Consultation Launched on Folic Acid Fortification

Peter Russell

June 14, 2019

A government consultation on fortifying flour in the UK with folic acid, and a positive decision by NICE on a drug for MS patients featured in health and medical news this week.

Folic Acid Flour Fortification

A consultation was launched on plans to add folic acid to flour in the UK.

The Department of Health and Social Care (DHSC) said fortification could help prevent babies being born with neural tube defects (NTDs).

The 12-week consultation, led by health departments in England, Scotland, Wales, and Northern Ireland, would consider what type of products could be included.

Around 1000 pregnancies are diagnosed with neural tube defects each year in the UK, of which more than 40% of cases are fatal.

If the UK added folic acid to flour it would follow the lead of more than 60 countries worldwide, the DHSC said.  In Australia, neural tube defects fell by 14% after folic acid was added to all flour.

UK wheat flour millers already have to add thiamine, niacin, iron, and calcium to their products.

Women trying to become pregnant are advised to take a daily supplement of 400 micrograms of folic acid before they conceive and during the first 12 weeks of pregnancy.

However, Clare Murphy, director of external Affairs at the British Pregnancy Advisory Service, said many women did not take supplements. "Folic acid can prevent NTDs, but only if taken very early in the pregnancy, and really before conception," she said.

"Currently, women are advised to take folic acid supplements during the early stages of pregnancy, but around half of UK pregnancies are unplanned, which means that many women have already missed the window to take folic acid by the time they realise they are pregnant."

The Scientific Advisory Committee on Nutrition (SACN) first called for mandatory folic acid fortification in 2006, and in 2017 said potential adverse effects of folic acid, did not provide a substantial basis for changing that recommendation.

Jo Instone from the British Dietetic Association said the consultation period would "give us an opportunity to set out the very strong, evidence-based case for fortification of flour with folic acid", and "allay any fears that people may have".

Kate Steele, chief executive of spina bifida charity, Shine, commented: "After more than 25 years of campaigning for this, we look forward to the day that mandatory fortification with folic acid finally becomes a reality.

"Its introduction will change many lives for the better by reducing the incidence of anencephaly and spina bifida."

Positive Decision on Orcrelizumab for MS

Decisions announced this week by the National Institute for Health and Care Excellence (NICE) included approval for ocrelizumab (Ocrevus, Roche) as an option for treating early primary progressive multiple sclerosis with imaging features characteristic of inflammatory activity in adults.

The final guidance reversed an earlier decision to reject the drug.

Publication of final guidance had been paused last November to allow time for further commercial discussions to take place between NICE, NHS England, and the manufacturer.

Support for the drug's approval attracted 21,000 signatures in an online petition.

The MS Trust welcomed the decision to approve ocrelizumab for routine NHS use in England. Chief Executive Officer, David Martin, said: "We commend the willingness of all three parties to find a solution which enables people with early, inflammatory primary progressive MS to access a treatment which will allow them to continue working and remain independent for longer.

"But we know this is just the start. More treatments for progressive MS are still desperately needed, and we will continue to fight to ensure everyone with MS can access the treatments they need."

No to Bronchoscopic Thermal Vapour Ablation 

NICE decided that current evidence on the safety and efficacy of bronchoscopic thermal vapour ablation for upper-lobe emphysema was "inadequate in quantity and quality".

The procedure should therefore only be used in the context of research, it said in final guidance.

The procedure involves passing a bronchoscope through the mouth or nose into the lungs to deliver steam to destroy the affected part of the lung, ablating the diseased tissue and allowing subsequent remodelling.

Treatment for DVT

Evidence on the safety of percutaneous mechanical thrombectomy for acute deep vein thrombosis (DVT) of the leg showed there were well-recognised but infrequent complications.

Specialist advisers and an appraisal committee considered the main safety outcomes to be: bleeding, haemolysis, vessel damage including stenosis, clot embolisation, and rethrombosis.

In final guidance, NICE said:

  • For acute iliofemoral DVT the evidence on efficacy was limited in quality and quantity, and that the procedure should therefore only be used with special arrangements for clinical governance, consent, and audit or research.

  • For distal DVT that did not extend into the common femoral vein, the evidence on efficacy was inconclusive, and that the procedure should therefore only be used for research purposes.

Cerebral Embolism Treatment

NICE said it had identified no major safety concerns in a review of evidence on percutaneous insertion of a cerebral protection device to prevent cerebral embolism during transcatheter aortic valve implantation (TAVI).

However, it noted inconclusive evidence on efficacy for preventing TAVI-related stroke.

In final guidance, it said the procedure should only be used with special arrangements for clinical governance, consent, and audit or research.

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