Pharmaceutical companies for 25 years have “imitated the basic business model of Hollywood” and have “focused on creating blockbusters,” which they “hope will appeal to masses” and “promote like mad,” according to the Times. Pharmaceutical companies must spend as much as $1 billion to promote new medications in their first two years on the market to make the products into a “mega-brand” with at least $1 billion in annual sales.

“Only now is it becoming clear that this business model couldn’t work forever,” as the strategy “had a flaw that executives have long ignored” — the approach “required extraordinary amounts of promotion at the expense of scientific creativity,” the Times reports. During the next several years, pharmaceutical companies will lose patent protection on a number of popular and profitable medications — such as the osteoporosis treatment Fosamax, manufactured by Merck, the antipsychotic Risperdal, manufactured by Johnson & Johnson, and the cholesterol medication Lipitor, manufactured by Pfizer — and the “industry’s scientists have hit a dry spell” and are “not discovering enough new drugs to replace the aging standbys,” the Times reports.

“It would be wrong to believe that this is the end of the industry’s wealth and power,” but, as some pharmaceutical companies “struggle, patients will bear the brunt,” with the prices of medications likely to “rise even faster,” according to the Times (Petersen, Los Angeles Times, 1/27).

January 28th, 2008 by Petersen with Los Angeles Times

SOURCE: Osteonecrosis and Fosamax › Pharmaceutical industry focus on ‘blockbuster’ medications

The FDA safety review of bisphosphonates, a class of drugs often used to increase bone mass in order to treat osteoporosis, was prompted after a study published last May in the New England Journal of Medicine found that patients taking these drugs had high rates of atrial fibrillation.

Bisphosphonates are used to increase bone mass and reduce fracture risk in patients with osteoporosis. They also are also used to slow bone turnover in patients with a disorder called Paget’s disease and to treat bone metastases and lower blood calcium in cancer patients. There are currently 8 bisphosphonates approved for use in the US. They are Fosamax, Reclast, Boniva, Actonel, Zometa, Aredia, Didronel and Skelid.

Research published in the May 7 issue of the New England Journal of Medicine found that bisphosphonates appeared to increase the risk of irregular heartbeats in some older women. Researchers conducting a review of a 1997 study of postmenopausal women on Fosamax found that there appeared to be 50 percent more risk of the serious heart rhythm irregularities in women who took the daily pill than among those who didn’t take it. About half of the 6,459 women took Fosamax, and 47 developed atrial fibrillation, compared to just 31 cases among the other women.

A second study published in the same issue of the New England Journal of Medicine cast doubt on another bisphosphonate, Reclast. In a study of 7,736 postmenopausal women with bone-thinning osteoporosis, the risk of a serious case of irregular heart rhythm was more than double that in the other patients.

In announcing the bisphosphonate safety review, the FDA said that it was “unclear how these data on serious atrial fibrillation should be interpreted. Therefore, FDA does not believe that healthcare providers or patients should change either their prescribing practices or their use of bisphosphonates at this time.” The agency will be seeking additional data on the possible atrial fibrillation risks associated with these drugs, and it expects the safety review of bisphosphonates to take about 12 months.

This is not the first time that the safety of Fosamax has been questioned. The drug has been linked to Osteonecrosis of the Jaw (ONJ), also known as Dead Jaw Syndrome, a condition in which the bone tissue in the jaw fails to heal after minor trauma such as a tooth extraction, causing the bone to be exposed. The exposure can eventually lead to infection and fracture and may require long-term antibiotic therapy or surgery to remove the dying bone tissue. In 2005, the Fosamax label was updated to include warnings about ONJ.

October 2nd, 2007

SOURCE: Osteonecrosis and Fosamax › Osteoporosis drugs to undergo FDA safety review