(Picture source: Panoramic Vision)
Economic Observer Network reporter Han Jing On September 14, Johnson & Johnson pharmaceutical subsidiary in China Xi'an Janssen Pharmaceutical Co., Ltd. announced the long-acting injection of Santuda for the treatment of schizophrenia [ Palm paliperidone ester injection (3M)] was officially launched in China. This medicine is suitable for patients with schizophrenia who have been adequately treated with Paliperidone Palmitate Injection (1-month dosage) for at least 4 months.
"A common situation among patients with schizophrenia during the treatment process is the patient's lack of compliance during treatment, which leads to a high recurrence rate of the disease." Chief Physician of Peking University Sixth Hospital , Honorary Psychiatrist Branch of the Chinese Medical Doctor Association Tang Hongyu, President and Director of the Post-Graduation Medical Education and Psychiatry Committee of the Chinese Medical Doctor Association, believes that further improving the level of standardized treatment, increasing the treatment rate, and using long-acting treatment programs to improve patient compliance and reduce the recurrence rate are the key to the treatment of schizophrenia. key.
Dr. Chen Weisheng, head of neuroscience, anti-infection and vaccine therapeutics at Janssen Asia Pacific Medical Affairs, said: "Seltastat can effectively improve patients' medication compliance and reduce disease recurrence rates."
Industry experts generally believe that long-acting injections are the It is an important step to help patients with schizophrenia control their illness and return to society. The launch of Sadoda, which is injected every three months, will undoubtedly be an important step in the long-acting treatment plan for schizophrenia.
It is a persistent, chronic major mental illness
"We may suffer from mental disorders throughout our lives." This line of subtitles displayed on the big screen is not a lie. Tang Hongyu introduced that people may suffer from mental retardation, ADHD (attention deficit hyperactivity disorder), epilepsy, autism, and children-specific mental disorders in childhood; people may suffer from schizophrenia, depression, and bipolar disorder in adolescence. , neurosis, personality disorder, suicide, study aversion, personality disorder, Internet addiction; may face schizophrenia, bipolar disorder, alcohol and drug dependence, perinatal depression, stress disorder in adulthood; may face problems in old age People may suffer from dementia, senile depression, organic mental disorders, suicide, etc.
According to the World Health Organization, more than 21 million people worldwide are suffering from schizophrenia. Data released by my country on April 7, 2017 show that as of 2016, there were 5.4 million patients in my country's database of patients with severe mental disorders, 3/4 of whom were schizophrenia. Data shows that there are currently as many as 7.8 million schizophrenia patients in China. Ma Hong, deputy director of the Mental Health Center of the China Centers for Disease Control and Prevention and chief physician of Peking University Sixth Hospital, pointed out that in reality, the number of schizophrenia patients may be far greater.
Schizophrenia is a persistent, chronic, major mental illness and the most serious form of mental illness. According to data and topics from various countries around the world, most of the genetic systems in patients are hereditary (certain gene segments on the chromosomes have defects, aberrations, conflicts), resulting in spontaneous hallucinations, or others can find that their performance is affected. Hallucinatory effects. There may be some latent characteristics in childhood such as being unsociable, estranged, impulsive, suspicious, jealous, innocently aggressive, arrogant and so on. The disease is more obvious in young adults, such as abnormal social function, impaired labor ability, disordered life, inability to be independent or take care of themselves, and poor ability to perform civil activities.
Schizophrenia affects a huge number of people, and the disease affects normal social functions and work ability, bringing a huge burden to families and society.
According to data, current medical technology cannot penetrate into the genetic system to solve diseases. In the future, medicine can prevent the next generation through genetic diagnosis (prenatal diagnosis). Long-acting sedatives may help the patient's condition. Such as risperidone, olanzapine, antitan, perphenazine, etc.
Patients with schizophrenia come in and out of the "revolving door"
Wang Gang, president of Beijing Anding Hospital affiliated to Capital Medical University, said that the recurrence of schizophrenia is similar to a "revolving door effect.""It's like they are repeatedly coming in and out of a revolving door." Wang Gang found in many years of clinical work that patients with schizophrenia often do not take medications on time and in the right amount as prescribed by doctors, which leads to recurring symptoms and frequent hospitalization for treatment,
Tang Hongyu said I met an old patient who I have known for more than 30 years last Monday. "This patient was suffering from schizophrenia at the time, and he was a type of schizophrenia with a very poor prognosis. But for thirty years, he had never interrupted treatment, and this was at a time when he could only be treated with oral medications. "Tang Hongyu said that now the patient has a normal job, a harmonious family, and lives an ordinary life. Tang Hongyu believes that with the support of his family, his own correct understanding and other factors, the patient controlled his condition because he insisted on taking medicine.
