Pharmac has reached an agreement with Aventis Pharma Ltd to fully fund the arthritis drug leflunomide.

The agreement will see leflunomide (brand name Arava) listed for the treatment of rheumatoid arthritis from 1 May 2002.

“Rheumatoid arthritis is a painful and debilitating disease so it is pleasing to be able to offer patients another fully funded drug to counter its effects,’’ says PHARMAC medical director Dr Peter Moodie. “This will come as good news for patients who now have a further option to existing subsidised drugs.”

Rather than being a drug that only treats the symptoms of rheumatoid arthritis, leflunomide is a disease modifying anti rheumatic drug (DMARD) that also targets the underlying cause. Rheumatoid arthritis is a progressively worsening autoimmune disease in which the body's natural immune system attacks healthy joint tissue causing inflammation and joint damage. Leflunomide suppresses the immune system and has a more rapid onset of action than other DMARDs.

Several DMARDs are already listed on the Pharmaceutical Schedule, such as methotrexate and sulphasalazine, but they are not suitable for all patients and some patients become intolerant of them. Leflunomide will provide an extra option for patients who have found they cannot use those drugs.

Leflunomide will be targeted at those who are intolerant of, or who aren’t responding sufficiently to, existing methotrexate and sulphasalazine.

Since it has considerable toxicity, like other DMARDs leflunomide needs to be used with great care, and this is why PHARMAC has developed Special Authority criteria, Peter Moodie says.

“Arava is an expensive drug and also one which can produce adverse effects even if used carefully. That’s why in this case it is wise to have Special Authority criteria in place to ensure the drug is targeted at people who will gain benefits from it. Clinical trials have shown that though it can be as toxic as existing immunosuppressant agents, it can be effective as a treatment for rheumatoid arthritis for patients for whom there is no other treatment available.”

“The Special Authority criteria have been developed in consultation with the New Zealand Rheumatology Association, this should ensure they correctly target leflunomide to those patients who will gain most benefit.”

Extending full subsidy to three dosage strengths of leflunomide is estimated to cost about $3.5 million over five years.

PHARMAC’s agreement with Aventis also involves a price reduction for the angina and high blood pressure drug diltiazem (Cardizem). Under the agreement, the price of diltiazem will be maintained at current levels for three years.

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