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The article is updated with the comments of Gerd Lärfars and Eric Gilland at 1:30 pm, Thursday, November 29th.
The way in which the NT Council should consider Ocrevus (okrelizumab) is, of course, of fundamental importance in determining whether the health sector can make extensive use of nonconforming medicines when the approved medicines are available. However, a clear position does not make the NT Council, although there are hints in the document.
"I think the recommendation is vague and hopes for a clearer message if we are going to use Ocrevus or the option not indicated on the Mabthera label in the treatment of forest diseases." This position therefore goes in the direction of no other Swedish authority has taken a clear stance on this, "said Eric Gilland, neurologist at Halland Hospital in Kungsbacka and vice president of the Swedish company ms.
Ocrevus was developed by the Roche pharmaceutical company to develop the drug against Mabthera lymphoma (rituximab). The latter has an unapproved indication to the extent that it plays a dominant role in the treatment of multiple sclerosis, but has not yet participated in the Phase 3 trials proving that Roche has behaved well with Ocrevus.
Both drugs have the same mechanism of action. However, the price of Mabthera is much lower.
The new NT Council recommendation largely addresses the role of Ocrevus in the treatment of progressive primary disease, where the drug is first with an approved indication. The NT Council's conclusion is that county councils can introduce Ocrevus as a treatment option for this more unusual and more serious variant of the disease.
However, in the case of a forest disease, a summary box at the beginning of the document contains a single sentence, which is generally recommended to the county council, namely: "choose the most cost-effective treatment among the available options in according to the needs of each patient, or according to local procedures ".
Today's Medicine has asked questions about the recommendation to NT Council President, Gerd Lärfars, by email.
You write that the recommendation applies only to progressive primary disease. Nevertheless, you have made a very general recommendation on the treatment of forest diseases that is not specifically aimed at Ocrevus, why then?
"Ocrevus got market approval for both of these indications and our assessment was that if we did not mention both indications, it would raise questions.We chose to consult MS experts in order not to put forward any treatment option for forest diseases, as several treatments may be relevant for this condition.
The fact that you do not explicitly discuss Ocrevus in the case of a forest disease can be interpreted as referring to the issue so as not to rule out the improper use of rituximab. How do you look at this interpretation?
– In the antecedents of TLV, rituximab is mentioned as a treatment option, but TLV chose not to use rituximab as a comparison option, which means that we can not evaluate this.
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