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Re: where's the love?

Posted by dr. dave on August 20, 2002, at 16:25:16

In reply to where's the love? dr. dave, posted by pharmrep on August 20, 2002, at 15:58:42

OK, sorry about being snitty about spelling, and I stand corrected on 'Forest'.

I think the Gorman paper is weak. Jack Gorman is paid by Forest. He is also paid by Lundbeck. His paper has only managed to get published in a paper he edits himself. He is not independent of the significant financial pressures surrounding this issue.

Generic citalopram is already available in Europe from what I gather, having been launched in Israel earlier this year.

What city am I in? I'm in a hospital in a little village in the mountains of Wales, at least an hour from anything resembling a city!

> > The statement '10mg Lex is 40mg Celexa' doesn't make any sense. Let's get down to the science here - '10mg lex' is 10mg of s-citalopram. '40mg Celexa' is 20mg s-citalopram plus 20mg r-citalopram. That's different. A study has been presented claiming 10mg Lexapro is as effective as 40mg Celexa - but Jack Gorman in his meta-analysis of the research states that this study was too small to demonstrate differences in efficacy. The result of one small trial is not necessarily the complete and absolute truth.
> >
> > Is the separation expensive? A slow-moving bed plant required to separate stereoisomers costs upward of $5 million. To me, that's expensive.
> >
> > Where do I get my info? From the published studies, which I have looked through thoroughly, and from a knowledge of pharmacology from studying at Cambridge University.
> >
> > The studies SUGGEST certain things, but are very very far from demonstrating them conclusively. Statistical significance of difference is inconsistent across the studies. Lexapro will certainly not be cheaper than generic citalopram which is available in Europe to the best of my knowledge.
> >
> > Although r-citalopram has some affinity to histamine (not 'histomine') receptors this does not mean it is 'inhibiting s-citalopram'. You cannot inhibit a molecule, you can only inhibit a process - which process involving s-citalopram is the r-citalopram/histamine receptor interaction inhibiting?
> >
> > The whole marketing of this drug seems to be based on sloppy science. I have no problem with Celexa, I prescribe it all over the place, but raising desparate people's hopes with woolly and wishful thinking I object to.
> >
> > I would be happy to discuss the shortcomings of any particular study on escitalopram that is publically available if we want to get into the science of it.
> ***I agree that the few studies out hardly represent the end-all-be-all of facts, but the 9 out now look promising. Pardon my appreviating...most of my posts I receive are like this, so I do it too. I met Dr. Gorman in June...he spoke for 1 hour and didnt hesitate on the research and efficacy findings. He said Lexapro has greater efficacy. As far as expense of isolating isomers...I dont know what the cost are to Forest...I only know that Lexapro will be less expensive to the patients than Celexa....and there is no generic for Celexa until late 2005 here or Europe. I may have oversimplified my histamine statement, but dont kill me for a typing error. (and it's Forest...not "Forrest")
> Forest hasn't even begun any marketing yet, only a few studies are out to show efficacy, side-effect profile, drug to drug interactions, and tolerablity.... The FDA actually encourages isomer science. What dont you like? I would like to cover the studies with you since you have seen them....typing is too hard...what city are you in?




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