painweek 2013

No matter how good your pain drug is, you still need FDA, payers and prescribers on side. This fact is very much reflected as a dominant theme of the abstracts submitted for PAINWeek 2013, which kicks off today.

Endo Pharmaceuticals shows it’s refusing to lie down over FDA’s decision to allow non-abuse deterrent competition to Endo’s reformulated Opana ER (oxymorphone), although it had previously disallowed non-abuse deterrent generic competition to Purdue’s reformulated OxyContin ER (oxycodone). Endo has submitted two abstracts, one in which it compares the physicochemical properties of Opana with OxyContin and finds that “both products provided a similar physical/chemical barrier to crushing and manipulation.” and the other in which it also tests its product against generic oxymorphone and finds, unsurprisingly, that generic oxymorphone tablets “were shown to be noncrush resistant and easily manipulated to a smaller particle size. In addition, the active ingredient was more readily extracted from the generic formulation” (29,30) Chew on that, FDA!

Purdue has kept its eye squarely on the payers. The results of one Purdue study show that “opioid abuse among individuals covered by large self-insured employers imposes substantial costs on employers”. Another demonstrates that use of abuse-deterrent oxycodone ER was associated with reductions in healthcare utilization and costs. A final paper takes a swing at payers imposing access restrictions to OxyContin by suggesting that this “ may increase … total healthcare costs... without an offsetting decrease in pharmacy costs, and implementing such strategies may impose a net cost increase to payers”. It goes on to warn that “Health plans should consider such unintended consequences of such access restrictions.” (95,94,5) Is that clear, bosses? If you want to cut costs, insist on Oxycontin ER!

Pfizer simply wants to prove that prescribers prefer abuse-deterrent formulations. Its survey of pain specialists finds that there is “a high level of willingness to…incorporate abuse-deterrent formulations as a component of risk mitigation.” (62) Strange. I would have thought that was well accepted. Perhaps Pfizer is still trying to justify why it paid so much to King for Remoxy oxycodone which features Durect’s ORADUR abuse-deterrent technology.

Takeda Pharmaceuticals markets Matrifin, a fentanyl transdermal patch, so it chooses to highlight the cost of one of the common side effects of oral opioids – constipation. It finds “significantly increased inpatient, outpatient and ER costs associated with opioid induced constipation…. and quickly warns that “the economic burden of OIC should be considered when evaluating the cost-effectiveness of pain treatments.” (133). I’m sure we’re all in agreement with that sentiment.

Finally, there are two other non-pharma studies I found to be of interest. One is presented by Massachusetts General Hospital, Boston. This study reports positive effect of topical diclofenac (Pennsaid) on clinical neuropathic pain.(59) I wonder if TPM/diclo gel can be proven to do the same? The final one comes from China Medical University. Its study, using a rat model, suggests that swimming rats feel less (neuropathic) pain. That must explain why they’re said to be first to swim away from a sinking ship...(12)


http://conference.painweek.org/media/mediafile_attachments/09/649-painweek2013acceptedabstracts.pdf