Reposted by William B. Feldman
New on FirstView: "Patent Thickets and Product Hops: Challenges and Opportunities for Legislative Reform" by @wbfeldman.bsky.social explains the strategies pharmaceutical manufacturers use to limit generic competition — and how to overcome them. #GenericDrugs
www.cambridge.org/core/journal...
www.cambridge.org/core/journal...
So, even if you are unwilling to trade environmental benefit for cost, which I definitely get, the choice will not even exist in these types of cases, which is all very frustrating!
So there will only be the expensive version of Breztri (with longer patent protection and slower generic competition).
And this will be bad for patients, much like the CFC-to-HFA transition.
And this will be bad for patients, much like the CFC-to-HFA transition.
Breztri is a good example. Will likely be the first MDI with a novel propellant in the US. AstraZeneca will pull the older version once the newer one is released for financial rather than regulatory reasons (with no ban on the horizon).
I hear you. I think keeping prices down is absolutely a priority--and sadly not where we are headed. The switch to novel propellants will be so lucrative for manufacturers and, in a some cases, there will be no lower-cost version that remains on the market.
Reposted by William B. Feldman
Key message here is that there is actually little conflict between good care and the environment. The most effective asthma care is also best for the environment.
-reduces the need to use reliever medication
-reduces the number of acute exacerbations
www.nice.org.uk/news/article... #RespEd #LungSky
-reduces the need to use reliever medication
-reduces the number of acute exacerbations
www.nice.org.uk/news/article... #RespEd #LungSky
Thanks as ever to Gregg Furie for his work and collaboration on these issues.
But one thing is clear: Only structural reform, and not individual decisions by even committed physicians, can ensure that patients with chronic respiratory disease have access to safe, effective, sustainable, and affordable therapy.
There are no easy answers here. We discuss some policy solutions in the piece.
...Loss of product exclusivity through patent expiration currently poses a much greater risk to revenue than climate related risks.” As with the last propellant transition, patients may be caught in the middle.
Here’s how AsraZeneca described the financial upside it sees: “Transitioning to new low GWP propellants as part of our Ambition Zero Carbon strategy will mitigate the financial risks posed to our MDI-based respiratory portfolio (e.g. Symbicort)…
New low carbon-inhalers are now under development, but these will be expensive and may be on-patent into the 2030s/2040s. Manufacturers earned billions from the last propellant transition (CFCs to HFAs) and could earn even more during this next round.
Many also have links to the tobacco industry; Phillip Morris International purchased an inhaler manufacturer in 2020 despite uproar by physicians.
Metered-dose inhalers are potent greenhouse gas emitters. Dry powder inhalers are better for the environment but are not suitable for all patients and not always available on formularies.
Our latest in @nejm.org on the dilemmas of treating patients with chronic lung disease.
www.nejm.org/doi/full/10....
www.nejm.org/doi/full/10....
The Moral Injury of Inhaler Prescribing | NEJM
Many inhalers that are vital for patients with asthma or COPD are associated with
societal harms that can worsen the very diseases the products are designed to treat.
How can this dilemma be resolved?
www.nejm.org
Reposted by William B. Feldman
Physicians who receive money from inhaler manufacturers prescribe more inhalers in the future. New findings from Hasan Nadeem, @wbfeldman.bsky.social &co:
pubmed.ncbi.nlm.nih.gov/39937634/
pubmed.ncbi.nlm.nih.gov/39937634/
Association Between Industry Payments and Prescription of Inhaled Medications - PubMed
Association Between Industry Payments and Prescription of Inhaled Medications
pubmed.ncbi.nlm.nih.gov
Reposted by William B. Feldman
🔎 New in JAMA IM: Avik Ray, @wbfeldman.bsky.social & colleagues assess the comparative effectiveness of diabetes drugs in COPD patients.
They find GLP-1s & SGLT-2s are associated with lower risks of moderate or severe COPD exacerbations vs. DPP-4s during follow-up: jamanetwork.com/journals/jam...
They find GLP-1s & SGLT-2s are associated with lower risks of moderate or severe COPD exacerbations vs. DPP-4s during follow-up: jamanetwork.com/journals/jam...
Reposted by William B. Feldman
United Health Group’s pharmacy benefit manager, Optum Rx, stopped covering Cole Schmidtknecht’s “life-changing” inhaler, suit alleges.
Man dies of asthma attack after inhaler cost skyrockets to more than $500
United Health Group’s pharmacy benefit manager, Optum Rx, stopped covering Cole Schmidtknecht’s ‘life-changing’ inhaler, suit alleges.
www.washingtonpost.com
Reposted by William B. Feldman
Democrats can win back some of the public’s trust by building an agenda around game-changing ideas *if* they address systemic issues like patent abuse at their root, rather than continuing to settle for legislation that is watered down and incremental at best. 1/8
🔗 www.nytimes.com/2025/02/01/o...
