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Feature Pharmaceuticals

Pfizer steps up battle to defend control of pregabalin

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h3119 (Published 08 June 2015) Cite this as: BMJ 2015;350:h3119
  1. Andrew Jack, editor, #FirstFT, Financial Times, London
  1. andrew.jack{at}ft.com

Pfizer’s actions over its biggest blockbuster drug sparks confusion

Pfizer has launched a charm offensive on UK doctors, after accusations of profiteering and concerns over increased paperwork for prescribers, and has taken to the courts to defend exclusive control over the main use of its valuable pain drug pregabalin.

The US pharmaceutical giant has written to the medical press to emphasise to doctors its desire to continue investing in research and development in patients’ interests, while arguing that its top selling drug should remain partly protected from competition, despite the expiry of the original patent.

Berkeley Phillips, Pfizer’s UK medical director, and Seema Patel, its medical director for established UK pharma business, apologised to doctors for confusion and said, “Our intention was neither to cause confusion, nor add to your workload.” But they insisted on the need to defend the company’s intellectual property rights.

The letter follows concern among doctors in recent weeks after they received circulars from the NHS cautioning that they should seek to prescribe pregabalin by using its brand name (Lyrica) when they prescribe the drug to treat pain.1 Pfizer had cautioned commissioning groups that to do otherwise could be “unlawful.”

The actions highlight the large financial sums at stake, unusual aspects of the patent system, and limitations in the way prescribing operates in the United Kingdom. “This is a massive case in intellectual property terms,” says one of the lawyers who is involved. “Lots of law firms are watching it. We have never had a case like it.”

Pfizer’s latest move came after the primary patent that the company held on the pregabalin molecule expired at the end of last year, spurring several manufacturers of generic drugs to launch cut price versions targeted at its indications for epilepsy and generalised anxiety disorder.

However, Pfizer continues until 2017 to hold exclusivity under a “secondary use” patent it was subsequently granted on pregabalin when the drug is prescribed for the treatment of neuropathic pain.

“Skinny labels”

Actavis and Dr Reddy’s, two generic drug manufacturers, have launched their own versions of the drug (under the brand names Lecaent and Alzain, respectively), sparking a legal riposte from Pfizer that has already gone to appeal and is scheduled for fresh hearings at the end of June.

Consilient Health has also offered its branded version (Rewisca), which requires pharmacists to order the drug from wholesalers under tight supervision. The generic manufacturers state on their websites that their product is only for the two indications that are no longer covered by patents, using a “skinny label” that does not include the pain treatment authorisation also granted on the drug by British regulators.

However, the British system, which encourages generic prescribing to maximise use of the cheapest version of drugs, offers no easy way to make a distinction between the different indications for which the drug is used.

UK and other authorities have long granted “second” or “further medical use” patents to drug companies, designed to provide financial rewards for continued research into their wider application. Drug companies argue that without such a process they would have no incentive to fund further long, costly, and uncertain research trials and regulatory approvals.

There are some precedents for skinny labels, which have allowed generic manufacturers in the past to officially sell drugs only for off-patent uses while in practice being able to benefit from sales for the small additional indications that technically remained under patent.

But no previous examples are on the scale of pregabalin. Pfizer estimates that in the UK 80% of the drug’s total prescriptions are for neuropathic pain. The income involved is substantial. The NHS last year spent nearly £250m (€340m; $380m) on Lyrica. Worldwide, the drug is the company’s most important, generating sales of $5.2bn in 2014, up substantially on previous years.

Pregabalin was originally devised by Richard Silverman, an academic at Northwestern University in Illinois, and was licensed to Parke-Davis, which later became part of Pfizer and which developed the drug for epilepsy. But the company tested other uses and says that from the late 1990s it has invested in about 50 clinical trials involving 12 000 patients to evaluate its use for neuropathic pain.

Drug industry executives argue that without the incentive of second indication patents, such research would never take place, and new drug applications would not be authorised. The alternative is that drugs are prescribed “off label,” based more on hunches than rigorous trials—allowing their use without large scale systematic testing of benefits or risks.

Not just a Lyrica issue

“This is not just a Lyrica issue, it’s an industry issue,” said Pfizer’s Phillips. “We are all for discovering new molecules, but increasingly, with our knowledge around science, mechanisms, and pathways, we will go back and test medicines in new conditions. If second patents are not protected, companies are not going to be able to invest in that sort of research, and patients will suffer.”

The industry has recently been exploring ways to improve collection of data on the use of drugs by indication. The absence of such data on prescription forms today eases doctors’ paperwork, encourages prescribing of lower cost drugs, and ensures the privacy of patients. But it makes it difficult for legitimate researchers to understand usage levels, follow how far guidance, such as that of the National Institute for Health and Care Excellence, is being followed, and to adapt pricing. A recent paper that the drug industry funded from the Office of Health Economics highlighted the scope to match prescriptions with diagnoses by combining pharmacy data with the National Institute for Health Research’s CPRD (clinical practice research datalink) database.2

Whatever the outcome of the Pfizer legal battle with its generic rivals, the case has sparked fresh debate over incentives for research and the trade-off between minimising administration while collecting information more systematically on prescription by indication.

Notes

Cite this as: BMJ 2015;350:h3119

Footnotes

  • Competing interests: I have read and understood BMJ’s policy on declaration of interests and declare the following interests: None.

  • Provenance and peer review: Commissioned; not peer reviewed.

References

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