We are excited to announce that the Federal Health Minister Greg Hunt MP announced that the first drug to treat ADPKD, JINARC® (Tolvaptan) will be available on the Pharmaceutical Benefits Scheme (PBS) from 1 January 2019 for eligible patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD).
This will provide Australians living with the most common life-threatening genetic kidney disorder affordable access to the first effective treatment to slow the decline of the disease, saving patients around $23,000 a year. This is a historic moment in providing hope to patients with polycystic kidney disease.
There are approximately 25,000 Australians living with ADPKD, a disease which causes thousands of cysts to grow within the kidneys, ultimately causing kidney failure, leading to dialysis or transplant.
Charmaine Green, 30-year-old Manager of PKD Australia, is living with ADPKD and has a toddler also with the disease, said “As a parent of a child with PKD I vividly remember seeing the ultrasound that confirmed tiny cysts growing in my son’s kidneys. People with this disease live with uncertain futures as their kidney function deteriorates. Research and clinical trials that deliver new treatments are welcome and I hope that this is just the beginning of new treatments available to treat PKD.”
Research has shown that vasopressin, a hormone that regulates fluid balance, contributes to the growth of kidney cysts in ADPKD. JINARC® (Tolvaptan) blocks the action of vasopressin and has been shown to reduce the rate of kidney decline in 2 large international kidney trials that included more than 100 Australians.
Peter Bardadyn, 55 years from Adelaide has a long history of PKD in his family and received Tolvaptan as part of the clinical trial, said “My Grandfather collapsed on the kitchen floor at 48. My Mum had an unsuccessful transplant in 1974, passing at 49. I’m almost 56 with 4-6 years before dialysis would be contemplated, so I’ve been lucky. This occurred for me in 2007 when I was offered the Tolvaptan trial as one of first in the country.”
It important to note a significant number of patients may not be able to tolerate JINARC® due to side effects including increased thirst and urine output. About 5% of patients on tolvaptan develop abnormalities in the blood tests to assess liver function. These are typically mild and reversible when tolvaptan is stopped, but some patients can develop more serious liver injury.
Peter said “At first it took a little acclimatisation but nothing dramatic at all…the toughest thing is checking into a hotel overseas for work and having to explain I need 6 bottles of water each night! …Both my children carry the gene and so when I agreed to the trial I knew that regardless of whatever happened to me, they would ultimately benefit. For me, the release of the drug means that every Mum and Dad out there in my situation will know that, today, the future for their afflicted children is now a little brighter.”
PKD Australia, the only organisation dedicated to finding treatments and a cure for PKD in Australia, would like to thank the patients involved in the Tolvaptan clinical trial and the PKD community whose voices helped the Pharmaceutical Benefits Advisory Committee (PBAC) reach a positive recommendation for the first treatment of ADPKD in Australia.
Helen Coolican, who worked to set up PKD Australia 4 years ago, has long dreamed of the possibility of a cure for PKD, said “PKD took my husband from us when our youngest was still at school. He’s missed graduations, weddings and most recently the birth of our first grandson. Now, for the next generation, which includes our four children, there is an option that could reduce the years sacrificed to this disease.”
Recognising the burden of PKD on families, Robert Gardos, Chairman of PKD Australia, commented, “Finally there is hope.”
Check out the patient video: https://youtu.be/jcpxZd8fPnU
Patient data collected through registries has been used to evaluate important outcomes in patients with Autosomal Recessive PKD (ARPKD), highlighting the importance of registries to determine best practice for patients and to inform research.
ARegPKD is an international registry that aims to gather the largest collection of detailed longitudinal data on clinical ARPKD courses worldwide, in order to contribute to the fight against this life-threatening disorder(1). Comprehensive prenatal, perinatal, and postnatal information was captured from 385 patients from ARegPKD and analysed for potential risk markers for dialysis during the first year of life. Identifying these risk factors may be helpful in prenatal parental counselling in cases of suspected ARPKD(2).
Conducting studies in rare diseases such as ARPKD and paediatric ADPKD are by nature difficult for many reasons. Registries can help determine optimal management plans and are an important aspect in the path forward for PKD. In the research of rare disease, patient registries have been described as the best tool to close the gap between research and therapeutics(3).
2. Risk Factors for Early Dialysis Dependency in Autosomal Recessive Polycystic Kidney Disease. Burgmaier, KathrinRanguelov, Nadejda et al. The Journal of Pediatrics, Volume 199, 22 – 28.e6
3. EURODIS NORD CORD, Joint Declaration of 10 Key Principles for Rare Disease Patient Registries
PKDA was a signatory last year on a call to the Federal Government to make dialysis more accessible for indigenous patients.
Representing PKDA at the meeting, Helen and Robert heard from experts and indigenous patients that the pressures of undergoing long-term dialysis far from home, away from their families and cultural commitments, can be so great for some Indigenous patients that they would rather die. Patients said that many people were dying a lonely death in cities and towns because of the poor accessibility of treatment centres in remote communities.
Helen expressed her shock and disappointment: “It’s a renal emergency. Why is it happening, and why has it existed for so long?”
Now, the Government has pledged to spend $57.8 million for dialysis in remote communities to help Indigenous patients stay at home.
Helen and Robert said of the Indigenous Patients Voices Forum at the time “it’s been an amazing privilege to be here, especially today, and to hear all of your stories. They’re so powerful and so moving, and I think it takes tremendous courage to stand up and speak from the heart as so many people have done.”
