The dangers of mass drug brand switches

So this is a subject that you no doubt will see featured heavily on this site, as after all, it was my forced switch from Humira to Imraldi and the months of poor health that followed, that inspired me to start this blog – see blog post ‘The inception’ (https://joelvsarthritis.co.uk/2019/11/07/example-post/).

I came across this article today from Guyon Espiner of Radio New Zealand:

https://www.rnz.co.nz/news/national/403116/three-deaths-following-epilepsy-drug-brand-switch

It’s a story about how at least three people in New Zealand with epilepsy have sadly died since a drug brand switch in a bid to save $30m.

The similarities with what the NHS did with biologics are obvious and there are two questions that keep coming to mind every time I read these stories:

  • Why are healthcare provider decision makers changing the more expensive drugs or treatments that are working rather than focusing on ineffective treatments or those requiring numerous branches of secondary care/support?
  • Why is everything done with a ‘big bang’ approach rather than a phased switch, perhaps starting with those patients with less-severe varieties of a condition, those at less risk etc.

I can’t talk about the epilepsy situation in NZ as apart from reading a handful of articles on the matter, I’m not well informed enough or qualified to have an option so I will discuss this in the case of my switch from Humira to Imraldi in January of this year.

My first question is probably a simple case of money. Healthcare leaders are looking for savings and efficiencies and those big-ticket drugs are the obvious choice – but this is short sighted. For example, In my case they might have saved a few hundred pounds per injection, per patient a month but what about all my hospital and GP visits since the switch and the almost instant flare-up? The physio, increased reliance on pain relief, steroid injections, new anti inflammatories to try and stem the tide, blood tests etc. Not to mention the wider impact with significantly increased absence/time off work? Suddenly that big number they are looking to save has started to be chipped away at and I am just one patient out of thousands that experienced adverse effects, flares or a general decline in health post-switch.

The second question I have less sympathy for. I understand it’s probably a contractual matter and healthcare providers don’t want too much of an overlap when switching drugs or products to a new provider but in the case of the NHS biologics change to biosimilars, the pace of implementation of the change was frightening, borderline dangerous. For example, the announcement was made in Oct-Nov 18 and I was told I was switching in January 19, with the first injection of the new drug by February 19. From what I’ve been told by clinicians, this approach was taken for virtually everybody, the CCGs couldn’t save money quick enough. So when the problem hit, everyone suffered – GPs, walk in centres, Rheumatology Depts, physios etc. the fact that I wasn’t able to get access to physio or hydrotherapy (the two go-to approaches for years whenever I flare) for the entire 10-11mths of this issue, told me the pressure those services were under from the influx.

For the sake of safety, wider healthcare services, people’s jobs, mental wellbeing, families and livelihoods, why isn’t a phased, more considered approach insisted upon for these drug changes? Especially when finance is the key driver in these changes rather than a patient’s treatment plan or for clinical reasons?

As always, I don’t claim to have the answers, I’m simply offering an opinion from a patients viewpoint. Please let us have your comments and views or if you are a medical professional that would like to share an opinion on this subject, then we’d love to hear from you.