12 Aug 2021
AMEND Trustee Calls for End to Price Gouging
The NHS should commission the manufacturing of generic drugs for its own use to prevent a supply shortage and compete with industry. Sign the PETITION HERE.
In 2014, when AMEND were first involved in the research to determine how patients who have had both their adrenals removed should receive replacement therapy, the price of hydrocortisone was going up and up. In 2007, it cost £1.07 for a month’s supply, but by 2014, the price had gone up to over £50. This prompted a review of the use of different steroids for the treatment of adrenal insufficiency, and it became clear that there was no evidence to guide us as to what the best replacement was, and also what doses of the different drugs should be used. http://www.imperialendo.co.uk/bmjPREDeditorial2014.pdf
It was clear that whatever was used, most clinicians were using doses that were too high. Typically patients used to be on hydrocortisone 20mg in the morning and 10mg in the afternoon, or if using prednisolone, 5mg in the morning and 2.5mg in the afternoon. The team at Imperial, London, started investigating and comparing the different steroids in patients with pituitary and adrenal disease, and AMEND was involved with the NIHR (National Institute for Health Research), who were looking for “research for patient benefit”. The NIHR recognised its importance, and have funded large national studies to compare hydrocortisone with prednisolone.
In order to undertake this research, the Imperial team had to get an MHRA marketing licence to make various strengths of hydrocortisone, prednisolone and placebo, and once they had this, in addition to using the drug for the research, they also launched various strengths on the open market in 2017, causing the price to fall. http://www.imperialendo.com/price-gouging/drug-pricing
In addition, in August 2021, the 2.5mg and 5mg strengths of hydrocortisone were added to the formulary, making it much easier for everyone in the UK to have these lower strengths. http://www.imperialendo.com/price-gouging/good-news
These studies are ongoing, and to know which steroid is best, will be published when the research (which is still recruiting patients) is completed. The work so far has already shown that the correct dose of replacement if you are going to use prednisolone is 3mg or 4mg daily (5mg is too much for most people). The team are currently also applying for a licence for a single tablet of 3mg or 4mg prednisolone, although, because we are lucky enough in the UK to have 1mg tablets, the MHRA are giving this a low priority.