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Access denied to essential medicines in developing world
Newsdesk Immune system stimulator shows promise against tuberculosis with 19% of controls. At 3 months these figures rose to 80% and 37%, respectively. SCV-07 also had a positive effect on cavity healing and tuberculosis symptoms including fever, cough, dyspnea, chest pain, and tachycardia. No adverse effects were observed. SCV-07: Decreases positive sputum assays for Mycobacteria 90 80 70 60 50 40 30 20 10 0
Control
SCV–07 *p<0·05
* re fo t Be men at tre
r1 te h Af ont m
* r3 te hs Af ont m
Effect of SCV-07 on mycobacteria in sputum.
Andrey Simbirtsev, from Verta Ltd, explains: “Modern therapy against tuberculosis is mainly based on chemotherapy, using several drugs with different modes of antibacterial activity. These drugs don’t kill
Cynthia Tuthill
Patients with positive sputum, %
A phase 2 clinical trial in Russia shows that SCV-07, a synthetic dipeptide that stimulates immune system activity, can be effective in fighting tuberculosis in combination with standard chemotherapy. The results were presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in San Diego, California, on September 28 by researchers from SciClon Pharmaceuticals Inc, San Mateo, California and Verta Ltd, St Petersburg, Russia. SCV-07 (␥-D-glutamyl-L-tryptophan) stimulates T-lymphocyte differentiation and specific immune response, and enhances interleukin 2 and interferon ␥ production in mice. In a single-arm trial on patients with pulmonary tuberculosis, 35 patients were treated with 100 µg of SCV-07 by intramuscular injection for 5 days in addition to standard tuberculosis chemotherapy. 27 control patients received no SCV-07. After 1 month, mycobacteria-negative sputum cultures were reported in 57% of the SCV-07 treated patients compared
mycobacteria, they only block the bacterial cell cycle; bacteria must be killed by the immune system. That is why stimulation of antituberculosis immune response is important for successfully tackling mycobacteria, especially in the case of multi-drug resistant (MDR) strains that are not blocked by chemotherapy”. Cynthia Tuthill, from SciClone Pharmaceuticals Inc, said: “This compound has the potential to be used in MDR tuberculosis since it is not an antibiotic and it would be difficult for the bacterium to develop resistance to the entire immune system’s attack. SCV-07 is well suited for use in patients with concurrent infections, such as HIV/tuberculosis”. Asked about the feasibility of expanding SCV-07 use, Tuthill says: “I think this drug is well positioned to be used widely, as it has been shown to be orally available and is effective after only 5 doses . . . We intend to further investigate oral delivery and the optimum dosage regimen”. Claudia Orellana
Access denied to essential medicines in developing world The WHO has warned that, although access to essential drugs has improved remarkably since the introduction of its model list of essential drugs in 1977, one third of the world’s population still lacks access to these drugs. “The list has clearly filled a need. By the end of 1999, 156 countries had a national list of essential medicines; three-quarters of these lists had been revised in the 5 preceding years”, WHO’s director-general, Gro Harlem Brundtland, told participants of a meeting (Oct 21, Geneva, Switzerland) held to mark the 25th anniversary of the WHO Model List of Essential Medicines. However, she warned: “There is now a global cry for equitable access to essential medicines for the prevention and treatment of HIV/AIDS. This also applies for access to other essential medicines, especially those for common childhood diseases, major infectious diseases, and chronic conditions”.
According to WHO, 60% of deaths among the world’s population living in poverty are caused by diseases such as malaria and HIV/AIDS. “95% of world’s 33 million people with HIV/AIDS don’t have access to lifesaving antiretroviral treatment. They die despite the existence of treatments and preventive measures that could protect them”, Bernard Pécoul of charity Médicins Sans Frontières (MSF) added. He praised the addition of 12 antiretroviral drugs to the list recently, but warned that despite a WHO policy change that price should not be a reason for exclusion of a drug from the list, high price remained an obstacle for many new antibiotics—including cephalosporins, quinolones, and macrolides—to be included. “The list must include these and other new medicines which improve treatment effectiveness and simplify treatment protocols. When people’s lives are at
THE LANCET Infectious Diseases Vol 2 December 2002
http://infection.thelancet.com
risk, WHO and member states have an obligation to impose solutions, even if they contradict the direct interest of commercial entities”, Pécoul noted. One way to increase access to essential medicines in developing countries is to encourage generic competition, according to MSF. For example, as a result of generic competition, the price of HIV triple therapy has dropped to less than US$300 from over $10 000 in May 2002. Another option is to buy these drugs in bulk, as is done by the Delhi Society for Promotion of Rational Use of Drugs. Since 1996, the society has been buying these drugs in bulk on behalf of state hospitals. As a result, Sangeeta Sharma said, her society receives quotations at 50–80% below the prices given to others and has been able to tackle constant shortages of essential medicines in government hospitals. Khabir Ahmad
711
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Control
SCV–07 *p<0·05
* re fo t Be men at tre
r1 te h Af ont m
* r3 te hs Af ont m
Effect of SCV-07 on mycobacteria in sputum.
