Hepatitis C News Digest; FDA Probes New Death In Tainted Wipes "Triad Prep Pads"
- File Under HCV News, Triad Prep Pads
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Special report: Tracking tainted wipes
Parents blame toddler's death on tainted wipes
The parents of a 2-year-old Houston boy who died from a rare infection are suing makers of recalled alcohol prep pads, claiming contaminated wipes caused fatal bacterial meningitis.
FDA knew of problems at plant that made tainted wipes
FDA defends actions on tainted wipes
Colo. hospital blew whistle on tainted wipes
Pressured firm closes line that made tainted wipes
Infection risk triggers new recall of wipes
Two-thirds of alcohol wipes contaminated
FDA asks maker of tainted wipes to stop production
Senators question FDA's response to tainted wipes
Wipe-maker shuts doors after U.S. Marshals arrive
Feds seize $6 million in products from wipe-maker
FDA admits weak oversight in tainted wipes review
Feds seek injunction against maker of tainted wipes
More potentially tainted medical products recalled
Suspect wipes used at VA medical centers
FDA admits weak oversight in tainted wipes review
Feds seek injunction against maker of tainted wipes
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The first death report that cites Bacillus cereus infection was submitted on behalf of Harrison Kothari, a Houston toddler whose case sparked investigation into whether Triad products included in a massive January recall were responsible for serious infections. The 2-year-old's parents have filed a lawsuitclaiming that contaminated Triad wipes led to the child’s fatal case of meningitis last year. Both that death and the 66-year-old man's death are part of an ongoing review, the FDA said.
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Six other death reports submitted by patients’ family members or their doctors question the role of Triad medical products without citing specific bacteria, according to a review of reports from Jan. 6 to June 28. Such reports are difficult to confirm because they don’t include enough information to guide investigators, said Shelly Burgess, an FDA spokeswoman.
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Officials with the Triad Group and H&P Industries Inc. have repeatedly said that no deaths or injuries have been confirmed to be caused by their products. Christy Maginn, a spokeswoman for the firm, said that the company hadn't seen the FDA reports and couldn't comment on the specific cases.
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Last month, federal officials filed a permanent injunction barring the Wisconsin sister firms from manufacturing or distributing any products because of the potential of life-threatening bacterial contamination.
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The records show that the FDA has received reports of 11 non-fatal infections tied to Triad alcohol prep wipes. They include eight related to the alcohol prep products; among those are five that specifically cite Bacillus cereus. In one instance, a hemophiliac patient developed a Bacillus cereus infection and the wipes tested positive for the bacteria, records show. The three other reports cite different pathogens.
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In addition, the FDA received one report of an infection caused by the bacteria that forced the March recall of hundreds of thousands of povidone iodine prep pads manufactured and distributed by the Wisconsin firms. The rare bacterium Elizabethkingia meningoseptica was detected in the blood of an infant with a central venous catheter. A Triad povidone iodine swab stick had been used to clean the skin before the line was inserted, the report said.
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The agency also received two reports of infections related to recalled sterile lubricating jelly used in medical exams.
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In addition, the FDA received nearly 250 reports of other minor problems such as swelling at the injection site, redness, nausea and vomiting.
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An ongoing msnbc.com investigation revealed that the FDA knew about problems with contamination and sterilization of the alcohol prep pads and other products dating back to at least 2009. It’s not clear how long the agency has suspected problems with Bacillus cereus because FDA heavily redacts inspection documents. However, redactions challenged by the Milwaukee Journal Sentinel newspaper showed that FDA documented the bacterium in a multi-week inspection that began Nov. 29, 2010.
Under pressure, FDA officials told two U.S. senators that the agency should have issued a warning letter to H&P Industries Inc. and the Triad Group last summer instead of allowing the company to voluntarily comply.
