TB Monitor International-Drug price cuts called a glass half full
Generics needed, experts say
Drug manufacturers Eli Lilly and Jacobus Pharmaceuticals have announced they will sharply cut prices on expensive second-line drugs desperately needed by pilot programs in Russia and other countries where multidrug-resistant TB is getting out of hand.
International TB experts praise the announcements, but say the price breaks — approved for only a limited quantity of drugs — hardly resolve the issue of where to find affordable, good-quality, second-line drugs.
Lilly manufactures capreomycin, which is difficult to make, and cycloserine, which causes such unpleasant side effects that no generic drug manufacturer has been especially interested in producing it.
Jacobus, a small company in Camden, NJ, makes a reformulated version of the old anti-TB drug PAS, an archaic but still important player in the fight against highly resistant strains of TB.
If nothing else, the price cuts have bought some much-needed time, concedes Michael Kimerling, MD, MPH, medical consultant to Medecins Sans Frontieres (MSF) and assistant professor in the schools of medicine and public health at the University of Alabama in Birmingham.
"It's good news, and it's a good gesture," says Kimerling. "This goes way beyond anything the drug companies have offered before. Now that the issue is on the table, it may push the discussion of access to drugs further along."
Even so, making the drugs affordable for the short term doesn't remove the bigger obstacles, says James Orbinski, MD, head of MSF International. Moral issues aside, many logistical issues still loom large, Orbinski explains. That's because kick-starting the generic drug industry's engines has presented one Catch-22 after another, he adds.
"To set a price for these drugs, you need to specify a quantity. To specify a quantity, you need to know the capacity of various programs around the world to treat multidrug-resistant TB properly, and to do that, you need to have programs that are geared up to handle these drugs properly to reduce the prospect of abuse and the generation of more drug resistance," he says.
New resistance could form
The trouble is that so far, not a single pilot program that has applied for permission to use the discounted second-line drugs has gotten the go-ahead, Orbinski adds. Only one agency has the power to grant such permission: the World Health Organization's Green Light Committee, a panel of world-class experts created to assure that programs don't mishandle the second-line drugs and create an even bigger mess.
Problems won't end even after pilots that have applied get the thumbs-up and generic drug factory wheels begin to turn, Orbinski adds. That's because sooner or later, once second-line drugs are unleashed on a large scale, resistance will develop regardless of how carefully people use them.
"It's inevitable," he says. "It's the nature of the drug interaction that resistance develops to every antibiotic eventually."
Unless research and development get a big kick in the pants, that raises the truly ominous spectacle of the spread of strains of TB for which no cure on earth exists, Orbinski adds.
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