Andrey Simbirtsev, from Verta Ltd, explains: “Modern therapy against tuberculosis is mainly based on chemotherapy, using several drugs with different modes of antibacterial activity. These drugs don’t kill
Cynthia Tuthill
Patients with positive sputum, %
A phase 2 clinical trial in Russia shows that SCV-07, a synthetic dipeptide that stimulates immune system activity, can be effective in fighting tuberculosis in combination with standard chemotherapy. The results were presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in San Diego, California, on September 28 by researchers from SciClon Pharmaceuticals Inc, San Mateo, California and Verta Ltd, St Petersburg, Russia. SCV-07 (␥-D-glutamyl-L-tryptophan) stimulates T-lymphocyte differentiation and specific immune response, and enhances interleukin 2 and interferon ␥ production in mice. In a single-arm trial on patients with pulmonary tuberculosis, 35 patients were treated with 100 µg of SCV-07 by intramuscular injection for 5 days in addition to standard tuberculosis chemotherapy. 27 control patients received no SCV-07. After 1 month, mycobacteria-negative sputum cultures were reported in 57% of the SCV-07 treated patients compared
mycobacteria, they only block the bacterial cell cycle; bacteria must be killed by the immune system. That is why stimulation of antituberculosis immune response is important for successfully tackling mycobacteria, especially in the case of multi-drug resistant (MDR) strains that are not blocked by chemotherapy”. Cynthia Tuthill, from SciClone Pharmaceuticals Inc, said: “This compound has the potential to be used in MDR tuberculosis since it is not an antibiotic and it would be difficult for the bacterium to develop resistance to the entire immune system’s attack. SCV-07 is well suited for use in patients with concurrent infections, such as HIV/tuberculosis”. Asked about the feasibility of expanding SCV-07 use, Tuthill says: “I think this drug is well positioned to be used widely, as it has been shown to be orally available and is effective after only 5 doses . . . We intend to further investigate oral delivery and the optimum dosage regimen”. Claudia Orellana
Access denied to essential medicines in developing world The WHO has warned that, although access to essential drugs has improved remarkably since the introduction of its model list of essential drugs in 1977, one third of the world’s population still lacks access to these drugs. “The list has clearly filled a need. By the end of 1999, 156 countries had a national list of essential medicines; three-quarters of these lists had been revised in the 5 preceding years”, WHO’s director-general, Gro Harlem Brundtland, told participants of a meeting (Oct 21, Geneva, Switzerland) held to mark the 25th anniversary of the WHO Model List of Essential Medicines. However, she warned: “There is now a global cry for equitable access to essential medicines for the prevention and treatment of HIV/AIDS. This also applies for access to other essential medicines, especially those for common childhood diseases, major infectious diseases, and chronic conditions”.
According to WHO, 60% of deaths among the world’s population living in poverty are caused by diseases such as malaria and HIV/AIDS. “95% of world’s 33 million people with HIV/AIDS don’t have access to lifesaving antiretroviral treatment. They die despite the existence of treatments and preventive measures that could protect them”, Bernard Pécoul of charity Médicins Sans Frontières (MSF) added. He praised the addition of 12 antiretroviral drugs to the list recently, but warned that despite a WHO policy change that price should not be a reason for exclusion of a drug from the list, high price remained an obstacle for many new antibiotics—including cephalosporins, quinolones, and macrolides—to be included. “The list must include these and other new medicines which improve treatment effectiveness and simplify treatment protocols. When people’s lives are at
THE LANCET Infectious Diseases Vol 2 December 2002
http://infection.thelancet.com
risk, WHO and member states have an obligation to impose solutions, even if they contradict the direct interest of commercial entities”, Pécoul noted. One way to increase access to essential medicines in developing countries is to encourage generic competition, according to MSF. For example, as a result of generic competition, the price of HIV triple therapy has dropped to less than US$300 from over $10 000 in May 2002. Another option is to buy these drugs in bulk, as is done by the Delhi Society for Promotion of Rational Use of Drugs. Since 1996, the society has been buying these drugs in bulk on behalf of state hospitals. As a result, Sangeeta Sharma said, her society receives quotations at 50–80% below the prices given to others and has been able to tackle constant shortages of essential medicines in government hospitals. Khabir Ahmad
711
For personal use. Only reproduce with permission from The Lancet Publishing Group.