‘Strong ethical reasons’ to consider switching patients on Vectura-linked inhalers

By Emma Wilkinson

18 Nov 2021

There are strong ethical reasons to consider switching patients with asthma and COPD onto alternative devices after the takeover of inhaler company Vectura by tobacco giant Philip Morris International, UK clinicians have argued.

In an article setting out the alternative options to 13 inhalers that use Vectura technology, Professor Nick Hopkinson, Professor of Respiratory Medicine at Imperial College, London, said the annual global death toll from smoking has been estimated to be 8.71 million.

He noted that the European Respiratory Society had stated that health professionals will avoid prescribing drugs from any company that enriches the tobacco industry due to the ethical implications.

And that patients were also likely to be reluctant to use devices linked to the tobacco industry.

The inhalers in question are used by 10 million patients worldwide, Professor Hopkinson notes with his co-author Dr Toby Capstick, Consultant Pharmacist in Respiratory Medicine at St James’s University Hospital in Leeds.

They include Flutiform, GSK Ellipta devices, some Novartis Breezhalers (Seebri, Ultibro and Enerzair), the article in the International Journal of Chronic Obstructive Disease says.

But there are several suitable alternatives that healthcare professionals can prescribe “to avoid directing income to the tobacco industry”, they conclude.

In some cases, this will mean a change in local prescribing policy or switching the patient to a different drug in the same class, which should only be done as part of shared decision making, Dr Hopkinson said.

Avoiding use of Vectura-linked inhalers in the first place or switching where possible reinforces the policy that the tobacco industry needs to be excluded from healthcare, the article argues.

“The objective is to avoid tobacco industry linked devices wherever possible rather than absolutely prohibit their use, to allow for the occasional instance where not using them would genuinely cause a deterioration in an individual patient’s condition,” they conclude.

And patients’ individual choices should also be respected, they add.

Speaking with the limbic, Professor Hopkinson said in his experience “when patients hear about this they don’t want their inhaled medication to be funding the tobacco industry and for most people there are alternatives”.

He added: “Switching does take time and it may not necessarily be the immediate priority so it may be more about what therapies to initiate all other things being equal.”

Professor Hopkinson noted that pharmaceutical companies who had partnered with Vectura to develop these devices had had this situation forced on them.

“But it’s important to make a fuss about this as this isn’t likely to be the last attempt by the tobacco industry to schmooze its way into healthcare.”

GSK has responded by saying that the Ellipta inhalers currently being used by about 240,000 Australians to manage their asthma and COPD are not Vectura inhalers.

It told the limbic that GSK had developed, manufactures and owns all rights in the Ellipta device and active ingredients and it was not in a partnership with Vectura.

“As per historical business agreement which expires in the next three years, GSK does pay royalties for patent licences to a company acquired by Vectura (SkyePharma). The license is to allow access to SkyePharma’s formulation technology relating to the use of magnesium stearate as an excipient in inhalers to give GSK confidence that it can bring its medicines to patients. It is not connected in any way to the Ellipta device or the active ingredients in the Ellipta portfolio,” its statement said.

GSK said it understood the concerns expressed by respiratory health physicians and others about this acquisition, and stated that “GSK has never sought and will never seek to enter into any direct relationship with PMI / tobacco companies.”

A spokesperson for Novartis said the company recognised “the negative role tobacco plays in respiratory health and the concern about a tobacco entity becoming involved in providing technology that helps treat patients with serious respiratory conditions.”

It said Vectura and co-development partner, Sosei Heptares, exclusively licensed certain intellectual property relating to glycopyrronium bromide and its use and formulation to Novartis in April 2005.

“Novartis has been and continues to be solely responsible for the development, manufacturing and commercialisation of the three of our inhaled products that contain glycopyrronium (Seebri® Breezhaler®, Ultibro®  Breezhaler®, Enerzair® Breezhaler®). Novartis pays licensing fees to Vectura for the use of certain technology for the manufacture and formulation of glycopyrronium bromide.”

A spokesperson noted that other inhalers such as Onbrez Breezhaler are not impacted.

“We have taken this decision to continue to use Vectura technology in the best interests of patients, but we understand that this issue has raised concerns and we will continue to investigate further actions to address these,” they said.

“Without the intellectual property licensed from Vectura, patients would not have access to Novartis’ respiratory products, or would experience a lengthy disruption in treatment.”

Sandoz in Australia and New Zealand does not currently distribute any products containing IP or technology licensed from Vectura.

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