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There are 75 million Americans with pain, fatigue, brain fog, and autoantibodies. Of those, 25 million have enough damage that physicians can make a specific autoimmune diagnosis, and many of those are diagnosed with more than one autoimmune disease. In the 300 years since physicians began diagnosing autoimmune conditions, the rates of autoimmune disease have steadily climbed. And more and more diseases are understood to be autoimmune in nature. There are more people with autoimmune problems than with cancer, heart disease, and diabetes combined.

If you have a chronic autoimmune condition, your physician is probably insisting that you take a disease-modifying drug to stop the progression of damage. These drugs are often expensive and come with many side effects. Autoimmune diseases are unpredictable, usually progressive, and often lead to early exit from the workforce.     

I, like many other physicians, expected drugs companies to develop more powerful and more effective drugs to stop and reverse the damage caused by autoimmunity—after all, they spend billions on research, as does the government. We physicians push our patients to take new drugs, but the cost of drug therapy is rapidly escalating. The numbers are shocking.

Here are the 15 most prescribed drugs and their total sales during a one-year period (2013–2014), as well as information on what the drug is meant to treat.

15. Copaxone

  • 2014 sales: $4.8 billion
  • Treatment for: Multiple sclerosis
  • Drug manufacturer: Teva Pharmaceutical Industries (NYSE: TEVA)
  • Company’s headquarters: Israel

14. Januvia

  • 2014 sales: $5.0 billion
  • Treatment for: Diabetes
  • Drug manufacturer: Merck & Co. Inc. (NYSE: MRK)
  • Company’s headquarters: United States

13. Spiriva

  • 2014 sales: $5.5 billion
  • Treatment for: Chronic obstructive pulmonary disease (COPD)
  • Drug manufacturer: The Boehringer Ingelheim Group
  • Company’s headquarters: Germany

12. Herceptin

  • 2014 sales: $5.6 billion
  • Treatment for: Various cancers
  • Drug manufacturer: The Roche Group
  • Company’s headquarters: Switzerland

11. Lyrica

  • 2014 sales: $6.0 billion
  • Treatment for: Nerve disorders
  • Drug manufacturer: Pfizer Inc. (NYSE: PFE)
  • Company’s headquarters: United States

10.Avastin

  • 2014 sales: $6.1 billion
  • Treatment for: Various cancers
  • Drug manufacturer: The Roche Group
  • Company’s headquarters: Switzerland

9. Rituxan/Mabthera

  • 2014 sales: $6.6 billion
  • Treatment for: Various cancers
  • Drug manufacturer: The Roche Group
  • Company’s headquarters: Switzerland

8. Nexium

  • 2014 sales: $7.7 billion
  • Treatment for: Acid reflux
  • Drug manufacturer: AstraZeneca (NYSE: AZN)
  • Company’s headquarters: United Kingdom

7. Remicade

  • 2014 sales: $8.1 billion
  • Treatment for: Arthritis, psoriasis, bowel diseases
  • Drug manufacturer: Johnson & Johnson (NYSE: JNJ)
  • Company’s headquarters: United States

6. Crestor

  • 2014 sales: $8.5 billion
  • Treatment for: High cholesterol
  • Drug manufacturer: AstraZeneca
  • Company’s headquarters: United Kingdom

5. Enbrel

  • 2014 sales: $8.7 billion
  • Treatment for: Arthritis, psoriasis
  • Drug manufacturer: Amgen Inc. (NYSE: AZN)
  • Company’s headquarters: United States

4. Abilify

  • 2014 sales: $9.3 billion
  • Treatment for: Serious mental illness
  • Drug manufacturer: Otsuka Group
  • Company’s headquarters: Japan

3. Sovaldi

  • 2014 sales: $9.4 billion
  • Treatment for: Hepatitis C
  • Drug manufacturer: Gilead Sciences (NASDAQ: GILD)
  • Company’s headquarters: United States

2. Lantus

  •  2014 sales: $10.3 billion
  • Treatment for: Diabetes
  • Drug manufacturer: Sanofi (NYSE: SNY)
  • Company’s headquarters: France

1. Humira

  • 2014 sales: $11.8 billion
  • Treatment for: Arthritis, psoriasis, bowel diseases
  • Drug manufacturer: AbbVie (NYSE: ABBV)
  • Company’s headquarters: United States

 

That means $21.6 billion is spent per year on Copaxone, Remicade, Enbrel, and Humira, drugs in the top 15 used to treat various autoimmune conditions. Rituxan is used for both cancers and autoimmune conditions, at the cost of another $6.6 billion per year.  

Because I have multiple sclerosis, I follow the development of drugs to treat MS very closely. For years there was no therapy or treatment and patients diagnosed with MS faced profound disability. The first disease-modifying drugs prescribed to MS patients cost $8,000 to $10,000 per year. Then newer biologic drugs were developed, at the cost of $60,000 per year or more. The rapid escalation in costs of disease-modifying drugs exceed the rates of inflation by a factor of 7 or more. The annual cost for MS drugs tops $19 billion per year. Today’s top-selling drugs are very powerful and incredibly expensive, costing $65,000 to $100,000 or more each a year.

Drug benefits insulate individuals somewhat from the cost of prescription medication. Over the years both demand for medication and its accompanying cost have increased dramatically, and these two factors are in part accelerating the cost of healthcare insurance premiums for individuals and businesses as well as the cost of long-term medications for Medicaid and Medicare patients. Whether the medication costs are borne by an individual, businesses, or the government, society ultimately will ultimately absorb these costs, leading to severe economic drag on the system. Small businesses that provide health insurance benefits will struggle with higher costs for health care premiums. Larger businesses will also have higher costs for health care premiums. Individuals and families will face higher out of pocket expenses for health care premiums, medication, and treatment.

These 15 drugs (except the hepatitis C drugs) are meant to be taken for life. They control symptoms fairly well, but only for a short time. In this paper that examined how long symptom reduction lasted using biologic autoimmune medications in rheumatoid arthritis, the remission was less than a year for over half of the patients. Only 14% had a remission lasting more than two years. Patients may spend hundreds of thousands of dollars for drug therapy over their lifetime without curing the diseases they are supposedly treating. Think about that. The drugs may reduce symptoms for a time, but the disease processes continue to smolder in the background.

What your physicians are not telling you is that the symptom reduction from the potent biologic drugs is often temporary. They are also not telling you that diet and lifestyle changes are often much more powerful than drugs at stopping disease progression and can even lead to regression of symptoms. More on that in Part 2…

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