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Mobic triumphs in Vioxx' wake

In the six months following the jolted 2004 withdrawal of Merck's COX-2 inhibitor, Vioxx, Boehringer Ingelheim grabbed the chance to push its product, Mobic

In the six months following the jolted 2004 withdrawal of Merck's COX-2 inhibitor, Vioxx, Boehringer Ingelheim grabbed the chance to push its product, Mobic, which boomed by 136 per cent as doctors sought to replace prescriptions for patients with arthritis, according to a new report from the Consumers Union, Best buy drugs.

The report, which looks at the US market exclusively, notes that not only did sales of Mobic and other Vioxx-alternatives soar, but so did their prices. Compared with the average 2.4 per cent price increase for all non-steroidal anti-inflammatory drugs (NSAIDs) in the post-Vioxx six-month period, Mobic's price leapt by 9 per cent - more than 3.5 times the average.

Author of the report Steven Findlay, who based his analysis on data from healthcare information company NDCHealth, noted that between September 2004 (Vioxx withdrawal) and March 2005, the average monthly retail price for Mobic 7.5mg rose 6.7 per cent (from $104 to $111) and by 10.6 per cent (from $142 to $157) for the 15mg dose.

Yet, despite the increases, and when there are a number of much cheaper generic products available (ibuprofen, naproxen and salsalate all cost $50 a month or less), prescriptions for Mobic continued to boom. This was in part driven by extra safety warnings released from the FDA regarding other Vioxx-alternatives Bextra and Celebrex (Pfizer).

However, the Consumers Union puts the main driver as marketing efforts: `The analysis reinforced the impact drug company marketing can have on physician prescribing and consumer drug preferences, especially at a time when consumers are confused and need to quickly find an alternative drug they can trust,' the report stated.

It points to the efforts undertaken by Mobic's promoters in the US, including a direct-to-consumer (DTC) campaign through which concerned patients and prior Vioxx-users were invited to ask their GP about Mobic - a relatively new and expensive product that as yet is unchallenged by generic copies.

Some of the high-profile DTC ads for Mobic, published in leading newspapers, contained free coupons that enabled patients to receive supplies of the drug free of any charges for a limited period.

ìMobic's sharp rise illustrates one of the persistent problems we have in constraining prescription drug costs - the powerful impact of drug advertising and marketing,î Findlay commented. ìDoctors and consumers are unquestionably swayed by the ads and promotions for costly new medicines, even when lower-cost options that are just as effective, are available.î

UK patient access

Separately in the UK, a row has flared up over patient accessibility to effective arthritis drugs, with many doctors in rheumatology units unable to afford the high prices of anti-tumour necrosis factor alpha (anti-TNFa) - a product that could offer ìhope and reliefî for many patients.

Even given that the National Institute for Health and Clinical Excellence (NICE) issued guidance in 2002 that anti-TNFa should be made available on the NHS across England and Wales, an estimated 1,700 patients who could benefit still have no access to the drug.

Of 148 rheumatology units in the UK, at least 45 (31 per cent) are unable to ensure that all patients who qualify for treatment of arthritis with anti-TNFa receive the medicine with more than half these units citing prohibitively high costs as the reason.

Some have also highlighted a patchy `postcode prescribing' problem.

Professor David Isenberg, a rheumatologist and president of the British Society for Rheumatology, said it was ìvery disappointingî. ìThe Department of Health should remind health trusts [that] they need to take urgent and immediate action to ensure people get the treatment they are entitled to.î

Some of the inflammatory arthritis-related conditions that could be treated with anti-TNFa are not yet covered by NICE guidance; these include ankylosing spondylitis and psoriatic arthritis. NICE is currently developing guidance for these conditions, however the DoH asserted that a lack of official advice should not prevent patients being administered the drugs for which they are eligible.

ìThe DoH has also made it clear that primary care trusts cannot refuse to fund a drug on the grounds that there is no NICE appraisal for it.î

30th September 2008

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