We have the Viking hypothesis that MS started in the Viking nations and then the British Distributed MS around the World. As ECTRIMS in Britain comes to a close, perhaps the Vikings are starting the end of company interest in Immune DMT in MS.
There are now well over ten DMT, with each new addition costing more than the last.
The next in line is probably ocrelizumab, which is an anti-CD20 B cell depleting monoclonal antibody. This looks set to sweep some of the current DMT under the table…but is it?
The MS bubble is set to burst by 2019 as fingolimod comes off patent and the introduction of generic fingo should see prices tumble. That is unless pharma has something up its sleeve. The major generic makers are also the people making MS DMT, which could through a spanner in the works. This could mean few, if any new drugs to treat relapsing MS, because the costs of the trials to show incremental benefit above what's there now will mean big pharma will be off to find rich pickings elsewhere.
However are the Swedes hastening this downfall?
The high cost of drugs appears to be all well and dandy in the USA, but it means that low and middle income can't get access to drugs because of cost. In Europe, where there is socialized medicine the costs put strains on the National Purses and this limits access to treatments.
If we consider those with high cost, such agents can be rationed. However it is clear that there are generic drugs that could be efficacious and more cost-effective. Can they be used, well according to the Health minister, Doctors have the right to prescribe off-label and in certain parts of Sweden Off-label accounts for about 90% of the MS drug use.
There is no doubt in my mind that anti-CD20 inhibits relapsing MS and also it appears to inhibit active progressive disease at least.
Ocrelizumab is a humanised anti-CD20 at the regulators at the moment. Ofatumumab is a human anti CD20- B cell depletor and is in phase III trial.
However there is a chimeric antibody antibody available called Rituximab, which is a chimeric part mouse part human antibody and the Swedes have been using it...... a lot, yep I mean a lot