Copaxone..value for money?

C

You know my favourite MS drug…yep you guessed it,…..it’s glatiramer acetate. This has been doing the rounds since the 1970s and was the World’s favourite MS drug. I have to say that as an EAEer I have struggled to get it to do much, except in one certain way, hence my tounge in cheek reports. I obviously don’t have the green fingers of some of my colleagues. Perhaps that’s why I don’t believe anything that comes out of their lab:-(

However, this post is genius, as it has ProfG and K sandwiched at both ends of the paper, so they know I won’t comment on this .

As you all know the Risk Sharing Scheme was a bit of a con to allow you to get access to drugs that the powers that be didn’t think were very good. So the RSS allowed access to drugs at reduced cost with the proviso that if they were found to be cost-effective could charge more, they were found cost effectivie and guess what? They charged more. Now I will let ProfG and K sing the virtue of this report. The cat has got my tonugue

Glatiramer acetate as a clinically and cost-effective treatment of relapsing multiple sclerosis over 10 years of use within the National Health Service: Final results from the UK Risk Sharing Scheme. Giovannoni G, Brex PA, Dhiraj D, Fullarton J, Freddi M, Rodgers-Gray B, Schmierer K. Mult Scler J Exp Transl Clin. 2019 Dec 5;5(4):2055217319893103. doi: 10.1177/2055217319893103. eCollection 2019 Oct-Dec

BACKGROUND: The UK Risk Sharing Scheme (RSS) provided information on the effect of first-line multiple sclerosis (MS) disease-modifying treatments on long-term disability.

OBJECTIVE: The aim is to provide results specific to glatiramer acetate (GA; Copaxone®) from the final 10-year analysis of the RSS.

METHODS: A Markov model was used to assess clinical effectiveness measured as Expanded Disability Status Scale (EDSS) progression and utility loss. Untreated patients from the British Columbia MS cohort (1980-1995) were used as a ‘virtual comparator’ group. A separate Markov model assessed cost-effectiveness, based on a 50-year time horizon (with a 50% treatment waning effect imposed at 10 years) and using NHS list price (£513.95 per 28 days). Results were expressed in quality-adjusted life years (QALYs).

RESULTS: In total, 755 patients with relapsing-remitting MS (RRMS) received GA, with a mean follow-up of 7.1 (standard deviation 1.3) years. EDSS progression was reduced by 23% (progression ratio 76.7, 95% confidence interval [CI] 69.0-84.3) and utility loss by 39% (progression ratio 61.0, 95% CI 52.7-69.3) compared with no treatment. There was no persistent waning in GA treatment effect over time (EDSS: p = 0.093; utilities: p = 0.119). The cost per QALY was £17,841.

CONCLUSION: GA had a beneficial effect on long-term disability and was a cost-effective treatment for RRMS.

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15 comments

  • Congratulations on this groundbreaking MS publication which shows Copaxone makes a difference only noticeable to the statistician crunching the numbers. How much individually were the authors paid by Teva? Massive COI?

    What a huge difference in MS patients and the taxpayer’s life this will make as it will justify a higher price tag for something that doesn’t work as a patient will worsen by 77%.

    Why only go 10 years on EDSS and what was the p value? 80% of MS patients progress to progressive phase of MS by 15 years, so why do studies not run this long as the data is obviously out there to see if Copaxone actually delays conversion of RRMS to SPMS or delays progression at this time, which I highly doubt.

    • So much for Christmas cheer, you really have a downer on us. I can rememebr when DJ hartley used to wax lyrical about flyfishing (British Telecom advert), now we get scrooge with abit of Bah humbug. Maybe we should change the name of the blog to “Daily Vent” so you can sit in your chair to have a go.

      As he often says Prof G has a “thick skin” and as for payment for paper, that’s a new one to me, but if you can get it, why not? Has Christmas come early to the two Profs. But before you start have a dig at us and about how we spend good taxpayers money, just ask yourself this, why can we not be part of a trial comparing hard and early verses the softly, softly approach? Why because we don’t have equipose, because this is not the approach we use. You know that I know that.

      • My apologies for the payment comments. It was rude and non-constructive. Although it is proven that payment by Pharma influences prescribing habits of physicians, I believe Dr. G is above this and will always do what is in best interests of the patient.

        My frustration is not with Bart’s team but with the stagnated state of research in MS, like a study justifying higher payment for the ineffective, although statistically significant, Copaxone. It is like a slow, rudderless ship to nowhere where Pharma is making insane profits off recycled, non innovative drugs from other fields while patients continue to worsen.

