Friday, April 23, 2010

A Cuirky Recommendation

Today I read an enthusiastic puff-up of a drug company called NeurogesX (NGSX), based on recent approvals for a patch called Qutenza for the treatment of the pain of shingles.

I can't say that I was enthusiastic about the name, but that's not what's going to make or break the company.

What has broken many post-puff-up drug companies in the past is lack of sales, and since one's sales success depends to a certain extent on what one's selling, I decided to look at the prescribing information provided by the company, using it as a reasonably full source of information about the drug. What I saw isn't encouraging.

The active ingredient is capsaicin. Not only is capsaicin a very old treatment, but it already exists as a topical treatment for herpes zoster, and it's not clear that the new patches are in any way superior to the old cream. Reading the warnings to the prescriber suggests that this is not going to be a blockbuster, even if we take into account that shingles aren't all that common:

"Do not use Qutenza on broken skin."

The non-broken lesions are likely to be close to already-broken blisters, and the patches are likely to be less easy to control than the competitor's cream.

"Apply Qutenza for 60 minutes and repeat every 3 months or as warranted by the return of pain (not more frequently than every three months)."

I'm supposed to become a zillionaire investing in a product which cannot be used more than once in three months, whether it's needed or not?

"Use only nitrile (not latex) gloves when handling Qutenza and when
cleaning treatment areas."

Most medical and paramedical professionals have disposable latex examination gloves around somewhere all of the time. Do they also have nitrile gloves? I'm not at all sure

"Apply a topical anesthetic before Qutenza application.... Remove the Qutenza patches by gently and slowly rolling them inward.... After removal of Qutenza, apply Cleansing Gel for one minute and then remove it with a dry wipe.... For those patients who require the use of opioids to treat pain during or following the procedure...."

This is starting to sound complicated.

"Do not use near eyes or mucous membranes.... Inhalation of airborne capsaicin can result in coughing or sneezing."

Shingles are not rare on or near the face.

I'm not saying not to buy NeurogesX; I'm just sayingthat you should look before you leap.

Full disclosure:

  • My prophecies about health-care companies are invariably wrong.

  • With all of the big health-care companies now facing patent-expiration and pipeline dangers, NeurogesX could be bought up or partnered even if their product is not very persuasive.


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