Friday, 21 November 2014

Should the NHS take on Big Pharma?

#MSResearch Should the NHS take on Big Pharma?

Why did Genzyme/Sanofi remove CAMPATH from the market before the development of Lemtrada? 

They are both Alemtuzumab, one was used for Cancer at a cost, for MS use of about £1000, and the other the MS drug at a cost of about £28,000. So this is a big jump in cost because of a bit of packaging and dilution of the amount of antibody in the packaging.

Whilst the company will argue they are recovering costs etc o the trials, they have removed the anti-cancer version from the market and would provide this for free for people with cancer, Why?

Maybe they could see the problem brewing that is now an issue for Roche/Novartis.
There is an antibody that is used to treat cancer, which stimulates growth of blood vessels to help them grow. To do this there is a production of vascular endothelium growth factor. This is targeted by a drug called Avastin . It was also found that injecting a small amount of this ($50 worth) into the eye also stopped a degenerative condition in the eye (macular degeneration). So the company did studies and licenced another version of the antibody, which was diluted compared to Avastin and marketed this as Leucentis at a vastly inflated price ($2,000). However, you can take Avastin and use it regularly in the eye disease and the cost is vastly reduced, saving the NHS vast sums of money. So Novartis threatened to sue (but didn't press the court case) the NHS.

Apparently this summer, the Italian Medicines Agency decided to reimburse patients who are given Avastin to treat age-related macular degeneration. And France’s National Assembly passed a law allowing for reimbursement of off-label medicines, and specifically mentioned Avastin.

The moves reflect efforts to cuts costs on medicines by cash-strapped European governments. Interestingly, anti-trust authorities in both Italy and France are eyeing Roche and Novartis on suspicion of anti-competitive practices.


The Royal College of opthalmologists says switching to the drug could save the NHS £100m and whilst eye docs in the UK can prescribe it "off-label", but they are only supposed to do that if there is no suitable licensed drug and are personally liable if they do.

The Royal College say regulators should find a way of getting round what they call the "bureaucratic hurdles" that prevent its use, and called for the General Medical Council and National Institute for Health and Care Excellence to provide guidance. It is suggested that either the regulators find a way to license a drug without the sponsorship of the company that owns it or NICE must find a way to consider an off-label drug that is not being submitted for appraisal by the companies.

Genzyme have thus avoided a headache by removing CAMPATH from the shelf.

The news that azathioprine can be at least as effective as beta interferons brings this issue into focus of MS and will have importance for the studies aiming to use/repurpose existing drugs for the treatment of progressive MS, because once a licenced pharma drug arrives for progressive MS then this problem will apply.

Should the NHS and UK Docs be taking on big Pharma for the sake of the coffers of UK PLC?

Maybe ProfG can do a poll

14 comments:

  1. Price gouging, pure and simple, which needs to be stopped pronto. No-one denies that Pharma needs to make a profit on their drugs otherwise they will pull out of MS but it needs to be fair and as some of these cases show, it isn't. Also decisions like the one by Teva to jack up the price of Copaxone to squeeze the last drops of profit out of a drug that is not only going out of profit but also now well down the order of efficacy, look terrible and reinforce the opinion that many here share that profit is the sole motivation.
    Things need to change.

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    1. MD2 I am not sure I agree with you here. Lucentis and Avastin are different products with different development programmes that required investment etc. Similarly, the Lemtrada MS programme was very expensive. I think Pharma need to be able to make their money back on their investment and profit to feed future drug discovery. If we remove the incentive for drug development, even if it is repurposing, we won't get new drugs. I agree we need some way of controlling costs as the pharma market is not really a market
      this is what NICE does. I am told the insurance companies drive a hard bargain in the US as well. What we do, however, need is a way of getting patients who can't afford these therapies, or are uninsured, access via patient access schemes or discounting schemes. We are lucky we live in a country with a socialist healthcare system.

      What I am saying is that we need a healthy profitable pharma industry to innovate and develop new drugs; they are the only show in town. Love them or hate them we need Pharma.