        I agree with you that “hit” them hard as early as possible with the most efficacious drug trial vs escalation drug therapy would be the most sane approach. Pharma already has these answers in their database to these questions if they combined their data with other Pharma co. and were really wishing to further MS research and treatments. This is clearly not the case.

    • That’s as maybe but in 2003 the choice was between copaxone and the beta interferons. I chose copaxone for its more favourable side effect profile and because I thought I’d manage injections better on a daily routine. I know it was having an effect because in the intervening weeks when I stopped it to transfer to gilenya four years ago, the MS really kicked in and I had huge cognition problems among other things. It was (according to the neuro) a fine decision on whether or not to switch, because the copaxone was doing its job. I was and am still EDSS 3.5. However I also know that lifestyle changes and physio interventions have been major factors.

      • “16 years Nice”

        Only problem is people live to 80 now.
        edss 3.5 is borderline spms…would urge you Kay to
        look into hsct on facebook…Luis F. below had it as did I.

      • “It was (according to the neuro) a fine decision on whether or not to switch, because the copaxone was doing its job.”

        Or…maybe it was doing absolutely nothing..and you just have run of the mill benign ms…which can go 15-25 years..before spms.

        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553030/

        You neuro should be sued for malpractice for having you on Copaxone instead of rituximab..ask him about hsct and see him freak.

        “However I also know that lifestyle changes and physio interventions have been major factors.”

        Your kidding yourself..pushups/diet don’t keep autoreactive b and t cells at bay…it’s illusion that you are controlling your disease..your borderline spms now and unless you do something for yourself (neuro is useless doesn’t care if you walking)..soon you might be looking at edss 5 – 6 in couple of years.

        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5221476/bin/ACN3-4-46-g001.jpg
        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5221476/

        • Mention HSCT at the time and the mortality rate was about 7 percent.
          Treatment is choice and we may not agree with people’s choices but we need to respect that. Some people chose not to become infertile from their treatment, that is a choice.

        • Anono, you come across as a very arrogant, unpleasant person with such comments. You have no right or qualification to be making predictions about someone else’s prognosis.

  • Dr. Panitch was my Doctor in 2007 when I was Undiagnosed and on my 3rd Exacerbation in 12 years. I thought he was crazy at first. After I got to know him, I grew to love and trust him. I am very picky about Doctors and I had worked with some great neurologists at University of Vermont Med Center. He asked me to be in the CombiRx study which I agreed to. The Nurse handed me 3 months of shots and said it was worth $40,000 USD. I thought, New car, pay down bills, mortgage, am I Worth It?
    I was on it until the end. Turns out I was randomized only to Copaxone even though I had a placebo flu reaction from saline weekly IM marked avonex. I had MRI’s and testing that said I was stable. I worked until a few years ago. No exacerbations since 2007. Copaxone gave me copay assistance to cover my deductible of $750 a year. Until Glatopa became available. Now the Copay assistance is gone. No grants. Same costs to insurance providers and My retirement policy supplement to Medicare Part D (another complicated system) I thought the price was supposed to go down with Generic? Now I read about what the younger MS Generation are taking and still I’m OK with the drug Dr. Panitch put me on 12 years ago. I have had a better outcome than those who’s came before me with No DMT’s. I used to take care of them. They got Admitted to the hospital and got high dose steroids periodically when MS knocked them down. I run on because it’s a long story. Each individual has a long story. I’m grateful for Any drug. The Healthcare Funding Schemes are deals made by Bureaucratica. Are they tainted? Is Research Tainted by Pharma? Was my famous Doctor Panitch tainted by Drug Manufacturers? Am I tainted by Hope and Placebo effects? So many factors. I hope you find a cure. Then the DMT wars can be ended. Then the costs of Disability Progression and lost wages, supportive care can be reduced. If Glatopa is My go to DMT, maybe the costs are still worth it. Or maybe the drug manufacturers made a great deal, leaving patients, insurance and government programs to pay more forever. Fin.

    • Thanks for your story, when I here the name of Dr. Panitch I think it is the neuro who tested gamma interferon…it appeared to make MS worse

      • “Dr. Panitch was my Doctor in 2007…I thought he was crazy at first. After I got to know him, I grew to love and trust him. I am very picky about Doctors…”

        “the name of Dr. Panitch I think it is the neuro who tested gamma interferon…it appeared to make MS worse”

        Apparently not picky enough.

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