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Maksabedian Hernandez EJ, Graf M, Portelli A, Shafrin J. Estimating the impact of biosimilar entry on prices and expenditures in rheumatoid arthritis: a case study of targeted immune modulators. J Med Econ 2022; 25:1118-1126. [PMID: 35965481 DOI: 10.1080/13696998.2022.2113252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To model changes in prices, utilization, and expenditures of targeted immune modulators (TIMs) for rheumatoid arthritis, accounting for biosimilar entry. METHODS Using IQVIA National Sales Perspective data between 2013 and 2019, we examined sales and expenditures of biologics and non-biological complex molecules, 20 quarters before and after patent exclusivity milestones. We estimated the impact of a molecule's exclusivity milestones and biosimilar entry on prices, using a regression discontinuity design (RDD). We then combined the RDD estimate with historical trends to assess the impact of adalimumab's exclusivity milestones on future TIM expenditures. RESULTS Changes in average molecule prices were associated largely with biosimilar uptake. For molecules with relatively high biosimilar uptake (>60%), prices fell considerably (-21.2% to -59.3%) one year after exclusivity milestones, whereas molecules with lower biosimilar uptake (<10%) experienced smaller price decreases (-2.4% to -8.4%). Average price reduction at the molecule level after biosimilar entry was not significant (-18.6%; p = .657). When applying the RDD results after adalimumab's exclusivity milestones, its projected share of total TIM market expenditures decreased from 48.0% in 2019 to 26.0% in 2025, whereas expenditures on Janus kinase inhibitors increased from 4.0% to 34.0%. CONCLUSIONS Biologics facing biosimilar competition may experience price decreases, potentially offering substantial savings to payers, patients, and society, although the magnitude of these estimates depends on biosimilar uptake. Formulary placement, along with manufacturer-payer dynamics, may also play a role in determining the impact on price and market uptake of biosimilars.
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Salman A, Salman MA, Ismaeel Saadawy AM, Tourky M, Shawkat M. Portal venous hemodynamics as predictors for the development and grades of esophageal varices in
Post‐HCV
cirrhotic patients: An Egyptian center study. ADVANCES IN DIGESTIVE MEDICINE 2021. [DOI: 10.1002/aid2.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ahmed Salman
- Internal Medicine Department, Faculty of Medicine Cairo University Cairo Egypt
| | - Mohamed A. Salman
- General Surgery Department, Faculty of Medicine Cairo University Cairo Egypt
| | | | - Mohamed Tourky
- General Surgery Department Omm Elmisrien General Hospital Cairo Egypt
| | - Mohamed Shawkat
- Internal Medicine Department, Faculty of Medicine Minia University Minia Egypt
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Han J, Lee HW, Jin Y, Khadka DB, Yang S, Li X, Kim M, Cho WJ. Molecular design, synthesis, and biological evaluation of bisamide derivatives as cyclophilin A inhibitors for HCV treatment. Eur J Med Chem 2020; 188:112031. [PMID: 31923861 DOI: 10.1016/j.ejmech.2019.112031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/20/2019] [Accepted: 12/31/2019] [Indexed: 12/25/2022]
Abstract
Hepatitis C virus (HCV) is a major cause of end-stage liver diseases. Direct-acting antivirals (DAAs), including inhibitors of nonstructural proteins (NS3/4A protease, NS5A, and NS5B polymerase), represent key components of anti-HCV treatment. However, some DAAs are associated with increased drug resistance and undesired side effects. Previous reports have shown that bisamides could be a novel class of cyclophilin A (CypA) inhibitors for treating HCV as a member of combinational therapies. To fully elucidate structure-activity relationships of bisamide derivatives and find a better hit compound with diverse binding modes, 16 biamides were designed with the help of docking program. They were then synthesized using one-pot four-component Ugi reaction. 7e with selectivity index of more than 18.9 (50% effective concentration of 5.3 μM, but no cytotoxicity at 100 μM) and unique binding mode that could be dived into gatekeeper pocket was selected as a new hit compound. Surface plasmon resonance experiments revealed that 7e is able to bind to CypA with a KD of 3.66 μM. Taken together, these results suggest that 7e as a CypA inhibitor could be used as an alternative anti-HCV agent in combinational therapy in the future.