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    2. Still doesn't seem right to me and the fact that they resort to litigation to prevent clinicians using the cheaper product concerns me.
      http://www.bmj.com/content/344/bmj.e3162
      http://blogs.wsj.com/pharmalot/2014/09/16/the-eyes-have-it-study-says-avastin-is-just-as-safe-to-treat-amd-as-lucentis/
      I'm not denying pharma needs to turn a profit and the reason why pharma is in MS is that they were convinced it was profitable for them to do so but when you see examples such as this and the price of outdated drugs being jacked up before they go off patent that already have earned billions it turns my stomach.
      As you say there is no pharma market with pricing strategy being what the market will bear, which begins to resemble a cartel. That the US government also now seems to be having grave misgivings about this suggests may perceptions may be correct.

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    3. "What I am saying is that we need a healthy profitable pharma industry to innovate and develop new drugs".

      Repurposing drugs has nothing to do with developing an agent with a specific MOA to treat a condition. Government agencies would be better off funding trials for repurposed drugs rather than allowing pharma to inflate the prices of their existing old medicines. There is no innovation here.

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  2. Prof G is happy with the status quo. If pharma companies are making big profits they will need expert advisers etc. I'm guessing lots of ex-medics turn up on the boards of the pharma companies. I think it's inaccurate to keep claiming that pharma take the risks so should be rewarded.

    Pharma profits are among the highest of any sector:

    http://www.bbc.co.uk/news/business-28212223

    You only have to look at the pay packets of senior staff in pharma companies to see that drugs are lucrative - the pay of a senior official at Biogen was over $20 million.

    Pharma is an industry, the companies have shareholders, they like all companies are focused on profit. That's the way it is. An alternative would be for government / non-profit organisations to fund research and trials. Unlikely with the current financial issues. But the tide is turning. Pharma profits look excessive and health services need to reduce the amount they spend on drugs. Hopefully the propsoe legisaltion on the repurposing of drugs will be a step in the right direction. The difference with pharma is that I don't want their good. I can choose whether I want to buy a Ferrari - expensive, but my decision. I have no choice when the government buys an MS drug on my behalf - I just want to preserve my brain. The real scandal is the billions made by the companies selling the original first line therapies - the efficacy of these drugs was marinal at best, and for many patients there was no benefit.

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    1. Regarding "The real scandal is the billions made by the companies selling the original first line therapies - the efficacy of these drugs was marinal at best, and for many patients there was no benefit." That is the telling point in MS therapies - did the DMTs have benefit (i.e. delaying EDSS progression) in the 20+ years they have been used?

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    2. I am not happy with the status quo; we have been trying to come up with a Big Pharma Alternative for a few years now but keep hitting a wall.

      http://multiple-sclerosis-research.blogspot.com/2012/12/bpa-why-is-drug-license-necessary.html

      http://multiple-sclerosis-research.blogspot.com/2012/12/bpa-drug-repurposing.html

      http://multiple-sclerosis-research.blogspot.com/2012/12/preliminary-poll-results-big-pharma.html

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    3. Anon 3:03:00 pm, you are clearly not well informed. I work for a Pharma company; it does not mean I am an ex-medic; I still see patients 1-day per week and I made a career choice to do so. I honestly believe that I can do more to help my patients working in Pharma than I can seeing them in my rooms. Please name me one MS drug that has not needed a Pharma company to get it to market? I suggest you read one of my favourite blog posts about Industry Neurologists; it explains what we do

      http://multiple-sclerosis-research.blogspot.com/2012/12/industry-neurologists-necessary-career.html

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    4. Big pharma's primary goal is going to be the stockholders. May more researchers be blessed with MS so they may know the crushing reality of the battle we face and not just the theory. It's easy to be cavalier when you aren't personally faced with the decision to risk PML or a progression of your disease.

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    5. Gosh, I can understand your sentiment and the horrible decisions we need to wrestle with are truly crap but I wouldn't wish MS on anyone.

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    6. Re May more researchers be blessed with MS: what a horrible sentiment towards people who are trying to help. You think the researchers will suddenly be blessed with healing superpowers along with the MS?

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    7. "May more researchers be blessed with MS so they may know the crushing reality of the battle we face and not just the theory."
      Well, 2 researchers I have worked with, who both worked on MS, have gone on to develop MS. Presumably this makes you happy?
      Perhaps working on MS is an unreported risk factor?

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    8. Plus members of the team may have a personal connection with MS, if we could wave a magic wand and it all goes away we would.

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    9. Indeed, I also have a family member with MS.

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