Oh, the Prices we Pay ... for Questionable Drug Marketing to Enrich Corporate Insiders - the Case of Questcor's H P Acthar Revisited
In 2007, we first discussed the case of the amazing pricing of H P Acthar, a very old drug of questionable usefulness, as an example of the irrationality of health care prices in the US, and of the failure of the organizations that ought to resist outrageous pricing in our mixed, pseudo-market based health care system to do so. A recent New York Times article has updated this case.BackgroundAs we wrote in 2007, ACTH (adrenocorticotrophic hormone) is a naturally occurring hormone that stimulates the activity of the adrenal gland, which produces cortisol and other glucocorticoid and mineralocorticoid hormones. ACTH produced from pigs' adrenals was first marketed as a biologic agent in the 1940s. It was used for some conditions that appear to benefit from the effects of increasing cortisol production induced by ACTH.It has been traditionally used to treat infantile spasms, a rare but distressing condition, and exacerbations of multiple sclerosis (MS). However, since the drug was introduced so long ago, it was never subject to rigorous controlled trials to assess its efficacy and adverse effects for these indications. Furthermore, since the 1940s, synthetic glucocorticoid hormones have become widely available as generic drugs. Yet these slightly newer drugs have never been rigorously compared to ACTH for infantile spasms or MS. The most recent review (edited in 2009) by the Cochrane Collaboration found that steroids and ACTH have so...
Publication date: Available online 31 May 2020Source: Neurología (English Edition)Author(s): F. Castillo-Álvarez, P. Pérez-Matute, J.A. Oteo, M.E. Marzo-Sola
The most commonly invoked rationale for giving steroids in patients with severe COVID-19 is to modulate the destructive inflammatory immune response that occurs with advancing disease.Medscape Medical News
Findings on neuroimaging suggest that for patients with progressive multiple sclerosis, constraint-induced movement therapy leads to changes in white and gray matter.Medscape Medical News
The two largest pharmacy benefit managers (PBMs), CVS Caremark and Express Scripts, have once againincreased the number of medicines on their standard formulary exclusion lists. Medicines excluded from formularies treat many chronic and complex conditions, including depression, diabetes and multiple sclerosis. As these PBMs control over half of the market combined, these changes have widespread implications for patients across the country.
We report here the case of a young girl with a very active AQP4-Ab NMOSD, with clinical worsening despite intensive immunosuppressant therapies. The use of OFA was associated to dramatic efficacy and great safety.
Conclusions: Rituximab is both safe and effective for the treatment of acquired angioedema with C1-inhibitor deficiency, ANCA-associated vasculitis, autoimmune hemolytic anemia, Behçet’s disease, bullous pemphigoid, Castleman’s disease, cryoglobulinemia, Goodpasture’s disease, IgG4-related disease, immune thrombocytopenia, juvenile idiopathic arthritis, membraneous nephropathy, relapsing-remitting multiple sclerosis, myasthenia gravis, nephrotic syndrome, neuromyelitis optica, pemphigus, rheumatoid arthritis, spondyloarthropathy, and systemic sclerosis. Conversely, rituximab failed to show an effec...
This article will examine some of the treatment challenges and the spectrum of co-existing autoimmune disease in NMOSD.
Mallinckrodt and the Federal Trade Commission (FTC) recently agreed to settle allegations of raising drug prices and engaging in anti-competitive practices by paying a $100 million fine and allowing a competitor to produce a similar medication. The drug, H.P. Acthar Gel, is used to treat infantile spasms and multiple sclerosis. Mallinckrodt allegedly raised the price of the prescription from $40 per vial to over $34,000 per vial. According to New York Attorney General Eric Schneiderman’s office, Mallinckrodt’s United States subsidiary (Questcor) purchased the drug in 2001 and raised the price an estimated 85,0...
ConclusionThe evidence suggests that RCI may improve inflammatory and autoimmune disease control and patient quality of life, particularly in complex patients, and yield healthcare cost savings that demonstrate the medicine ’s value.FundingMallinckrodt Pharmaceuticals Inc.
Conclusions Although it's a rare adverse effect and tend to show good prognosis physicians should pay careful attention to symptoms and findings of nephropathy during follow ups of patients under treatment with these agents.
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