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Affiliation(s)
- Jinhe Han
- College of Pharmacy, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Hye Won Lee
- Virus Research Group, Therapeutics and Biotechnology Division, Korea Research Institute of Chemical Technology, Daejeon, 34114, Republic of Korea
| | - Yifeng Jin
- College of Pharmacy, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Daulat B Khadka
- College of Pharmacy, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Suhui Yang
- College of Pharmacy, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Xiaoli Li
- College of Pharmacy, Chonnam National University, Gwangju, 61186, Republic of Korea
| | - Meehyein Kim
- Virus Research Group, Therapeutics and Biotechnology Division, Korea Research Institute of Chemical Technology, Daejeon, 34114, Republic of Korea.
| | - Won-Jea Cho
- College of Pharmacy, Chonnam National University, Gwangju, 61186, Republic of Korea.
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Li DK, Ren Y, Fierer DS, Rutledge S, Shaikh OS, Lo Re V, Simon T, Abou-Samra AB, Chung RT, Butt AA. The short-term incidence of hepatocellular carcinoma is not increased after hepatitis C treatment with direct-acting antivirals: An ERCHIVES study. Hepatology 2018; 67:2244-2253. [PMID: 29205416 DOI: 10.1002/hep.29707] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/12/2017] [Accepted: 11/20/2017] [Indexed: 12/12/2022]
Abstract
UNLABELLED Recent studies have reported higher rates of hepatocellular carcinoma (HCC) in individuals treated with direct-acting antivirals (DAAs). However, making definitive conclusions has been challenging because of the heterogeneous populations and methodologies of these reports. We investigated whether DAA use is associated with higher rates of incident HCC compared to treatment with interferon (IFN)-based regimens. We performed a retrospective, population-based cohort study using the Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES) database. In a cohort of 17,836 persons, sustained virological response (SVR) was achieved by 66.6% and 96.2% of the IFN and DAA groups, respectively. Among all treated persons, risk of HCC was not higher in the DAA group compared to the IFN group (hazard ratio, 1.07; 95% confidence interval, 0.55, 2.08). Among persons with cirrhosis who achieved SVR, neither the HCC incidence rate nor HCC-free survival were significantly different in the DAA group compared to the IFN group (21.2 vs. 22.8 per 1,000 person-years; P = 0.78 and log-rank P = 0.17, respectively). Untreated persons with cirrhosis had a significantly higher HCC incidence rate (45.3 per 1,000 person-years) compared to those treated with either IFN or DAAs (P = 0.03). Both groups of treated persons had significantly lower probability of HCC development compared to untreated persons (log-rank, P = 0.0004). CONCLUSION DAA treatment is not associated with a higher risk of HCC in persons with cirrhosis with chronic HCV infection in the short term. Previously reported higher rates of HCC associated with DAA treatment may be explained by both the presence of relatively fewer baseline HCC risk factors in persons treated with IFN as well as selection bias, given that DAA regimens were used to treat persons at higher risk for developing HCC. (Hepatology 2018;67:2244-2253).
