The Health News – 29 April 2014

Overview

  • Australian women could soon trade two-yearly Pap smears for a more accurate test every five years, in what health experts say is one of the biggest shake-ups to cancer screening in decades.
  • Drug companies will be forced to give the Federal Government full refunds in cases where their medicines do not work.
  • The Centre for Personalised Immunology at the Australian National University (ANU) is the first centre of its kind in the world, that will treat rare immune disorders.

Health News on HPR.

Cervical cancer screening set for major changes which may see five-yearly testing – By Sophie Scott and Alison Branley

Australian women could soon trade two-yearly Pap smears for a more accurate test every five years, in what health experts say is one of the biggest shake-ups to cancer screening in decades.

The move is likely to come after the Medical Services Advisory Committee (MSAC) recommended the shift to five-yearly cervical screening using the HPV (human papillomavirus) test.

The proposed regime, which is likely to start in 2016, is based on the latest scientific evidence that found the new test will work better by detecting HPV, which is known to be the first step in developing cervical cancer.

Collected in the same way as a Pap smear, testing under the new plan will start for women at age 25 and finish with an exit test between the ages of 70 and 74.

MSAC says women who are HPV-vaccinated will still require cervical screening as the vaccine does not protect against all types of HPV that can cause cervical cancer.

Women with symptoms such as pain or bleeding can have a test any time.

Australian health authorities say the changes are possible because more than 80 per cent of young people now get the HPV vaccine, a rate much higher than many overseas countries.

Professor Annabelle Farnsworth from pathology group Douglas Hanley Moir says the changes are significant.

“It is a bold move and Australia is one of the first countries to be able to make these changes to screening because of the high take-up of the HPV vaccine program,” she said.

Cancer Council chief executive Professor Ian Olver says the changes are likely to be introduced in 2016, but until then women are advised to have tests every two years.

“The Pap test program reduced deaths by 50 per cent in 10 years. The HPV test is predicted to further reduce mortality by 15 per cent,” he said.

The MSAC recommendations will be considered by government after extensive consultation with state and territory health authorities, medical and pathology experts and community groups.

Drug companies to give refunds to government in cases where medicines Kalydeco and Soliris do not work – Sophie Scott

Drug companies will be forced to give the Federal Government full refunds in cases where their medicines do not work.

The Pharmaceutical Benefits Advisory Committee (PBAC) has handed down its recommendations on two controversial drugs, one for cystic fibrosis and the other for a rare blood condition.

Patients have largely welcomed the positive recommendations from the committee.

Under the pay-for-performance model, patients will be taken off expensive medications if they are not seen to be responding to the treatment.

A Health Department spokeswoman says the model, which is a shift away from paying for the medicines regardless of the outcome, has only been used once before.

Under the recommendations, drug companies will not be allowed to charge the Government more than original estimates and must undertake continuous clinical research.

The PBAC will set the health measures that indicate effectiveness.

The decision was a partial win for those lobbying for cystic fibrosis drug Kalydeco to be subsidised by the Government.

The drug helps those with a rare genetic form of the disease, and has been heralded by some as almost a cure.

It is estimated Kalydeco, which costs $300,000 per year for each patient, could help about 200 Australians with the condition.

Vertex, which makes the drug, says it is “deeply disappointed” by the conditions attached to the recommendations.

International general manager Simon Bedson said the proposed changes would halve the number of Australians eligible for treatment.

People who are very sick would be excluded from treatment, and patients showing only mild improvement or a slight improvement in quality of life would be discontinued.

“The conditions of the PBAC recommendation will prevent patients who could benefit from Kalydeco from being able to get it or from remaining on treatment even when demonstrating improvement,” Mr Bedson said.

“Unlike any other country, Australia is seeking to impose strict eligibility and discontinuation criteria to limit the number of patients who could benefit or are showing benefit from this medicine.”

They have urged the Government to reject the PBAC’s recommendation.

The Cystic Fibrosis Foundation was unavailable for comment.

The PBAC also recommended a similar model for Soliris, a treatment for Atypical Haemolytic Uraemic Syndrome.

The condition, which causes abnormal blood clots and mainly targets the kidneys, affects about 60 Australians.

The drug will cost taxpayers up to $200 million over five years.

World-first centre opens for research into individual gene therapies for immune disorders – By Carl Smith

A pioneering research centre to develop individual genetic therapies that will treat rare immune disorders is opening in Canberra.

The Centre for Personalised Immunology at the Australian National University (ANU) is the first centre of its kind in the world.

The researchers will focus on immune deficiencies, where the body’s natural defences are dampened, and auto-immune disorders, where the patient’s immune system attacks itself.

Centre co-director Professor Carola Vinuesa says the field of personalised immunology will revolutionise the way immune disorders are treated.

“Up to very recently, diseases like auto-immune diseases, so we’re talking about diseases like Lupus, Rheumatoid Arthritis, Multiple Sclerosis, were all treated as if they were a single disease,” Professor Vinuesa said.

“The only treatments available therefore were treatments that basically dampened the entire immune system.

“By knowing precisely what is the mechanism of disease in each patient we can start to tailor treatments specific for each patient. And we find that each patient, even though they might be diagnosed with the same disease, might need a completely different drug.

“So the treatments are now more effective and would have potentially less side effects.”

Co-director Professor Matt Cook says many of the disorders are only vaguely diagnosed and are treated with broad, generic medicines.

“Up until now, a lot of progress has been made in treating these diseases but essentially it’s based on therapies that can be applied to a large number of individuals,” he said.

“Not everyone responds in the same way to treatment, some respond better than others, some get more side effects than others.

“So we think that if we can identify the pathway that leads to an individual’s version of a particular disease, then that will lead inevitably to a specific treatment.”

Adam Friederich was aged 19 when he was diagnosed with Common Variable Immune Deficiency – one of the disorders the researchers are focusing on.

The condition destroyed his immune system, making him susceptible to infections and viruses, and preventing vaccinations from having an effect on his body.

Mr Friederich says the disease prevents him from playing with his three young children.

“My body doesn’t make the antibodies that normally tell your immune system what to do and what’s good and what’s bad and what to attack and what to leave alone,” he said.

“I have to try not to be too involved when they’re very sick, but you’ve also got to trade off that you have children to try and spend time with them.

“So you just have to take the risk and do it.”

Mr Friederich has had his spleen removed because of the disorder and has to constantly take antibiotics and other injections.

Professor Cook says although each specific disorder only affects a small proportion of the population, these types of disorders are taking their toll.

“Individually each of these diseases can be quite rare, but collectively they account for a lot of illness in the community.”

He says rapid advances in technology that allow sequencing of the genome, alongside more refined techniques for sorting that data intelligently, have made the centre’s work possible.

The researchers have already found some successful treatments for individual patients and believe the new centre will speed up the process of finding more.

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