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Patients must be at least 80-85 percent adherent to therapy for the HCV treatment to be effective, and Accredo has results demonstrating that patients who receive therapy from Accredo's nurses and specialist pharmacists are nearly 10 percent more adherent than those who get their therapy from another provider. Accredo has also been successful in using genotype information to identify patients who may need only 24 weeks of therapy, resulting in drug cost savings up to $13,000.
Accredo's high-touch care model helps educate patients about their treatment and the necessity to adhere to it. This includes patient instruction about using their medications, communicating with doctors about treatment programs and assisting patients to manage side effects. This, in turn, helps to improve patient outcomes and reduce costly hospitalizations or the wastage of expensive medications that are not being properly taken.
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As Accredo has improved care for HCV patients, boceprevir and teleprevir will likely improve patients' odds for beating the condition that affects 3.2 million Americans, sparing thousands of patients from liver failure, potential transplants or cancer.
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"These new drugs will likely be game-changers for HCV patients, but patients are going to need help adhering to treatment," said Richard Faris, vice president and national practice leader for Medco's Rare and SpecialtyTherapeuticsResourceCenter. "Medco's enhanced clinical oversight and expertise in gene-based medicine enables us to help patients get the right treatment and stay on therapy."
The U.S. Food and Drug Administration (FDA) approved the medications in May to supplement treatments of pegylated interferon and ribavirin in patients with HCV genotype 1, the most common type of the virus. The new treatments improve efficacy to approximately 75 percent from 50 percent when pegylated interferon and ribavirin, the standard of care for HCV since 2001, are used together for 48 weeks. At the same time, the new drugs can shorten the duration of treatment to 24 weeks in most patients. Despite being oral drugs, the new treatments that prevent HCV from replicating add a layer of complexity to an already complex treatment program
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The Accredo Model
The Hepatitis C Therapeutic Resource Center at Accredo has been successful in helping patients, physicians and payers with this difficult therapeutic regimen. Accredo's approach is to maximize clinical effectiveness for patients and benefits plan sponsors by reducing the potential for waste. Failure to properly monitor the therapy, genotype and viral load can cost up to $64,000 in unnecessary drug costs for treating an HCV patient. Pegylated interferons are dosed in precise increments based on a patient's weight.
Patient adherence to these therapies is crucial to achieving a successful course of therapy, but made difficult given their significant side effects and intensive drug regimen. Accredo's Hepatitis C Therapeutic Resource Center services include patient training, preventing drug waste, coordination of care, genetic screening, and patient monitoring and counseling to overcome barriers to treatment adherence.
Hepatitis C and its costs
HCV – and subsequent liver cirrhosis – is the leading cause of liver transplant and it is estimated that 30 percent of the 17,000 people on the liver transplant list are infected with HCV. The initial cost for a liver transplant is $315,000 with follow-up care costing $22,000 annually. HCV is also a leading cause of liver cancer. HCV patients also can have significant co-morbidities that require complex care from specialty pharmacy. For example, in the United States up to 8 percent of those with chronic HCV may be HIV co-infected. Overall, an estimated 6,200 persons with bleeding disorders are affected by HCV, representing 44 percent of all persons with hemophilia and 5 percent of all persons with von Willebrand disease. Persons above the age of 21 have the highest rates of infection, since they were most likely to get human blood products as treatment.
About Medco
Medco Health Solutions, Inc. (NYSE: MHS) is pioneering the world's most advanced pharmacy® and its clinical research and innovations are part of Medco making medicine smarter™ for more than 65 million members.
With more than 24,000 employees worldwide dedicated to improving patient health and reducing costs for a wide range of public and private sector clients, and 2010 revenues of $66 billion, Medco ranks 34th on the 2011 Fortune 500 list and is named among the world's most innovative, most admired and most trustworthy companies. Accredo Health Group, Inc., is a wholly-owned subsidiary of Medco.
For more information, go to http://www.medcohealth.com.
