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An Otago-led study has successfully trialled a less painful way of delivering treatment to prevent rheumatic heart disease progression.

A new way of delivering treatment to prevent rheumatic heart disease progression is significantly less painful than an almost 70-year-old existing treatment, a University of Otago-led study has found.

The Cure Kids funded study, published in Plos One, was conducted by public health researchers from New Zealand and Australia seeking to improve a painful monthly method of treatment that many patients avoid.

Dr Julie Bennett
Dr Julie Bennett

Lead author Dr Julie Bennett explains that in rare cases, people suffering from a group A streptococcus infection, such as strep throat, can go on to develop acute rheumatic fever or rheumatic heart disease, which causes almost 400,000 deaths worldwide each year.

“Acute rheumatic fever and rheumatic heart disease have all but disappeared from high-income countries, yet in Aotearoa New Zealand they remain an alarming and inequitable cause of preventable suffering and death for Māori and Pacific peoples,” Dr Bennett says.

Since 1955, acute rheumatic fever patients, the majority of whom are children or teenagers, have needed painful monthly intramuscular injections of benzathine penicillin.

“To prevent heart failure and death, patients with rheumatic fever need to have very painful deep penicillin injections into their backsides every month for a minimum of 10 years. The penicillin is to prevent the patient having any more Strep A infections, which can lead to greater heart damage.”

However, patients generally find the injections so painful and disruptive to their daily lives that it is difficult to keep up with regular monthly treatment.

Researchers have now responded to the urgent need to improve the delivery of long-acting penicillin.

The new study trialled a new way of delivering penicillin using a small needle inserted into patients’ stomachs, Dr Bennett says.

“Patients said this method was less painful than their usual injection. This method also enabled a larger dose of penicillin to be administered, which meant only needing to have an injection every three months.”

The new method has now been trialled on more than 50 patients in the North Island.

More than 95 per cent of study participants reported wishing to remain on the new method of treatment instead of returning to their monthly injection.

“This method shows enormous promise as an alternative mode of penicillin delivery and may increase adherence through improved patient experience,” Dr Bennett says.

“Greater adherence may prevent disease progression and death here in New Zealand and globally.”

The Phase II clinical trial is subject to Medsafe approvals and treatment guidelines before the new treatment method can be adopted.

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