Pharmaconservation: back to the future

Recycling old drugs is not new.  Clinicians quite often prescribe treatments with drugs that are “off label”, that is, proven for other conditions. Up to one-fifth of all available drugs are prescribed off-label. Almost 90% of drugs that are approved for one condition have other conditions that they can treat. Fortunately, most off-label uses are converted into regulated use once research establishes their efficacy.

New drug development takes a long time but the time to reposition an old drug is relatively quick.

When a venture capitalist repackaged and repriced, an old drug by 5000%, he highlighted the financial opportunities that exist in recycling. Thalidomide, a drug banned because it caused birth defects, now has a place in the treatment of some blood cancers. Sales of thalidomide, repositioned for multiple myeloma, reached US $271 million in one year alone.

New drug development takes a long time but the time to reposition an old drug is relatively quick.  The costs of successfully bringing new pharmaceutical compounds to market run into billions of dollars and take up to 10-20 years. For cancer treatments alone, only one of every 5000–10,000 prospective anticancer agents receive FDA approval and only 5% of the drugs entering the first phase of clinical trials are ultimately approved. Whereas, repositioning of a previously approved drug can be as short as 3-12 years.

Recycling is good business for cash strapped governments and academic researchers because it is cheap. Newer techniques of research such as data mining hold vast potential to uncover new uses for old drugs without ever stepping into a laboratory. Mining can make links in the large data sets that are not obvious to clinical researchers and, from these connections, treatment pathways can be developed.

Both in the US and UK governments have invested in this type of pharmacoconservation. The Center for Advancing Translational Sciences, has collaborated with eight companies to test 58 abandoned drugs for new uses. Similarly, the UK Medical Research Council is spending US$15 million so that UK researchers can study 22 abandoned compounds.

It is an important leap back to the future to explore how drugs that have gone past their use-by date for one condition can be used in another. At time when more cuts in the health budget are looming, it might be the only real way to maximise savings in health spending.

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