jackiejay wrote:is this information totally reliable?....is this BMJ widely read....don't know anything about it....would doctors in Canada and U.S. read this?
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It is too early to reach any conclusion about the cost effectiveness of disease modifying treatments from this first interim analysis. Important methodological issues, including the need for additional comparator datasets, the potential bias from missing data, and the impact of the "no improvement" rule, will need to be addressed and long term follow-up of all patients is essential to secure meaningful results. Future analyses of the cohort are likely to be more informative, not least because they will be less sensitive to short term fluctuations in disability.
cheerleader wrote:Because most drug trials are funded by drug companies, the true efficacy of these drugs is often overstated.
...and found out that the drugs were worth NOTHING, since patients on them did worse than the controls.
cheerleader wrote:scorpion,Maybe not conspiracies, but the pharmaceutical companies are at the forefront of MS research as donors to the MS Societies and major universities.
Of course CCSVI can be tested. Read what Dr. Zamboni himself said - that it needs more testing.babiezuique wrote:MMCC
I'M from Canada. Here we don't ''lawsuit'' as you do in the state. We have a different medical system than yours... When a canadian is cling for a lawsuit... it is not the same song than when it is an american.
CCSVI as nothing to do with drugs.... it is a condition. That can be tested and mechanicaly treated.
We don't know each other, but this is something that anyone who knows me would double over in hysterics about. I have never been quiet about anything in my life. In fact I am about to launch a one person campaign against Biogen.babiezuique wrote:Do you seriously think that we have to be quiet like a beaten child....in front of this historical scandal?
The fact that the prices would have had to be cut to zero (given outcomes were less than those of the controls) is hardly a reason for not proceeding. If patients are to continue to receive drugs through the scheme, big price cuts seem necessary.
cheerleader wrote:The real problem is that the patients on drugs did worse than controls. That's mine and Jeff's concern, as I look at a fridge full o' copaxone.
marcstck wrote:I do think that the CRAB drugs are nothing more than a sophisticated form of symptom management, and do nothing to address the root causes of the disease. In that respect, they've taken the eyes of researchers off the real target, and focused them on the "autoimmune theory" for far too long.
Mark, as usual a very balanced and thought-out response. The fact that EDSS is "notoriously hard to measure" should not play into anything here as the measurement difficulties would exist in both cohorts (besides it could easily be argued that relapse rates are equally hard to measure and perhaps even more subjective). The size of these cohorts, as noted in the article, is unprecedented, making any systematic measurement bias highly unlikely. On top of that the EDSS scores were not just equal to the untreated population, THEY WERE SIGNIFICANTLY WORSE. I would invoke the ghost of the old lady in the Wendy's commercials of the 80's and say, "WHERE'S THE PLACEBO EFFECT!!"marcstck wrote:I've read and reread the piece in the BMJ. It's major focus is that an agreement reached between the NHS and the drug companies to revisit the price paid for the CRAB drugs once efficacy data was available was never put into action. It concludes that the price paid for the drugs is not worth the efficacy that they display. It does not state that the drugs themselves are worthless.
The article presents some contradictory evidence, stating that the control group (which were 5000 untreated Canadian patients, not their British counterparts) showed less progression than the group on the DMD's. Later in the piece, though, it states that after one year on the drugs, 38% of those using the drugs showed an improvement in their EDSS.
None of the phase 1, 2, or 3 CRAB drug trials used EDSS as an endpoint, instead using relapse rates and enhancing lesions as seen on MRI. EDSS is notoriously hard to quantify, which is why very few drugs have been tested on patients with progressive disease, who typically do not suffer relapses or enhancing lesions.
My take away from all of this is that the NHS has concluded that they overpaid for the drugs, based on the fact that the drugs were less effective than originally predicted. The scant amount of data cited in the article begs for a more thorough disclosure of the trial results, but my understanding of the piece as it stands does not lead me to conclude that the CRAB drugs can be declared entirely worthless.
They are obscenely expensive given the modest efficacy they have displayed, but the fact is that many patients have experienced fewer relapses and less enhancing lesions as a result of taking these drugs. Whether or not they impede progression has never really been ascertained.
I do think that the CRAB drugs are nothing more than a sophisticated form of symptom management, and do nothing to address the root causes of the disease. In that respect, they've taken the eyes of researchers off the real target, and focused them on the "autoimmune theory" for far too long.
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