This proves that adherence to treatment is the key to treating schizophrenia.
However, the characteristic of schizophrenia is that patients have no self-control and have problems with their understanding and perception of the disease, so they will refuse treatment. The treatment of most schizophrenia patients is a process of constant battles of wits and courage between doctors and patients, and between family members and patients on medication issues.
Tang Hongyu pointed out that nearly 75% of schizophrenia patients will show some non-compliance within two years of discharge. Non-compliance means that they no longer continue to receive treatment. Clinical studies have shown that interruption of treatment is the leading cause of relapse in schizophrenia. And the impact of medication non-adherence on the relapse of schizophrenia is very obvious, even in developed countries. For example, the overall treatment discontinuation rate in the United States is as high as 64%. According to surveys, the non-compliance rate of patients with treatment within one year after discharge is about 42%, and the non-compliance rate may increase significantly after two years. From a clinician's perspective, it may be higher. According to statistics, the one-year relapse rate of Chinese schizophrenia patients is about 40%, and the five-year cumulative relapse rate is about 48%. Some foreign studies have shown that if a patient does not take medication for even one week in a year, the patient's risk of recurrence will increase exponentially.
"After relapse due to non-compliance of schizophrenia patients, the prognosis will drop sharply. The patient will go into a vicious circle. After non-compliance, the disease will relapse. After relapse, treatment will be repeated. The efficacy of the re-treatment will decrease, resulting in the patient's social function being worse. The worse the understanding of the disease, the worse the compliance, forming a vicious circle." Tang Hongyu said.
Ma Hong and one of his patients, Xiao Zheng, shared the treatment process at the venue. Xiao Zheng, who comes from the Northeast, became ill for the first time after playing games without sleep for 4 days and 3 nights. Since suffering from schizophrenia, Xiao Zheng has not been able to go to school. "I would secretly throw away the medicine when my family and doctors weren't paying attention, or take it and spit it out." After the symptoms stabilized, Xiao Zheng always felt that he had recovered. Taking too much medicine would have side effects on the body. Therefore, his illness recurred and his condition was not very stable. Two years ago, Ma Hong and Xiao Zheng met for the first time. At this time, Xiao Zheng had already passed through the "revolving door" for the fourth time. After being treated in the psychiatric department of Peking University Sixth Hospital for a period of time, when he was about to be discharged and returned to his hometown, Xiao Zheng and his father came to Ma Hong's clinic, hoping to bring some medicine home to take. After understanding Xiao Zheng's condition, Ma Hong recommended that he receive long-acting injection treatment. Because Shansida was not covered by medical insurance at that time, Xiao Zheng's father was hesitant. But Xiao Zheng believes that he is more willing to accept this once-a-month injection treatment than taking medicine.
Xiao Zheng is not the only example of such a lack of compliance leading to recurrence of illness.
Over the years, the government and doctors have been working hard to build a mental health prevention and treatment system. Although the situation has improved, it is still unsatisfactory. Because it takes a long time to build a sound and complete system, but patients not only need treatment in the hospital, but follow-up maintenance treatment after discharge is an important aspect. "Clinical studies have found that long-acting injections are a key means that we believe can solve the compliance problem." Wang Gang said.
Patients treated with long-acting injections are more likely to recover
"There are not many patients in my outpatient clinic who take medicine well." Ma Hong said that patients treated with tablets have relapsed because they did not follow the doctor's instructions to take medicine. There are many patients in the door.According to data in the system, the cure rate for this type of patients is less than half; while patients who use long-acting injections can work, study, and live with greater peace of mind.
Wang Gang believes that long-acting injections have great advantages over oral drugs. First, it can improve patient compliance, and second, it can avoid repeated reminders to patients to take medicine. The tug-of-war between taking medicine and not taking medicine often occurs between patients and their families, and it has also become an important source of conflict between them. Third, long-acting injections are more convenient. In addition, it can reduce accidents during treatment. For example, a doctor prescribes a month's worth of medication to a patient, which may be several bottles for some patients, which increases the risk of overdose.
