Personalized medications through pre-testing

Personalized medications: coffers are skeptical

06/02/2014

Even if an individualized drug remains science-fiction, more and more pre-tests are used when different off-the-peg drugs are available. The health insurance companies have doubts whether such tests really improve the quality of treatment.

Not all medications work the same for everyone
Not all drugs work the same way in all people. What works wonders for one patient may be dangerous for another. There are enough examples. For example, lung cancer, in which targeted drugs in an advanced stage only come into question in 15 percent of patients. Or HIV, where a drug has lethal side effects in three percent of those treated. For both drugs there is a genetic test with which the risk can be clarified before the therapy. The buzzword is called „Personalized drug therapy“. Many consider this a trailblazing way. Nevertheless, doubts remain. The health insurance companies say that the benefits have not been proven.

One of the most promising fields of health research
According to a news agency dpa, Federal Research Minister Johanna Wanka (CDU) said in presenting an action plan last year, that individualized medicine is one of the most promising fields of health research. The ministry plans to invest up to 100 million euros in research and development in this field by 2016. Currently, according to the Association of Research-Based Pharmaceutical Companies (vfa), 30 to 40 medicines are personalized. In theory, pre-genetic testing could provide three types of predictions: how well the drug works in a patient, how well he tolerates it, and how it is best dosed.

Personalized medication especially in tumor therapy
According to vfa, there are the most personalized drugs in tumor therapy. „Basically, we keep a lot of it“, said Bernhard Wörmann, Medical Director of the German Society for Hematology and Medical Oncology. Such tests are even prescribed for some anticancer drugs: they should only be prescribed if a certain cell characteristic is present. „The point is that only the patients get the medicine that really helps them“, declared Woermann. However, there are such tests only for less than 20 of well over 100 cancer drugs. He thought more desirable, but not all mechanisms of action were equally well suited for it.

Patients have to pay expensive tests themselves
Bad Vilbel-based Stada AG is one of the drug companies active in this field. To this end, it works together with the Frankfurt biotechnology company Humatrix. They are distributing DNA tests for post-treatment of breast cancer, high cholesterol and patients with increased risk of heart attack and thrombosis. As Stadapharm CEO Lothar Guske announced, the latest product is a test, „Help doctors and patients decide which of 16 possible antidepressants works most effectively.“ Patients have to bear the cost of such a test, around € 400, but themselves. However, health insurance companies usually pay for tests that prevent expensive but perhaps unnecessary cancer therapy.

Fundamental doubts of health insurance companies
Basic doubts register the health insurance companies. It has not yet been proven that such tests really improve the quality of treatment. All in all, the data available so far fell short of the high expectations, according to a policy paper of the Central Association of Statutory Health Insurance Funds. So sometimes two tests with one and the same tumor sample would even lead to different results. Personalized medicine is fundamentally challenged by some scientists. Not only in terms of costs, it is argued about what is in this area even meaningful and ethical. The chairman of the German Ethics Council, Christiane Woopen, asked in the past year according to a dpa report: „Patients are driven into the paradise of medical progress on the lollipop of personalized medicine or they are stretched out in front of the carts of molecular biology research and the pharmaceutical industry?“ (Ad)

Picture credits: Dr. med. Klaus-Uwe Gerhardt