Ali McBride discusses medicines that have been on the market for the last few years.
Right now we have several therapies which are currently in the marketplace which have been in existence probably for two or three years.
Carfilzomib actually comes up as one example that had been new to the marketplace for multiple myeloma, but this is an IV therapy. We now have different types of therapies for patients. Some are combination orals, and IV, some intravenous based therapies as well as oral combination.
We've seen that with drug therapies like RVD. The lenalidomide, bortezomib, and also bexamethasone. We're actually looking at a different scenario. We're actually looking at combination for example elo plus revlimid, and dex. In other cases, we're looking at ixazomib especially with ixa being shown to be less with, again, potential RD.
If we're looking at these therapies in combination, or with a combination of IV and oral, we're going to have lots of issues. One, for orals, are of course going to be the most prevalent question, are these patients adherent?
When we're looking at oral‑based therapies, whether we look back at revlimid lenalidomide in these cases, or other therapies coming up the lines we have seen, these therapies really have to be regulated, and also compliant to the big factor.
We can really regulate this, or really take away from this, the analogy of the ADAGIO Study, started looking at [inaudible 3:13], and that study that had shown that patients who were not adherent to therapies had poor outcomes in the CML model.
There'll need to be a lot of discussions about the new oral proteasome inhibitor, how it's being given, compliance issues, and that can actually be faces or forces with insurance, with healthcare providers, as well as with specialty pharmacy.
When we're looking at these drug therapies, that becomes a critical component of the question piece. The other question that's really going to pop up is with the IV infusion. We saw elotuzumab get approval just recently as well as daratumumab.
In both of these situations, these patients have a higher risk of infusion reaction. We're dealing with issues, and relations to a new fusion center which may include, again, infusion management, pre‑medications, and also looking at the patient during that first initial dose which they had a higher risk of reactions during that period of time.