It is wonderful to see some momentum behind the off-label use of DMTs for treating MS. Since the Swedish experience with rituximab was published a few weeks ago the position paper on reducing the cost of MS treatments below came to my attention with an accompanying blog post, ‘Stand-up for Rituximab‘.
- Azathioprine*
- Cladribine
- Cyclophosphamide*
- Fludarabine*
- Leflunomide
- Methotrexate*
- Mitoxantrone
- Rituximab*
- HSCT/BMT
Excerpts:
…… The unaffordability of MS medications is driven by the outrageous prices that are in no way tied to the benefits these medications provide….
Kister & Corboy. Reducing costs while enhancing quality of care in MS. Neurology October 11, 2016 vol. 87 no. 15 1617-1622
The rapid escalation in prices of disease-modifying therapies (DMTs) for multiple sclerosis (MS) over the past decade has resulted in a dramatic overall increase in the costs of MS-related care. In this article, we outline various approaches whereby neurologists can contribute to responsible cost containment while maintaining, and even enhancing, the quality of MS care. The premise of the article is that clinicians are uniquely positioned to introduce innovative management strategies that are both medically sound and cost-efficient. We describe our “top 5” recommendations, including strategies for customizing relapse treatment; developing alternative dosing schedules for Food and Drug Administration–approved MS DMTs; using off-label therapies for relapse suppression; and limiting the use of DMTs to those who clearly fulfill diagnostic criteria, and who might benefit from continued use over time. These suggestions are well-grounded in the literature and our personal experience, but are not always supported with rigorous Class I evidence as yet. We advocate for neurologists to take a greater role in shaping clinical research agendas and helping to establish cost-effective approaches on a firm empiric basis.
Oct 18, 2014 … “In response to some of the comments yesterday I have to stand up for people living with MS in South Africa and defend their right to treatment.
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4 days ago … The study below summarises the off–label experience of using rituximab to treat both relapsing and progressive forms of MS in Sweden.
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Sep 5, 2016 … HSCT-BMT had been added to our essential unlicensed treatments list # PoliticalSpeak #MSBlog #OffLabel. An important issue we, and others, …
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Jun 18, 2015 … Therefore we are in a Catch-22 situation at present with regard to the use ofoff– label rituximab for treating MS in the NHS. This is great pity as it …
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Oct 18, 2016 … #ClinicSpeak & #OffLabel: alemtuzumab between a rock and a hard place … that 3rd, and subsequent courses, of alemtuzumab are off–label?
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Jan 14, 2016 … BartsMS Off–label Cladribine use Information Sheet. For those Health Care professionals and People with MS who may be interested. We have …
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Apr 15, 2015 … “After last week’s post on off–label prescribing, I contacted our health policy unit about formally addressing this issue in the UK with the aim of …
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Dec 30, 2015 … “A part of the solution we have been promoting the use of off–label, cheaper, alternative DMTs to treat MS. The following is our Barts-MS …
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Dec 16, 2014 … Off–label rituximab as an add-on therapy in patients with breakthrough disease on first-line agents was associated with an 88% reduction when …
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Apr 15, 2016 … The use of off–label drugs to treat MS in resource-rich environments remains a hot potato. Despite been given the green-light to do so by our …
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Jul 26, 2016 … “Let’s hope the rituximab data is good enough for NHS England to adopt off–label prescribing in MS; at present they won’t. At last, we will know …
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Jan 27, 2016 … The issues in the disease areas discussed in this piece dovetail to some extent with our off–label prescribing initiative and the Barts-MS …
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Do you think we are too 'under the thumb' of pharma?Could we make more intelligent choices? What would you do for co-morbid MS and rheumatoid arthritis?
Re: "Do you think we are too 'under the thumb' of pharma?"Possibly, but we have created the beast. We can't develop drugs without them. It is too expensive and risky to do this under models. It is not them or us. We need to view it as a partnership.
Are you dumping your cladribine programme?
NO
Re: "Are you dumping your cladribine programme?"No there is a lot of activity on this front; DrK is leading on it. We want to do comparative efficacy trials in resource-poor settings and we want to do a trial of cladribine in more advanced MS including pwMS in wheelchairs.