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Vincent Rajkumar Profile picture
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16 Mar, 4 tweets, 2 min read
At a list price of ~$19,000 a month, I will not be using or recommending much of melphalan flufenamide (Pepaxto) for multiple myeloma.

The drug needs to show superiority over cyclophosphamide or melphalan in a randomized trial. #CostVR
Myeloma drug costs are unsustainable. They reflect what's going on in all cancers. If key opinion leaders are silent this will continue. Our recommendations must reflect and take into account value.
I said the same when selinexor and panobinostat were approved. Pricing has to be related to incremental value.

Forget the pharma talking point that high prices are needed for innovation. If every drug can be priced high regardless of value there is no incentive for innovation.
We have a system that favors adoption of higher priced drugs compared to lower priced alternatives.

Explains why "equivalent" denosumab gains market share over 20 times lower priced Zoledronic acid. @oncology_bg @guptaarjun90 @JAMAOnc jamanetwork.com/journals/jamao…

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Vincent Rajkumar Profile picture
17 Mar
This report that has me somewhat concerned about vaccine escape by a variant. Most previous reports were neutralizing antibody studies. These are clinical results.

Astra Zeneca vaccine was only 10% effective against the B.1.351 variant in South Africa. nejm.org/doi/full/10.10…
Among 39 mild to moderate cases with this variant, 20 occurred in placebo group and 19 in vaccine group. Means: No protection seen.

I'm still optimistic that there will be protection against severe disease and deaths.
There were no severe cases of COVID in this study. No hospitalizations or deaths. It's a small study (n=2021).

Time will tell. Even more reason to consider vaccinations from a global standpoint. Because leaving parts of the world unvaccinated is self defeating.
Read 4 tweets
Vincent Rajkumar Profile picture
16 Mar
Astra Zeneca vaccine and blood clots. Here's what we know:

11 people in Europe with central venous sinus thrombosis out of 17 million who have received the vaccine.

7 in Germany
3 in Norway
1 in Spain

Almost all <50 years of age.
Austria has 2 serious thrombotic events.
What we don't know:

1) Whether blood clots and vaccine are causally related.
2) Whether the central venous thrombosis rates are higher than expected.
3) Whether the patients had any unique underlying problems.
4) Why this has not occurred in the UK.
What we have to consider:

Incidence and Risk of clots (if confirmed) versus incidence and risk of COVID.
Read 11 tweets
Vincent Rajkumar Profile picture
16 Mar
Many countries in Europe are pausing vaccination at a time when COVID cases are rising and vaccination rates are low. Look at the number of new cases per day. What could go wrong?
As millions of people get vaccinated there will be reports of disease associations, mostly coincidental. Investigate. But its important to balance risks. Every single day delay in vaccination matters.
I don't know the exact details of the type of blood clots being reported. Does anyone have reliable information? Can you post links?
Read 5 tweets
Vincent Rajkumar Profile picture
13 Mar
1/ A single pill of thalidomide taken during pregnancy can cause major birth defects.

This most notorious drug caused birth deformities in >10000 infants worldwide. It was taken off the market in 1961

But thalidomide never went away. It is sold legally today. How?? The story 👇
2/ Thalidomide was first marketed in 1957 as a sedative. By 1960 it was sold in >40 countries. Wrongly touted as the safest sedative for pregnancy.

In 1961 Widukind Lenz and William McBride independently concluded that the drug was teratogenic. It's caused severe birth defects.
3/ Birth defects occur when even a single pill is taken between days 35-49 of pregnancy.

Thalidomide went off the market in 1961. Due to the wisdom of Dr. Frances Kelsey at the FDA, the drug was never marketed in the US.
Read 19 tweets
Vincent Rajkumar Profile picture
12 Mar
Not approving the Astra Zeneca vaccine was a mistake. We lost 2 months.

Not releasing Astra Zeneca vaccine doses to other countries is a bigger mistake and self defeating. @RebeccaDRobbins @noahweiland nytimes.com/2021/03/11/us/…
Self defeating because COVID thrives on the weakest link. Mutant variants arise when the virus multiplies uncontrolled in many hosts. Vaccination has to be approached from a global perspective to stem the tide of newer mutants, some of which may be resistant to current vaccines.
I simply don't understand what is there to debate. We have enough vaccines for all our residents and hundred million more.
Read 4 tweets
Vincent Rajkumar Profile picture
12 Mar
1/ Cells that make antibodies are called plasma cells. When they become cancerous, you get myeloma.

Im a myeloma doctor and researcher. Even with various chemotherapy drugs, it's almost impossible to kill all plasma cells.
2/ Immunity is a strange thing. It has allowed life to be sustained all these millions of years.

The fact that we cannot easily wipe our the immune system even with lots of chemotherapy tells you how evolutionarily preserved the system is.
3/ Unfortunately the immune system needs some introduction to a new enemy. And it needs some time to mount a response.

COVID was totally new. It surprised everyone's immune system. And it was also virulent and spread very easily. So we ended up with this awful pandemic.
Read 7 tweets

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