This press release contains "forward-looking statements" as that term is defined in the Private Securities Litigation Reform Act of 1995. These statements involve risks and uncertainties that may cause results to differ materially from those set forth in the statements. No forward-looking statement can be guaranteed, and actual results may differ materially from those projected. We undertake no obligation to publicly update any forward-looking statement, whether as a result of new information, future events or otherwise. Forward-looking statements are not historical facts, but rather are based on current expectations, estimates, assumptions and projections about the business and future financial results of the pharmacy benefit management ("PBM") and specialty pharmacy industries, and other legal, regulatory and economic developments.
SOURCE Medco Health Solutions, Inc.
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Today, Moore is completely cured of the disease. “I feel wonderful,” said the 62-year-old Decatur resident. “I’m optimistic about living many more decades.”
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Hepatitis C cases in region on the rise
Federal, state and local health officials are trying to figure out why the number of hepatitis C cases in six central and northern Wisconsin counties has increased.
Health officials are in the middle of an investigation into the problem, said Melanie Behr, nursing supervisor for Portage County Community Health. Although it's listed as one of the six counties, Portage County hasn't seen the same increase as the other five counties, she said. However, Behr wants to wait for the results of the investigation before making any assumptions about the situation.
"I think anytime you have an increase in hepatitis C, it is concerning," Behr said.
The state and federal agencies gave the counties a survey to use when talking with people to determine a commonality for what people were doing when they were infected with hepatitis C, Kuennen said.
The six counties aren't alone in the problem, Kuennen said.
"It's happening nationwide; it's not just Wisconsin, or the northern region," she said.
Heroin use is becoming more socially accepted, Wood County Investigator-Sgt. Scott Saeger said. Nationally, health department officials think 35 to 70 percent of drug users who inject are infected with hepatitis C, Saeger said.
To avoid contracting the disease, people should make sure they use clean needles every time and never share a needle, Kuennen said. People can become part of a clean needle exchange program by contacting their local health department.
"I never ask their names," Kuennen said. "I'll be happy to give the contact information to them; this disease needs to stop."
Kuennen also recommends people who are getting tattoos or piercings check to make sure the provider is state certified and inspected.
Tattoo artists need to check their sanitizing equipment monthly and provide the records to county officials during inspections, said Kate Carlson, Wood County environmental health specialist. This protects the health of clients.
Kuennen recommends that anyone who has ever shared a needle get tested for hepatitis C. One of the problems with the disease is that it usually doesn't have any visible symptoms until the person who has it becomes very sick. Eventually, the disease will cause the skin and eyes to turn orange.
If hepatitis C is caught early, doctors can help patients live a long life with a good
quality of life, Kuennen said.
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Medicare proposes change in anemia drug usage
It said such an action would be "consistent with revised U.S. Food and Drug Administration guidelines."
Last week, the FDA changed the labels for Amgen's Epogen and Johnson and Johnson's Procrit to call for lower dosing of the anemia drugs, which have been linked in recent years to safety concerns such as increased risk of heart problems.
"Clinicians should use the lowest dose of ESA (erythropoiesis stimulating agent) sufficient to reduce the need for red blood cell transfusions," Patrick Conway, chief medical officer at the Centers for Medicare and Medicaid (CMS) said in the statement.
Amgen said it recognizes that the labeling for ESAs has changed, but is concerned that the proposal would remove an important safeguard designed to protect dialysis patients from being undertreated.
The Medicare guidelines "should have a measure that protects patients from hemoglobin levels that fall too low," the biotechnology company said in an emailed statement.
Sales of the anemia drugs have declined steeply in recent years, but Amgen's Epogen, along with its second-generation drug Aranesp, and J&J's Procrit are still expected to generate around $6 billion in 2011 sales, according to data from Thomson Reuters Pharma.
The proposed change would apply under Medicare's quality performance standards for "bundled" payments to dialysis providers and would affect payment years 2013 and 2014, the agency said.
CMS projected that its payment rates for dialysis treatments would increase by 1.8 percent in 2012, representing projected inflation of 3 percent less a projected productivity adjustment of 1.2 percent. It also estimated that federal payments to dialysis facilities in 2012 would total $8.3 billion.
