US drug firm fights Dutch docs over costly most cancers drug

• 

  Judith Pennarts

  Nieuwsuur investigative editorial group

• Sander Zurhake

  healthcare editor

Medical doctors who attempt to spend much less cash on costly medicines in a wise manner go up towards pharmaceutical corporations. That is evident from analysis by fellow analysis editorial employees at NOS and Information hour.

Medical doctors routinely give decrease doses of most cancers medication, whereas sustaining effectiveness for the affected person. That might save tens of millions of euros yearly. The pharmaceutical firm MSD is accusing docs of “testing susceptible sufferers”. The foyer group for pharmaceutical corporations (VIG) believes that controlling drug prices has gone too far.

New most cancers medication are very costly, and the effectiveness of those medication is usually unclear. Partly because of this, docs give usually a decrease dose. This has fewer unwanted effects and is cheaper too.

Take, for instance, immunotherapy Keytruda, the best-selling drug on this planet. Gross sales of MSD medication have grown quickly: 25 billion {dollars} in 2023 and greater than 250 million euros within the Netherlands. Medical doctors use this immunotherapy for 9 several types of metastatic most cancers.

There is no such thing as a doubt that this remedy is profitable in some sufferers, however the dosage degree is efficient. MSD now prescribes customary dosing. However in response to docs and pharmacists, that dosage is typically too excessive and might result in unwanted effects.

So Michel van den Heuvel, professor of lung oncology on the Radboud college medical middle, began a research in 2020 to research two facets: wherein the affected person makes the drug and what dose it stays efficient, to scale back each prices and unwanted effects.

The Treatmeds basis, which funds efficacy research on behalf of well being insurers, funded this analysis, which MSD didn’t need, says Van den Heuvel. The pharmaceutical firm requested for clarification by letter. “That they had large issues with the assertion that we may safely decrease the dose,” Van den Heuvel stated. It could be harmful for sufferers.

MSD then had a heated debate with the hospital’s administration, says Van den Heuvel. “We couldn’t escape from the concept monetary pursuits performed an vital position. Should you scale back the dosage by 25 % or extra, this may have an effect on income. It is extremely related to billions.”

Based on Treatmeds director Jeroen Nugteren, pharmaceutical corporations usually are not taken with value discount research. “That’s not instantly in the very best pursuits of the shareholders of the pharmaceutical corporations.”

Ultimately, MSD couldn’t object as a result of the analysis had already been authorised by an impartial medical ethics committee.

Individually from this analysis, the skilled affiliation of medical oncologists (NVMO) issued an advisory in 2021. Primarily based on new scientific insights, the affiliation advisable decrease Keytruda doses to docs.

MSD wrote one other one pressing letter, this time to the umbrella group Well being Insurers Netherlands. Within the piece, within the fingers of the analysis editor, the pharmaceutical firm writes that oncologists are “making an attempt to deal with susceptible sufferers within the discipline” and that “there is no such thing as a scientific proof based mostly on analysis on “randomization” that justifies decrease doses. Well being insurers and oncologists noticed no cause within the letter to vary the recommendation.

“Randomized analysis or comparative analysis with the identical analysis methodology shouldn’t be at all times mandatory,” says Gabe Sonke, an interventional oncologist at Antoni van Leeuwenhoek and a pioneer within the discipline of effectiveness research.

“Measuring within the blood whether or not a decrease dose has the identical impact as the unique dose may be scientifically sound. This has been properly studied. As an expert physique, we consider this can be a good and protected manner for the to provide these medication.”

Thirty hospitals now administer decrease doses safely, with fewer unwanted effects, less expensive and scientifically confirmed, in response to the skilled associations concerned.

However MSD nonetheless considers the strategy “experimental”. In response, the skilled associations of medical oncologists, pulmonologists and hospital pharmacists say that “we reject this proposal and that additionally it is unfounded”.

The associations level to an earlier MSD package deal label: “On this, the pharmaceutical firm initially suggested the dosage of Keytruda at 2 milligrams per kilogram of physique weight. a affected person weighing 100 kilograms doesn’t imply that the earlier recommendation was “experimental” reactive.

MSD emphasizes that “value financial savings shouldn’t be a cause to take a threat for affected person well being.”