"From a global perspective, the proportion of long-acting injections used in our country is relatively low. The world average can reach about 30%, and our country is only more than 1%." Wang Gang believes that there is still a lot of improvement in long-acting injections in our country space.
Among the several goals proposed in the National Mental Health Work Plan (2015-2020) issued by the General Office of the State Council in 2016, two goals are particularly worthy of attention. The first goal is to achieve 80% registration and management rate for severe mental disorders and 80% treatment rate for schizophrenia. Wang Gang believes that the process of achieving this goal is arduous, but hopes that it can be achieved through the efforts of all parties. Another goal is to increase the number of practicing psychiatrists to 40,000, which has risen from about 20,000 at the end of 2015 to 30,000 at the end of 2017. It is hoped that all sectors of society will make further efforts in this regard.
is committed to developing injections with longer injection intervals
As a pharmaceutical company, Xi'an Janssen has been making a lot of efforts in developing the antipsychotic drug .
From the initially introduced oral drugs Risperdal (taken 730 times a year) and Ruida launched in 2009 (taken 365 times a year), to the long-acting injections Hengde and Sansida, every new drug is developed. Reduce the frequency of medication.
Chen Weisheng, head of neuroscience, anti-infection and vaccine therapeutics at Janssen Asia Pacific Medical Affairs, said: "Setodex, which will be launched this year, can effectively improve patients' medication compliance and reduce disease recurrence rates. Compared with placebo, Santoda It has excellent performance in delaying disease recurrence, drug safety and tolerability, which will effectively reduce the disease burden for patients and their families." According to Chen Weisheng, the results of a long-term, double-blind, placebo-controlled trial. It showed that only 9% of the patients in the Santoda group relapsed, while 29% of the patients in the placebo group relapsed; in addition, compared with patients who received placebo, patients randomized to the Santoda group had a shorter time to relapse compared with patients who received placebo. longer.
In addition to being a psychiatrist, Wang Gang’s other identity is the national project leader of Santuoda’s new drug registration trial in China. He formed a research team with psychiatrists from more than 20 units across the country to promote the completion of the project and witnessed its launch. Studies have shown that Santuda is very effective in relapse prevention. "A survey of schizophrenia patients (n=537) in four hospitals in Beijing, Hebei and Liaoning found that the patient's medication non-compliance rate one year after discharge was 42.1%, and the relapse rate was 40.8%. Situoda can reduce the annual relapse rate Down to about 6%. "Wang Gang believes that these technologies are of great clinical significance and value to doctors.
The National Health Commission issued the "Working Standards for the Management and Treatment of Severe Mental Disorders (2018 Edition)" at the end of May this year, and wrote in the "Principles of Drug Treatment for Home Patients": "For patients with poor treatment compliance, weak family monitoring capabilities or no supervision, "For patients who are at risk of causing accidents, long-acting injection treatment is recommended," and listed commonly used antipsychotic drugs, including paliperidone, risperidone microspheres for injection and paliperidone palmitate injection.
Xiao Zheng found a job in Inner Mongolia in April this year after starting Sansida injection treatment. Overjoyed, Xiao Zheng went to report to the unit before he could take the injection and . Ma Hong urged Xiao Zheng to take the injections on time, so Xiao Zheng had to ask for leave from the leader and truthfully told the truth about his condition. After returning from the injection, the leader politely dismissed him. Ma Hong also felt sad when he learned about Xiao Zheng's experience.
After Ma Hong introduced Santuda, which is injected four times a year, to Xiao Zheng, Xiao Zheng was very happy, "If this drug had been developed earlier, I might not have lost my job."
Injected Santuda Later, Xiao Zheng continued to look for a job and hoped to get married and have children soon.
"As long as they don't relapse, they can live like us." In Ma Hong's view, long-acting injections can change the lives of these schizophrenia patients.
"On August 31, just 24 hours after the release of the drug test report, a 19-year-old schizophrenia patient from Guangdong Province became the first patient in mainland China to receive treatment with Sadoda. The patient has now returned to school. Life. As of today, nearly a hundred patients from all over the country have received treatment with Santuoda." Asgar Rangoonwala, President of Xi'an Janssen Pharmaceutical Co., Ltd., believes that Chinese schizophrenia patients have a strong demand for curing the disease and pursuing a happy life, and this is also the reason. Reasons why companies continue to face challenges in developing new drugs.