While Medicare traditionally covers just elderly and disabled Americans, kidney disease patients are an exception. The program covers all those with end stage renal disease under a decades-old law.
Medicare said it would accept comments on the proposed rule until the end of August and will respond to them in a final rule to be issued by November 1.
(Reporting by Deena Beasley)
FDA Inspects Half A Dozen Plants In India
Several industry executives said teams of inspectors of the US Food and Drugs Administration (FDA) did not find any major deficiency during inspection of facilities of Ranbaxy Laboratories, Orchid Chemicals & Pharmaceuticals , Emcure Pharma, Nectar Lifesciences and Ind Swift Laboratories over the course of the last four weeks. But this could not be officially confirmed from FDA, which did not respond to an e-mail query sent last Thursday.
While in the case of Ranbaxy and Nectar, a go-ahead from the FDA will mean that they can begin exporting to the US from their units, in the case of other companies, an FDA approval will allow them to continue exporting. FDA conducts audit to ensure that Indian drugmakers meet US drug manufacturing norms so that the medicines made at these facilities are safe for American citizens, before they are allowed to be sold in the US market.
Senior industry executives said this was the first time that FDA had inspected so many manufacturing units in India during such a short span of time. "The US government may be trying to expedite approval of generic drugs to reduce healthcare cost, which is a welcome move," D G Shah, secretary-general of Indian Pharmaceutical Alliance , an association of big Indian drugmakers said.
An estimated $30-40 billion worth of drugs, including top-selling drugs like Lipitor ( Pfizer )), Nexium (Astra Zeneca) and Plavix ( Bristol Myers Squibb), will lose patent protect protection in the next 1-2 years. This means generic firms can launch their versions at one-tenth of the price of the original brand, if they have FDA approval. For the US consumer, sale of more generic drugs will result in greater competition and therefore, lower prices. Ranbaxy Laboratories, the country's largest drugmaker, stands to benefit the most from a favourable report from the FDA.
The US constitutes a fourth of Ranbaxy's total sales and a nod from the FDA will permit the Gurgaon-based firm to sell new drugs in the US from its Indian plants, nearly three years after FDA banned and halted marketing approval of new drugs from its two main plants for data fabrication. Two FDA officials spent about two weeks examining the drugmaker's new manufacturing facility at Mohali, Punjab and it is learnt that they have not pointed out any major flaw during the examination. A Ranbaxy spokesperson declined comment.
FDA officials carried out separate four-day inspections at the active pharmaceutical ingredient (API) plants of two Chandigarh-based firms, Nectar Lifesciences and Ind Swift, at their Dera Bassi plants. Nectar can begin exporting APIs to the US once it gets a formal approval from the American regulator. For Ind Swift, which already exports to the US, this was a re-inspection which concluded about a week back, said the company's managing director NR Munjal. The Nectar Lifesciences spokesman declined comment.
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P&G wins round in Fixodent cases
Procter & Gamble has won a big victory in its defense of dozens of lawsuits over its Fixodent products.
A federal judge in Miami threw out the lead case in a series of lawsuits that claimed using the denture cream caused nerve damage.
U.S. District Court Judge Cecilia Altonaga did not rule on the merits of the plaintiffs' claims. But she ruled that the expert witnesses the plaintiffs planned to call would not be permitted to testify.
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Roche drops plans to develop Chugai diabetes drug
TOKYO, July 5 |
TOKYO, July 5 (Reuters) - Swiss drugmaker Roche Holding AG has dropped its plans to develop and sell a diabetes treatment with Chugai Pharmaceutical and has handed back the overseas rights, the Japanese drugmaker said on Tuesday. The drug CSG452 was dropped after a review by Roche of its pipeline, Chugai said.
Chugai said it will consider other partners to help it develop the drug and has not changed its plans to submit it for approval to Japanese health authorities in 2013.
(Reporting by Mayumi Negishi and Edwina Gibbs; Editing by Edmund Klamann)

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