If meso does get approval and dr's do offer off label use, will...

If meso does get approval and dr's do offer off label use, will this be available to everyone for free?

No that would be logistically impossible. MSB couldn't make enough and provide enough for free.

Doctors might request access to an off label drug and find it isn't available because of demand. MSB simply may not have sufficient supply to meet off label use requests. I'm pretty sure companies that provide off label use can recoup their costs of making it but I don't have a source to back that up. What they can't do is in any way promote off label use themselves they can only respond to inquiries made of them. So Doctors would need to show quite a bit of initiative.

Or will they have to pay for? As it's quite an expensive therapy I imagine if it's not funded by the government maybe not everyone can afford it? I'm not familiar with the USA health system

I think you are right. I don't have sources to hand but your understanding is in line with mine.

Also they said they will have study centres outside of the USA so this would open up more recruitment opportunities in regions where there is not an approved therapy?

Yes, Australia and the US are mentioned but also the possibility of others - that's a fair point.

Keen to hear your thoughts

Thanks

I've actually self reported my own previous post because on a closer reading of the referenced article it had a statement contradicting what I thought it was saying.

The range of possible alternative second line therapies to steroids really does look to be quite limited.

Top of page 3 "Several agents have been added to steroidsin comparative studies but no evidence supports the use of thesein combination for aGvHD therapy." So that's the authors position in his 2020 paper.

I don't mind saying mea culpa I got something wrong. But I don't want to mislead people.
Apologies.