What is a fair price for the
sofosbuvir?
In April of this year, the New England Journal of medicine announced a major, long-awaited therapeutic
breakthrough. In association with
another antiviral - but without interferon, a new molecule, Sofosbuvir, allowed
cure rates of hepatitis C from 93 to 99% after 24 weeks of treatment in patients
infected with HCV genotype 1 in failure of protease inhibitor in the fibrotic
stages. The good news quickly became subject of controversy; developed by Gilead,
the treatment should be proposed to 60.000 euros for twelve weeks, 600 eur par tablet. In France, the number of patients at
all stages is of about 250.000. The cost would be truly unbearable if we
treated all patients – though, however, they probably could all benefit from it.
This kind of problem can be addressed
by negotiations and usually price/volume agreements- more sales, lower price.
But it is worrying that for most of public opinion and health officials,
Sofosbuvir appears as an economic problem rather than a major therapeutic
breakthrough- whereas, leaving apart the patient life and life quality (!!!), it is also a major
economic progress if you compare to rather inefficient interferon (70.000 euros), not to speak of liver transplant
A more pertinent question
perhaps is this: Why do France and Europe invent us less and less drug in
France and Europe, why do not we have success stories like Gilead? Gilead,
founded in 1987 by Michael Riordan, a 29-year-old doctor infected by the virus
of dengue on a humanitarian mission and wanting to devote himself to antiviral
research, has developed and put on the market within a few years many truly innovative drugs, among other (anti-parasitic) Ambisome, (antiviral)
Tenofovir, Cayston (antibiotic), the Emptricitabine (antiviral), the Flolan
(Antithrombin), the Volibris (endothelin antagonist, first treatment for
pulmonary hypertension), Macugen (synthetic protein derived from VEGF, against
macular degeneration due to age), the famous Tamiflu, anti-viral flu A and B
and first class of inhibitors neuramidinase.
Long live the
pharmaceutical industry !
Perhaps this is because we
have become accustomed to consider drug as a cost, everywhere easy victim of ministers
looking for savings, and not as a progress, pharmaceutical companies as
profiteers, and not as entrepreneurs who take risks (cf. the mortality rate of
the biotechs!) to invent remedies ; because drugs are seen as social expenses
and not as patient benefit. I have always had difficulty to understand why when
the French buy fewer cars, this is a national tragedy, to be
remedied with subsidies, whereas if they buy drugs for their health, it
is anti-civic behavior to punish! (And, by the way, yes, it may be justified to
prescribe an antibiotic for a viral infection - almost all of the 50 to 100
million victims of the Spanish flu died of secondary bacterial infections, not
the virus!)
So, remember. In 1967 appeared
beta blockers. It was the first effective treatment against this 'silent
killer' –hypertension- and dozens of years of life gained for many. They were
followed in 1981 by inhibitors of the enzyme conversion, by antagonists of
angiotensin (1995), becoming increasingly specific and safe. By the way, this
success is the illustration of the need for several drugs targeting the same
pathologies and also the same mechanisms to cover the variety of individual
situations. I 1977, there were the first antiulcer medicines, antihistaminics;
peptic ulcer and its unbearable pain, and its dangers that have long poisoned
the life of our parent or grandparents has gradually ceased to be a surgical indication
and is well and safely treated by these antihistamines, and antibiotics, and
Proton pump inhibitors (1989). In 1980, the therapeutic entered the era of
genetic engineering with the production of the first recombinant interferon
that allowed to treat previously untreatable viral diseases, with also insulin
recombinant production (1980), and then growth hormone (1985) and many others,
that will treat all patients without restriction, more easily and avoiding horrendous
problems with viral contamination of natural hormones. In 1983, it was the discovery
of the first anti-rejection drug, cyclosporine; without this new therapeutic
class, the extraordinary adventure of transplants of all kinds would have been
simply impossible, despite the ingenuity and technical prowess of surgeons. In
1985 was released the first antiviral drug active against HIV/AIDS, first of a
long series; never any threatening and deadly epidemic for humanity was fought
as quickly. In 1988, a new class of drugs, Statins could effectively treat this
second silent killer that is the 'bad cholesterol '. From 1994, triptans could
relieve migraine sufferers-only migrainous can understand what it means. In
1998, a antibody obtained by genetic engineering to effectively address the
pain and disability caused by rheumatoid arthritis. In 2001 appeared Gleevec,
first anticancer targeted drug, which acts directly on the proteins altered in
some cancers (and not killing the cells in a quasi-indifferenciate manner);
This was the first of the kinase inhibitors, a class in continuous expansion ;
there will be no "magic bullets" against cancer, but more and more
drugs tailored to each type of cancer - it comes out almost every year. New
antidiabetic agents (a disease in expansion and still badly treated), the
gliptines, appeared in 2006. And progress continues ; for example, new treatments,
simple small chemical molecules have appeared against the terrible cystic
fibrosis...
I am rather proud to work in
pharmaceutical research, in an industry that saves, heals, improves the lives
of humans. And yes, there should be aggressive, wise, encouraging policy for
therapeutic progress in Europe to ensure there will still be in next future a
pharmaceutical industry in France and Europe ; otherwise we will have to buy new
expensive drugs elsewhere, or do without.
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