Pharma Strategy Blog

Commentary on Pharma & Biotech Oncology / Hematology New Product Development

One of the most useful things I gathered, intelligence-wise, for a client project this week was from following some cancer patients stories via their their blogs.  This is social media monitoring at is best.

Why?

Autumn1

Because they tell it as it really is, no strings attached…  

What the treatment involves, the practicalities, the side effects, the tests, and everything else in between, including the weather and how the medications affect things like taste, for example. 

I learned that the 3 infusions needed for their particular protocol took seven hours.  Ouch! Imagine how tiring that would be for the patient and caregiver who was with them shepherding them around , the nursing staff monitoring it and everyone else involved?

As we go about our daily lives we forget how easy it is to take life for granted.  This sort of real information keeps us human and our feet on the ground.

The rival product in development is a pill.  You can pop it at home over breakfast while watching the morning news.  Sometimes we forget that simpler is easier but not always better, though.  

For short term treatments, remembering to take the pills is relatively easy but over the long term, compliance becomes a problem, either because you feel good and forget to take the pills or because chronic therapy can induce its own side effects and symptoms and perhaps you feel the need for a break from the relentless of it.  After all, how many of us forget (or can't be bothered) to take antibiotics in the third week of a course, let along consider daily consumption for a more chronic condition? 

Thus, I wasn't entirely surprised to see an article in the FT this week about the Novartis deal with Proteus, a company who focuses on compliance solutions:

"The company is testing technology that inserts a tiny microchip into each pill swallowed and sends a reminder to patients by text message if they fail to follow their doctors’ prescriptions."

Finanical Times

Now, that may sound a little like Big Brother is watching you and the cynical might think that companies are more interested maintaining their profits by keeping refill prescriptions on schedule, but for some serious diseases it may also affect outcomes.  In my experience, with acute conditions approximately 15-18% of patients forget to take all their pills, but this sadly rises to 25-35% with chronic therapy over time.

Another way companies can track the data from their own products is analyse the data from their Patient Assistance Programs (PAP).  One time when I was working on the industry side as a marketer, we did this and were surprised to find that even with free drug, the compliance rate was about 25% for a cancer therapy taken chronically after about 18 months or so.  We knew this would only get worse over time as patients feel better and think their cancer is in remission.  That was a sobering thought because the risk of the cancer coming back is high unless the oncogenic clone was suppressed.  It also underscores the importance of continuous patient and physician medical education; perhaps this is where patient programs through selective use of social media can be effective in reaching a wide audience.  The message is never ever take anything for granted.

Think about the impact of chronic therapies for life threatening diseases like cancer, for example.  As more companies are developing oral small molecule tyrosine kinase inhibitors (TKIs), so cancer moves from an acute condition to a chronic one.  However, with TKIs their mechanism of action is based on constantly competing with ATP to suppress the oncogenic clone and keep the disease in check.  This means that not taking the drug over time can lead to a return of the disease, new mutations and possibly even major relapse or patients becoming refractory or resistant to their therapy.  That is the last thing an oncologist wants to see.  


There are other ways to improve compliance, including Pharmacies tracking refills over time and phoning you with a friendly when you are overdue or chips in the bottle caps instead of the pills themselves.  The loose pill bottles favoured in the US actually contribute the problem.  Unless you get into an almost religious routine, it is easy to forget sometimes whether you took your daily dose or not and we haven't even considered the effect of patients deliberately self medicating less with to save money or because some side effects were bothering them.  At least the weekly or monthly blister packs common in Europe make it easier to remind oneself to take the prescription on schedule more easily.

Ultimately, though, the goal with these tools is about helping to improve patient outcomes.  This is a trend we are probably likely to be seeing more of in the future.

3 Responses to “On compliance and is Pharma listening to patients?”

  1. mariancutler

    As ‘big brother’ as the Novartis/Proteus deal appears on the surface, at least they’re trying to find solutions that impact patient-treatment management positively.
    Call it compliance, adherence or persistence (and talk to enough pharma companies and they all have different names for the same problem) in the US we do a terrible job providing sound, meaningful solutions to this serious, life-threatening problem. And, yes, I’d put not finishing all of your antibiotics as life threatening simply because if you don’t take all of your amoxicillin why would you be any better with your Gleevec?
    I long for the time when pharma factors in compliance/adherence/persistence into developing their drugs; it’ll happen, just not soon enough. It’s a simple push-pull dilemma: as much as I don’t want a disease, I don’t want to be reminded I have that disease more.
    Patients want drug holidays, they want a built in break from treatment. Let’s start trusting them to come back to therapy by accounting for day passes (so to speak). Need more proof? The single drug regiment with the best compliance/persistence rates? Birth control; and, not because the desire for proactive family planning is so great. It’s because for 7 days out of a 28-day cycle women can take a break. That drug holiday rebuilds their stamina for the upcoming 21 days. It’s a breath of air before getting back to work.
    And, speaking of birth control, and back to a note in your post … blister packs. Patients want medicine to be as simple as possible. It’s time US pharma companies adopt more blister packs and do away completely with all the SKUs they feel compelled to create. Think about all that money spent on packaging RX products/SKUs only to have them sit behind a pharmacy counter while consumers take home a non-descript, brown bottle with a laser-printed label. Waste of money, for sure but wasted opportunity for both branded and patient impact.
    .

  2. MaverickNY

    Thank you for taking the time to put some interesting thoughts together, Marian, it is appreciated.
    Drug holidays and cancer treatments don’t always go to well together though, mainly because the oncogenic clone requires constant suppression to stop the cancer cells proliferating. That said, there are some therapies such as Pfizer’s Sutent where the regimen involves 2 weeks on and a week off every 21 days but this was mainly due to tolerability issues.
    The choice between bottles and blister packs is a tough one. As a European, my instinct is to choose a blister pack if there is only one pill per day to take.
    For the commercial launch, we actually had a choice but with the treatment needing at least 4 pills a day until a single capsule could be approved later, the bottle was easier and made more sense for patients when they (and nurses) were given the choice in market research.

  3. NancyR

    I’ve talked with cancer patients who see this issue not as compliance but as priorities.
    This group of patients is frustrated by the quality of today’s cancer treatments .. after all, with some exceptions, most cancer drugs don’t help most metastatic patients for very long.
    So a “non-inferior” pill version of an existing drug (especially a drug that’s off-patent) will cost more and work about as well as the less expensive IV option.
    Their feeling is: Why don’t the R&D resources target new drugs, instead of this oncology form of “me-too” drugs?
    I understand their frustration. I know this is off-topic, but wanted to provide their perspective.

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