stab wound to the neck.
Police said they had charged the 57-year-old with wounding a person with the intent to cause grievous bodily harm.
Refused bail, the patient subsequently appeared before Parramatta Local Court and was scheduled to appear again at the Downing Centre Local Court, in Sydney, on 27 November.
In 2006, Melbourne GP Dr Khulod Maarouf-Hassan was stabbed 26 times by a patient at her Noble Park practice.
Samuel Benjamin— who had a history of psychiatric illness and had come to believe the medical profession was trying to kill him— was charged with murder but later found not guilty as a result of mental impairment. He was sentenced to a nominal term of 25 years in a psychiatric institution.
The case triggered a long debate about the safety of GPs and their staff, including calls for a national register to document incidents.
ADVERTORIAL funded by MSD
When to prescribe LAGEVRIO as the preferred * COVID-19 oral antiviral on the PBS? 1, 2
* LAGEVRIO must be for use when nirmatrelvir-ritonavir is contraindicated. 1, 2
For your at-risk adult patients who test positive for COVID-19, LAGEVRIO may be prescribed when: 2-4
1 2 3
The patient has a history of clinically significant hypersensitivity reactions to nirmatrelvir-ritonavir
The patient has severe renal impairment or severe hepatic impairment
There is a risk of potential drug-drug interactions with nirmatrelvir-ritonavir that cannot be safely managed
Considerations include: 5
• Can the medicine be withheld safely?
• Can a dose adjustment be done easily?
• Can the patient be advised on adverse events to monitor for?
Why is the choice of oral antivirals relevant in patients aged ≥70 years?
50 % of Australians aged ≥65 years live with 2 or more chronic conditions 7
ABS data from the National Health Survey 2022
Scan QR code to access the Liverpool COVID-19 Drug interaction checker 6
Chronic conditions often require multiple medications, which may increase the risk of potential drug-drug interactions. 8
PBS information: Authority required( STREAMLINED): LAGEVRIO must be for use when nirmatrelvir(&) ritonavir is contraindicated. 1 The contraindications to nirmatrelvir(&) ritonavir can be found using the Liverpool COVID-19 Drug interaction checker or the TGA-approved Product Information for nirmatrelvir(&) ritonavir. 1, 4, 6 Visit www. pbs. gov. au for more information.
References: 1. Pharmaceutical Benefits Scheme. www. pbs. gov. au( accessed March 2024). 2. Pharmaceutical Benefits Scheme. Lagevrio ®( molnupiravir) Pharmaceutical Benefits Scheme Factsheet – Updated June 2024. https:// www. pbs. gov. au / publication / factsheets / covid-19-treatments / PBS-Factsheet-lagevrio-molnupiravir-June-2024. pdf( accessed September 2024). 3. LAGEVRIO Product Information, October 2023. 4. Paxlovid( nirmatrelvir-ritonavir) Product Information. September 2024. 5. University of Liverpool. COVID-19 Drug Interaction Prescribing Resources – Assessing a patient for treatment with Paxlovid. Available at www. covid19-druginteractions. org / prescribing _ resources / paxlovid-patient-assessment( accessed October 2024). 6. University of Liverpool. COVID-19 Drug Interaction Checker. Available at https:// covid19-druginteractions. org / checker( accessed March 2024). 7. Australian Bureau of Statistics. Health conditions prevalence( 2022). Available at https:// www. abs. gov. au / statistics / health / health-conditions-andrisks / health-conditions-prevalence / latest-release( accessed August 2024). 8. Shini Rubina SK et al. Diabetes Metab Syndr 2022; 16( 3): 102451. 9. Bernal AJ et al. N Engl J Med 2022; 509 – 520. 10. Van Heer C et al. Lancet Reg Health West Pac 2023; 41:100917. 11. Gentry CA et al. J Infect 2023; 86( 3): 248 – 255. 12. Lin DY et al. JAMA Netw Open 2023; 6( 9): e2335077. 13. Park HR et al Infect Chemother 2023; 55( 4): 490 – 499. 14. Ahmad WA et al. Clin Microbiol Infect 2024; 30( 10): 1305 – 1311.