🔗 www.nytimes.com/2025/02/01/o...
Reposted by William B. Feldman
🚨 Just out today (online)! 🚨
Our results show that a common argument against #QALYs (based on the use of subgroup analyses) is not justified with empirical data.
With co-authors: @leah-rand.bsky.social , @wbfeldman.bsky.social, & @akesselheim.bsky.social from @portalresearch.org.
Our results show that a common argument against #QALYs (based on the use of subgroup analyses) is not justified with empirical data.
With co-authors: @leah-rand.bsky.social , @wbfeldman.bsky.social, & @akesselheim.bsky.social from @portalresearch.org.
Reposted by William B. Feldman
Treating COPD with DPI triple therapy had slightly lower exacerbation rates than with MDI triple therapy (about 7-9% lower). Better for patients, better for planet!
Mimms write up www.mims.co.uk/triple-inhal... and BMJ paper www.bmj.com/content/387/...
Mimms write up www.mims.co.uk/triple-inhal... and BMJ paper www.bmj.com/content/387/...
Triple inhalers in COPD: no outcome disadvantage with low-carbon option, study suggests
Patients using a triple combination dry powder inhaler had a slightly lower rate of COPD exacerbations than those using a high-carbon metered-dose inhaler, a retrospective study has found.
www.mims.co.uk
by Aaron S. Kesselheim — Reposted by William B. Feldman
Dry powder inhaler shows similar effectiveness and safety to metered-dose inhaler, w numerous implications including that environmentally-friendly prescribing in this case is also clinically equivalent -- led by @wbfeldman.bsky.social of @portalresearch.org in BMJ: www.bmj.com/content/387/...
Comparative effectiveness and safety of single inhaler triple therapies for chronic obstructive pulmonary disease: new user cohort study
Objective To compare the effectiveness and safety of budesonide-glycopyrrolate-formoterol, a twice daily metered dose inhaler, and fluticasone-umeclidinium-vilanterol, a once daily dry powder inhaler,...
www.bmj.com
Great to work on this piece with Samy Suissa, @akesselheim.bsky.social. Jerry Avorn, Max Russo, Sebastian Schneeweiss, and Shirley Wang. @portalresearch.org
Particularly given the added climate impact of metered-dose inhalers, health systems designing formularies and setting treatment guidelines may consider steps to increase use of fluticasone-umeclidinium-vilanterol relative to budesonide-glycopyrrolate-formoterol.
We found that budesonide-glycopyrrolate-formoterol was associated with a slightly higher incidence of moderate or severe COPD exacerbations compared to fluticasone-umeclidinium-vilanterol in patients with COPD treated in routine clinical care.
There are two single-inhaler triple therapies available in the US: one a metered-dose inhaler (budesonide-glycopyrrolate-formoterol, Breztri Aerosphere) and the other a dry powder inhaler (fluticasone-umeclidinium-vilanterol, Trelegy Ellipta).
By way of background: Metered-dose inhalers are associated with 20-times the greenhouse gas emissions as dry powder inhalers--with emissions in the US equivalent to roughly 550,000 cars on the road each year.
www.commonwealthfund.org/blog/2023/hi...
www.commonwealthfund.org/blog/2023/hi...
A Hidden Contributor to Climate Change — Asthma Inhalers
The U.S. health care system could reduce emissions from asthma inhalers and mitigate their negative impact on population health.
www.commonwealthfund.org
I'm excited to share a new study out today in @bmj.com comparing the two single-inhaler triple therapies on the US market.
Brief thread below!
www.bmj.com/content/387/...
Brief thread below!
www.bmj.com/content/387/...
Comparative effectiveness and safety of single inhaler triple therapies for chronic obstructive pulmonary disease: new user cohort study
Objective To compare the effectiveness and safety of budesonide-glycopyrrolate-formoterol, a twice daily metered dose inhaler, and fluticasone-umeclidinium-vilanterol, a once daily dry powder inhaler,...
www.bmj.com
by Aaron S. Kesselheim — Reposted by William B. Feldman
Pre-holiday PPV: Fed Circuit in Teva v Amneal follows recommendation in amicus brief written by @wbfeldman.bsky.social and Sean Tu of @portalresearch.org, affirming delisting of improper inhaler patents from OB and helping promote timely generic competition: fedcircuitblog.com/wp-content/u...
fedcircuitblog.com
We filed an amicus brief in the case to underscore the problems of device-only patent listings. More info below. @akesselheim.bsky.social @seansst5.bsky.social t5.bsky.social @portalresearch.org
www.linkedin.com/posts/willia...
www.linkedin.com/posts/willia...
William Feldman, MD, DPhil, MPH on LinkedIn: Amicus Brief in Teva vs. Amneal
On Friday, we submitted an amicus brief in Teva vs. Amneal.
Teva is suing Amneal for infringing its device-only patents on ProAir HFA (albuterol). This case…
www.linkedin.com