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Affiliation(s)
- Darrick K Li
- Department of Medicine, Massachusetts General Hospital, Boston, MA.,Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Yanjie Ren
- VA Pittsburgh Healthcare System, Pittsburgh, PA
| | - Daniel S Fierer
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Vincent Lo Re
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Tracey Simon
- Department of Medicine, Massachusetts General Hospital, Boston, MA.,Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Abdul-Badi Abou-Samra
- Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar and New York, NY
| | - Raymond T Chung
- Department of Medicine, Massachusetts General Hospital, Boston, MA.,Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Adeel A Butt
- VA Pittsburgh Healthcare System, Pittsburgh, PA.,Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar and New York, NY
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Schumock GT, Stubbings J, Wiest MD, Li EC, Suda KJ, Matusiak LM, Hunkler RJ, Vermeulen LC. National trends in prescription drug expenditures and projections for 2018. Am J Health Syst Pharm 2018; 75:1023-1038. [PMID: 29748254 DOI: 10.2146/ajhp180138] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2018 in nonfederal hospitals, clinics, and overall (all sectors). METHODS Drug expenditure data through calendar year 2017 were obtained from the IQVIA (formerly QuintilesIMS) National Sales Perspectives database and analyzed. New drug approvals, patent expirations, and other factors that may influence drug spending in hospitals and clinics in 2018 were also reviewed. Expenditure projections for 2018 for nonfederal hospitals, clinics, and overall (all sectors) were made based on a combination of quantitative analyses and expert opinion. RESULTS Total U.S. prescription sales in the 2017 calendar year were $455.9 billion, a 1.7% increase compared with 2016. The top drug based on expenditures was adalimumab ($17.1 billion), followed by insulin glargine and etanercept. Prescription expenditures in nonfederal hospitals totaled $34.2 billion, a 0.7% decrease in 2017 compared with 2016. Expenditures in clinics increased 10.9%, to a total of $70.8 billion. The decrease in spending in nonfederal hospitals was driven by lower utilization. The top 25 drugs by expenditures in nonfederal hospitals and clinics were dominated by specialty drugs. CONCLUSION We project a 3.0-5.0% increase in total drug expenditures across all settings, a 11.0-13.0% increase in clinics, and a 0.0-2.0% increase in hospital drug spending in 2018. Health-system pharmacy leaders should carefully examine their own local drug utilization patterns to determine their own organization's anticipated spending in 2018.
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Affiliation(s)
- Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL.
| | - JoAnn Stubbings
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Michelle D Wiest
- UC Health, Cincinnati, OH, and James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH
| | - Edward C Li
- Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME
| | - Katie J Suda
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | | | | | - Lee C Vermeulen
- University of Kentucky College of Medicine, Lexington, KY, and UK HealthCare, Lexington, KY
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Schumock GT, Li EC, Wiest MD, Suda KJ, Stubbings J, Matusiak LM, Hunkler RJ, Vermeulen LC. National trends in prescription drug expenditures and projections for 2017. Am J Health Syst Pharm 2017; 74:1158-1173. [PMID: 28533252 DOI: 10.2146/ajhp170164] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Historical trends and factors likely to influence future pharmaceutical expenditures are discussed, and projections are made for drug spending in 2017 in nonfederal hospitals, clinics, and overall (all sectors). METHODS Drug expenditure data through calendar year 2016 were obtained from the QuintilesIMS National Sales Perspectives database and analyzed. Other factors that may influence drug spending in hospitals and clinics in 2017, including new drug approvals and patent expirations, were also reviewed. Expenditure projections for 2017 for nonfederal hospitals, clinics, and overall (all sectors) were made based on a combination of quantitative analyses and expert opinion. RESULTS Total U.S. prescription sales in the 2016 calendar year were $448.2 billion, a 5.8% increase compared with 2015. More than half of the increase resulted from price hikes of existing drugs. Adalimumab was the top drug overall in 2016 expenditures ($13.6 billion); in clinics and nonfederal hospitals, infliximab was the top drug. Prescription expenditures in clinics and nonfederal hospitals totaled $63.7 billion (an 11.9% increase from 2015) and $34.5 billion (a 3.3% increase from 2015), respectively. In nonfederal hospitals and clinics, growth in spending was driven primarily by price increases of existing drugs and increased volume, respectively. CONCLUSION We project a 6.0-8.0% increase in total drug expenditures across all settings, an 11.0-13.0% increase in clinics, and a 3.0-5.0% increase in hospital drug spending in 2017. Health-system pharmacy leaders should carefully examine their own local drug utilization patterns to determine their own organization's anticipated spending in 2017.
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Affiliation(s)
- Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Edward C Li
- Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, ME
| | - Michelle D Wiest
- UC Health, Cincinnati, OH, and James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH
| | - Katie J Suda
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - JoAnn Stubbings
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | | | | | - Lee C Vermeulen
- University of Kentucky College of Medicine, Center for Health Services Research, Lexington, KY
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Schumock GT, Vermeulen LC. The Rising Cost of Prescription Drugs: Causes and Solutions. Pharmacotherapy 2016; 37:9-11. [DOI: 10.1002/phar.1873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Glen T. Schumock
- Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Lee C. Vermeulen
- University of Kentucky; Center for Health Services Research; College of Medicine; Lexington Kentucky
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