[Ip-health] Glaxo chief: Our drugs do not work on most patients

[Alan Story]

http://news.independent.co.uk/world/science_medical/story.jsp?story=3D47113=
9


Alan Story
Kent Law School
Canterbury UK
acs3@kent.ac.uk



Glaxo chief: Our drugs do not work on most patients
The Independent
By Steve Connor, Science Editor

08 December 2003


A senior executive with Britain's biggest drugs company has admitted that
most prescription medicines do not work on most people who take them.

Allen Roses, worldwide vice-president of genetics at GlaxoSmithKline (GSK),
said fewer than half of the patients prescribed some of the most expensive
drugs actually derived any benefit from them.

It is an open secret within the drugs industry that most of its products ar=
e
ineffective in most patients but this is the first time that such a senior
drugs boss has gone public. His comments come days after it emerged that th=
e
NHS drugs bill has soared by nearly 50 per cent in three years, rising by
=A32.3bn a year to an annual cost to the taxpayer of =A37.2bn. GSK announce=
d
last week that it had 20 or more new drugs under development that could eac=
h
earn the company up to $1bn (=A3600m) a year.

Dr Roses, an academic geneticist from Duke University in North Carolina,
spoke at a recent scientific meeting in London where he cited figures on ho=
w
well different classes of drugs work in real patients.

Drugs for Alzheimer's disease work in fewer than one in three patients,
whereas those for cancer are only effective in a quarter of patients. Drugs
for migraines, for osteoporosis, and arthritis work in about half the
patients, Dr Roses said. Most drugs work in fewer than one in two patients
mainly because the recipients carry genes that interfere in some way with
the medicine, he said.

"The vast majority of drugs - more than 90 per cent - only work in 30 or 50
per cent of the people," Dr Roses said. "I wouldn't say that most drugs
don't work. I would say that most drugs work in 30 to 50 per cent of people=
.
Drugs out there on the market work, but they don't work in everybody."

Some industry analysts said Dr Roses's comments were reminiscent of the 199=
1
gaffe by Gerald Ratner, the jewellery boss, who famously said that his high
street shops are successful because they sold "total crap". But others
believe Dr Roses deserves credit for being honest about a little-publicised
fact known to the drugs industry for many years.

"Roses is a smart guy and what he is saying will surprise the public but no=
t
his colleagues," said one industry scientist. "He is a pioneer of a new
culture within the drugs business based on using genes to test for who can
benefit from a particular drug."

Dr Roses has a formidable reputation in the field of "pharmacogenomics" -
the application of human genetics to drug development - and his comments ca=
n
be seen as an attempt to make the industry realise that its future rests on
being able to target drugs to a smaller number of patients with specific
genes.

The idea is to identify "responders" - people who benefit from the drug -
with a simple and cheap genetic test that can be used to eliminate those
non-responders who might benefit from another drug.

This goes against a marketing culture within the industry that has relied o=
n
selling as many drugs as possible to the widest number of patients - a
culture that has made GSK one of the most profitable pharmaceuticals
companies, but which has also meant that most of its drugs are at best
useless, and even possibly dangerous, for many patients.

Dr Roses said doctors treating patients routinely applied the
trial-and-error approach which says that if one drug does not work there is
always another one. "I think everybody has it in their experience that
multiple drugs have been used for their headache or multiple drugs have bee=
n
used for their backache or whatever.

"It's in their experience, but they don't quite understand why. The reason
why is because they have different susceptibilities to the effect of that
drug and that's genetic," he said.

"Neither those who pay for medical care nor patients want drugs to be
prescribed that do not benefit the recipient. Pharmacogenetics has the
promise of removing much of the uncertainty."

Response rates

Therapeutic area: drug efficacy rate in per cent

Alzheimer's: 30
Analgesics (Cox-2): 80
Asthma: 60
Cardiac Arrythmias: 60
Depression (SSRI): 62
Diabetes: 57
Hepatits C (HCV): 47
Incontinence: 40
Migraine (acute): 52
Migraine (prophylaxis)50
Oncology: 25
Rheumatoid arthritis50
Schizophrenia: 60
   8 December 2003 10:16