Agreement seals new kidney cancer, smoking cessation, arthritis treatments

Patients with a form of kidney cancer will have a new treatment option as part of a multi-product agreement between PHARMAC and Pfizer.

The agreement includes sunitinib (Sutent), a treatment for renal cell (kidney) cancer), the smoking cessation drug varenicline (Champix) and the auto-immune disorder treatment etanercept (Enbrel), and has long-term cost savings. Sunitinib and varenicline will become funded for the first time, while etanercept has its funding widened. These aspects of the agreement come into effect from 1 November 2010.

Sunitinib

PHARMAC medical director Dr Peter Moodie says about 450 New Zealanders each year are diagnosed with renal cell carcinoma, and there is currently a lack of funded treatment options for patients with advanced disease. Currently, interferon alpha is the principal treatment for people with advanced disease, but can be difficult to tolerate and has limited effectiveness.

“Until now, once people had tried interferon alpha they were basically at the end of their treatment options. Now, there is a new funded option and improved treatment in the form of sunitinib,” he says.

PHARMAC estimates about 76 people per year will seek treatment with sunitinib.

Etanercept

Dr Moodie says the access widening for etanercept is also a step forward for diseases such as rheumatoid arthritis, psoriasis, ankylosing spondylitis and psoriatic arthritis. Etanercept is the second of the TNF-alpha inhibitor biologic class of drugs to be funded in New Zealand for this group of diseases.

“Adalimumab has been funded since 2006 and many people have benefited from using it,” says Dr Moodie. “However, there is a group of patients who may not be able to use, or may not respond to adalimumab, so a further treatment option is good to have..”

Etanercept has been funded for juvenile idiopathic arthritis since 2004, so this decision is to widen access to the treatment. PHARMAC estimates that up to half of the people treated with TNF-alpha inhibitors each year (currently about 1,300 people) will eventually be prescribed etanercept.

Varenicline

The smoking cessation treatment varenicline (Champix) will provide another option for people seeking help to stop smoking. PHARMAC already funds nicotine replacement therapy (NRT), bupropion (Zyban) and nortriptyline for the same task.

Dr Moodie says PHARMAC’s clinical advisors had initially been concerned about funding varenicline because of its safety profile. However, varenicline is now part of Medsafe’s Intensive Medicines Monitoring programme, and PHARMAC has been careful to target varenicline’s use through funding rules that require people to try at least one other funded product previously, and to use varenicline only as part of a comprehensive smoking cessation programme.

PHARMAC estimates that up to 8000 people per year will be prescribed funded varenicline within three years.