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Drug company money and retina drug use

A new study reveals that some eye specialists who receive money from pharmaceutical companies are more likely to use drugs promoted by those companies than similar drugs that are equally effective but less expensive. Although the data can’t confirm a cause and effect between money from industry and the prescribing habits of some physicians, researchers at Washington University School of Medicine in St. Louis report in the journal JAMA Ophthalmology that they have identified a “positive association between reported pharmaceutical payments and increased use” of drugs prescribed to treat several retinal problems.

AN ANALYSIS OF RECORDS MADE PUBLIC BY THE U.S. PHYSICIANS PAYMENTS SUNSHINE ACT, SHOWS THAT THERE IS AN ASSOCIATION BETWEEN REPORTED PAYMENTS FROM PHARMACEUTICAL COMPANIES AND THE DRUGS THAT SOME RETINA SPECIALISTS USE IN THEIR PATIENTS WHO HAVE MACULAR DEGENERATION AND OTHER RETINAL DISEASES. OPHTHALMOLOGY RESEARCHERS AT WASHINGTON UNIVERSITY SCHOOL OF MEDICINE IN ST. LOUIS IDENTIFIED THAT ASSOCIATION CRUNCHING NUMBERS FROM 2013, THE MOST RECENT YEAR FOR WHICH THE INFORMATION IS AVAILABLE. JIM DRYDEN HAS MORE…

THE ABILITY TO ASSOCIATE PAYMENTS FROM PHARMACEUTICAL COMPANIES WITH THE DRUGS THAT DOCTORS ACTUALLY PRESCRIBE PROVIDED RESEARCHERS WITH AN OPPORTUNITY TO LOOK FOR CONNECTIONS. THE RESEARCH TEAM MAKES IT CLEAR THAT THEY CAN’T IDENTIFY A CAUSE-AND-EFFECT RELATIONSHIP BETWEEN DRUG COMPANY PAYMENTS AND THE RETINAL THERAPIES SOME DOCTORS USE, BUT THEY DO FIND AN ASSOCIATION. WASHINGTON UNIVERSITY RETINA SPECIALIST RAJ APTE SAYS HISTORICALLY, DOCTORS LIKE HIM HAD ONE DRUG THAT WORKED PRETTY WELL, KNOWN AS AN ANTI-VEGF AGENT, THAT THEY COULD INJECT TO TREAT SEVERAL RETINAL DISEASES. APTE SAYS ALTHOUGH IT WORKED WELL, IT WAS NOT FDA-APPROVED FOR USE IN THE EYE. THEN, A FEW YEARS LATER, TWO OTHER DRUGS WERE INTRODUCED, AND THOSE MEDICATIONS DID GET FDA APPROVAL. ALL THREE DRUGS ARE ABOUT EQUALLY EFFECTIVE, BUT WHEN THE LATTER TWO CAME TO THE MARKET, THEY WERE HEAVILY PROMOTED. APTE SAYS THAT HISTORY ALLOWED HIS TEAM TO LOOK AT A UNIQUE INTERACTION.

(act) :15 o/c conditions, off-label

The utilization of medications that are approved by the FDA and

promoted by industry, versus a medication that is not approved

by the FDA but also used extensively for the same conditions,

off-label.

APTE’S TEAM FOUND THAT THE TWO NEWER, FDA-APPROVED DRUGS, CALLED RANIBIZUMAB AND AFLIBERCEPT, WERE USED MORE OFTEN BY DOCTORS WHO GOT PAYMENTS FROM THE DRUG COMPANIES THAN THE OLDER DRUG, BEVACIZUMAB.

(act) :15 o/c not promoted

What we found was a positive association between payments from

pharmaceutical companies and usage of the two promoted medications,

which also happen to be FDA-approved, compared to the medication,

bevacizumab, that’s not FDA-approved and not promoted.

APTE’S TEAM ALSO FOUND THAT THE DRUG COMPANIES DIDN’T HAVE TO PAY OUT VERY MUCH.

(act) :19 o/c the association

And this is not just us. It’s been shown before, in other studies,

that it’s not the dollar amount. It’s really the interaction

between the provider and the industry that influenced it. There

was an increase, but it really was the fact that there was an

interaction that would influence the association.

THE STUDY DOES NOTE THAT THE NEWER, PROMOTED DRUGS COST OVER $1900 PER DOSE, WHILE THE OLDER, OFF-LABEL DRUG COSTS ABOUT $60 PER DOSE, BUT APTE SAYS IT ISN’T POSSIBLE WITH THESE NUMBERS TO IDENTIFY A CAUSE-AND- EFFECT RELATIONSHIP BETWEEN PAYMENTS AND USE OF THE DRUGS.

(act) :28 o/c good start

And I think as we start collecting data, five and 10 years from

now, you know this is going to become more clear, and we’ll get

more sophisticated metrics and an understanding of what this means.

And so, I’m really not willing to make any conclusions about causality

because I just don’t know if our data truly says that. If five years

from now, you know, more robust data shows us that, then we would

be able to say something. But I think right now, this is a good start.

APTE’S TEAM REPORTS ITS FINDINGS IN THE JOURNAL JAMA OPHTHALMOLOGY. I’M JIM DRYDEN…

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