It was the voices, hard work and determination of these strong people and communities, their carers and their supporters that has led to this great outcome, a step towards equitable outcomes for all kidney patients.
As the 2018 Budget was announced we welcomed the new investment into health. A few words stood out to us from the Health Budget: Rare, genetic and chronic.
To us Rare genetic and chronic = PKD. So, we put together a wish list of what we hope the 2018 health Budget could mean for PKD.
“The Government will deliver $6 billion in record funding for Australia’s health and medical research sector, including $3.5 billion for the National Health and Medical Research Council, $2 billion in disbursements from the Medical Research Future Fund and $500 million from the Biomedical Translation Fund.”
Dr Gopala Rangan (the chair of our SAB) is the lead investigator of the PREVENT-ADPKD clinical trial which is funded by NHMRC.
The new trial, using water to treat PKD, known as PREVENT-ADPKD is led by Dr Annette Wong, Carly Mannix, Professor David Harris and Dr Gopi Rangan at the Westmead Hospital and the Westmead Institute for Medical Research.
The trial will investigate whether drinking the right amount of water can prevent adult polycystic kidney disease (ADPKD) progressing to kidney failure.
“A positive study result will show that water is a cheap, safe and effective treatment,” Dr Rangan explained.
Story originally published by the Westmead Institute for Medical Research, republished on our website with their permission. Photo: Dr Gopi Rangan and his team from the Westmead Institute and the Westmead Hospital from Westmead Medical Research Foundation
The aim was to develop a new test that uses whole genome sequencing (WGS) to diagnose autosomal dominant polycystic kidney disease (ADPKD). Sequencing genes to determine a causative mutation in ADPKD is difficult using traditional gene sequencing methods.
This is due to six ‘pseudogenes’ – which are non-functional genes, almost identical in DNA sequence to the causative genes. Dr Mallawaarachchi and a team of clinicians and scientists trialled WGS and found it more detailed and accurate than current testing. This has led to the establishment of a genetic test for Australian ADPKD families. More accessible genetic testing will allow patients to be diagnosed sooner, allow families to better inform their family planning decisions, help to predict prognosis and allow better selection of living kidney donors for kidney transplantation.
In the long term, improved genetic testing will accelerate our understanding of the underlying cause of ADPKD – an important step in finding a cure. To read Dr Mallawaarachchi final report please see here.
Our bodies depend on a hormone called vasopressin to regulate fluid balance. When our bodies are not hydrated more of the hormone, vasopressin is produced. High vasopressin levels (which occur when we don’t get enough fluid) have been linked to cyst growth in ADPKD. Drinking more fluid can reduce vasopressin levels and may slow the progression of ADPKD.
Tolvaptan is a selective vasopressin type 2 receptor inhibitor and blocks vasopressin’s actions at the cellular level. Results from the Phase 3 REPRISE trial of tolvaptan, which was conducted in 21 countries for treatment of ADPKD were announced late last year by Otsuka Pharmaceutical (Otsuka).
In the REPRISE trial, Tolvaptan reduced the rate of decline of kidney function by 35 percent over a 12-month period, compared to the placebo. These results built upon their previous trial, known as TEMPO 3:4. The REPRISE trial focused on ADPKD patients with more severe kidney disease than those in the TEMPO 3:4 trial. To summarise the TEMPO 3:4 trial, Tolvaptan, when given over a period of 3 years, slowed the increase in total kidney volume and the decline in kidney function (as measured by glomerular filtration rate). Key safety findings were generally consistent in both the REPRISE and TEMPO 3:4 trial.
In these two trials patients who received tolvaptan had a higher frequency of adverse events such as excessive thirst, increased urine production and urination during the night. Furthermore, Tolvaptan led to more instances of increased liver-enzyme levels, which resolved after the discontinuation of the drug. Those who received placebo had higher frequencies of adverse events related to ADPKD, such as kidney pain, haematuria (blood in the urine), urinary tract infection and back pain.
The Australian PBS listing application for Tolvaptan will be reviewed at the March 2018 meeting of the Pharmaceutical Benefits Advisory Committee (PBAC). As part of the review process, the PBAC welcomes input from patients and their families, carers, members of the public, health professionals and members of consumer interest groups. These submissions provide accounts of how the medication under consideration will impact the lives of individuals.
To complete the consumer input form, please go to the PBAC online submission form. Or you may write a letter to the PBAC at the following addresses:
Mail: PBAC Secretariat MDP 952, Department of Health and Ageing GPO Box 9848 Canberra ACT 2601
Facsimile: (02) 6289 4175
The Outcomes of the PBAC meeting will be available on the PBS website six (6) weeks after the meeting. Public submissions for medicines being considered at the March 2018 meeting will be received up until the deadline date of 7 February 2018.
Sources: 1: Torres, V. E. et al. Tolvaptan in patients with autosomal dominant polycystic kidney disease. N. Engl. J. Med. 367, 2407–2418 (2012). 2: Torres, V. E. et al. Tolvaptan in later-stage autosomal dominant polycystic kidney disease. N. Engl. J. Med. 377, 1930–1942 (2017) 3: van Gastel M, D, A, Torres V, E, Polycystic Kidney Disease and the Vasopressin Pathway. Ann Nutr Metab 2017;70(suppl 1):43-50
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