Australian Doctor 8th Nov Issue | Page 15

ausdoc . com . au 8 NOVEMBER 2024

NEWS 15

My most memorable day as a doctor ?

This is what happened …

May , 1980 Dr Brendan McPhillips

GP , Sydney , NSW

I WAS an intern at Sydney Hospital . It was my first surgical term , and I was with the colorectal team .

For the first month , I was completely overwhelmed by the long days

ADVERTORIAL funded by MSD

Why choose LAGEVRIO for your elderly patients who test positive for COVID-19 ? 1 , 4

LAGEVRIO lowered the risk of hospitalisation or death vs placebo 4 , 5

REGISTRATION STUDY : LAGEVRIO vs placebo : 4 , 5

30 % ( ARRR ) and the Everest of investigations and procedures for the patients — most of which I had never heard of and had no idea how to order .

There was the total intimidation of working among surgeons ( Mr not Dr !) whose tolerance for incompetence was zero .

And for that month , I was incompetence personified .

But it gradually changed . I learnt the ropes and came to feel more as if I belonged .

• Unvaccinated patients

• Aged ≥18 years ( median 43 years )

• Patients with ≥1 risk factor

• During the Delta period ( May-October 2021 )

EFFICACY RESULTS IN NON-HOSPITALISED ADULTS WITH COVID-19 THROUGH DAY 29 4 , 5

All-cause hospitalisation or death

LAGEVRIO ( N = 709 ) N (%)

PLACEBO ( N = 699 ) N (%)

48 ( 6.8 %) 68 ( 9.7 %)

All-cause death 1 ( 0.1 %) 9 ( 1.3 %)

Based on a planned interim analysis of LAGEVRIO vs placebo : The adjusted risk difference was -6.8% ( 95 % CI : -11.3%, -2.4; 7.3 % [ 53 / 377 ] vs 14.1 % [ 28 / 385 ]; p = 0.0024 )

ARRR = Adjusted Relative Risk Reduction

Access study designs for registration study 5 and Australian Real World Evidence 6

LAGEVRIO : similar side effect profile to placebo 4

Treatment-related adverse events ≥ 1 % ( LAGEVRIO vs placebo ): Diarrhoea ( 2 % vs 2 %), nausea ( 1 % vs 1 %), dizziness ( 1 % vs 1 %) 4

One surgeon in particular , Dr Mark Killingback , struck me as both highly skilled and ethical , although I could not quite picture him as a fallible human being .

Most patients who came in had been admitted for surgical removal of bowel malignancies , and most were elderly .

However , one day a young woman appeared on the ward . She was in her 30s , and her husband and young children were with her .

ADJUSTED RISK DIFFERENCE % ( 95 % CI )

-3.0 % ( -5.9 %, -0.1 %, p-value not available )

I did the admission .

She had a suspicious mass in her large intestine , which Dr Killingback was going to remove .

However , when we did the surgery , it was discovered that she had widely disseminated metastases throughout her abdomen , and he simply closed the incision without removing any of the tumour .

I remember being shocked and disoriented : she was too young to have something as catastrophic as this .

It was decided to start her on chemotherapy , but she and her husband were told there was little hope .

The day that stays with me occurred about a week later .

It was the evening , and I was meant to be going home . The young woman had been having pain throughout the day , and by 5pm , it was clear that she had a bowel obstruction .

Dr Killingback was called in to assess the situation .

The husband was there as well , but there was debate at the bedside as to whether it was safe to operate again .

Suddenly , the husband burst into tears and began begging Dr Killingback to please save his wife ’ s life .

I remember the look of confusion and distress on the surgeon ’ s face .

He took me and the registrar into the corridor and asked us what he should do .

I couldn ’ t quite believe that he was asking for my opinion .

We told him we would stay and assist in the surgery if that was the right thing . And that is what happened .

I think this was the day I became a doctor .

This eminent surgeon showed me that , with all his prestige and experience , coming face to face with a decision about life and death , we are all human , and as such , we are called upon to act as human beings .

AUSTRALIAN REAL-WORLD EVIDENCE : During an Omicron wave in Victoria , in vaccinated patients aged ≥70 years , LAGEVRIO reduced COVID-19 related hospitalisation or death vs no treatment . 6

Reduction in Hospitalisation

29 %

LAGEVRIO ( n = 15,673 ) vs no treatment ( n = 10,637 ) ( 95 % CI : 0.58-0.87 ; p = 0.003 )

Reduction in Death

55 %

LAGEVRIO ( n = 19,962 ) vs no treatment ( n = 13,721 ) ( 95 % CI : 0.38-0.54 ; p < 0.0001 )

†

No †

No known drug interactions based on limited data available 4

• Australian data

• Vaccinated patients

• Aged ≥70 years

• During Omicron period ( July-October 2022 )

Study assessed the efficacy of oral antiviral treatment available during that period vs no treatment on rates of death and hospitalisation within 35 days from a mild to moderate COVID-19 diagnosis . Results shown are for LAGEVRIO vs no treatment only . Additional analyses were performed but results are not shown .

LIMITATION : No safety analysis was performed . These study findings are limited by the confounding observational nature of the study whereby unobserved confounders may over estimate the treatment effectiveness of LAGEVRIO .

LAGEVRIO is a simple † option for appropriate patients 4

dose adjustments required in patients with renal and / or hepatic impairment 4

Dr Mark Killingback

BORN in 1930 , he became president of the Australian Colorectal Surgical Society and helped to establish the Section of Colon and Rectal Surgery at the Royal Australasian College of Surgeons .

The college ’ s Mark Killingback Prize — established in 1995 to encourage young colorectal surgeons — is named in his honour .