If you were asked to name the best-selling medication in the United States last year, what would your guess be?  Not the most prescribed drug, but the medication with the most revenue, mind you.  I know what you are thinking — it must be a cardiac drug, due to the prevalence of heart disease.  Lipitor?  Close, but that would be the lifetime sales king ($141 billion).  Maybe a diabetic drug?  There are obese people with diabetes everywhere.  No, wait, an opioid — that has been in the news all over the place in the last year.  Well, the answer is not exactly clear cut, depending on what source you quote.  However, it does appear that between July 2013 and June 2014 the best-selling medication in this country was aripiprazole (Abilify), with sales of $7.2 billion, and the most prescribed medication was levothyroxine (Synthroid), with 22.6 million prescriptions written.  For me, however, the big enchilada is the world’s best-selling injectable, adalimumab (Humira), which raked in $10.7 billion in global sales in 2013.  See the articles in Medscape and The Guardian.

About a year ago, a very close friend was diagnosed with psoriatic arthritis.  Literally the next day, as I was watching that old dinosaur “NBC Nightly News,” on comes a commercial for adalimumab for the treatment of rheumatoid arthritis.  Then, a few weeks later, another commercial for the same medication, this time with indications for psoriatic arthritis.  A month after that, adalimumab for Crohn’s disease.  Talk about direct marketing to consumers.  It turns out that adalimumab (Humira) has been approved by the Food and Drug Administration for seven different indications.  It is a recombinant human IgG1 monoclonal antibody specific for human tumor necrosis factor, which blocks typical inflammatory and immune responses seen in rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease and ulcerative colitis.

No wonder it is the world’s best-selling medication — look at all those indications and the number of people affected by those diseases.  But, as a dues-paying member of the New Hampshire Medical Society, you may wonder how things look in our neck of the woods.  The New Hampshire Department of Health and Human Services published data for 2013 on the issue of arthritis in our state and the nation.  According to the Centers for Disease Control and Prevention, approximately 50 million Americans are affected by some type of arthritic condition (22%), whereas in New Hampshire, 26% of respondents (age 18 or older) to a statewide survey indicated being told by a healthcare professional about having arthritis, gout, lupus or fibromyalgia.  A total of 48% of the respondents indicated a limitation of activities of daily living, 32% indicated a limitation at work, and 71% indicated they were overweight or obese.  Of significance was data that shows that emergency room visits and in-patient admissions for arthritic conditions have been increasing over the past few years.

As we approach the upcoming Annual Scientific Conference in November, which will focus on physical and mental health issues in the disabled patient, arthritis diagnoses can serve as examples of how early diagnosis and appropriate management can lead to decreased pain, improved functional outcome and decreased healthcare costs.

While the cost of the newest medications such as adalimumab may not be inexpensive ($1,316 per injection), the improvement of quality of life, hopefully, will be worth the price.  See the results for Crohn’s disease.

Still holding onto your Pfizer stock hoping to cover your kids’ college costs?  Well, there’s a new kid on the block.  See the Forbes.com article.

Regards,

Stuart J. Glassman, MD

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