Kiwi arthritis patients lose access to vital drug after it turns out to be effective treatment for COVID-19

New Zealand will be left without access to an effective arthritis drug after Roche, the only company in the world with the rights to make it, said it won't be able to fulfil its contractual obligations.

About 400 Kiwis rely on tocilizumab funded through Pharmac for "a number of conditions such as rheumatoid and juvenile arthritis", director of operations Lisa Williams said. 

But tocilizumab is also showing promise as a potential treatment for COVID-19. Research involving Kiwi scientists published in March found it works by "stopping one of the protein signals that activate cells involved in the immune response", resulting in a 24 percent drop in mortality, Newshub reported at the time

"Because of this, there has been increased demand for tocilizumab," said Williams, noting other countries have either put limits on its use or are experiencing shortages. 

New Zealand's stockpile of the anti-inflammatory drug is expected to run out by the end of October. Roche says it probably won't have any more for us until January. 

Phillip Kearney, chief executive of Arthritis NZ, told Newshub it's a difficult situation. 

"Obviously from a COVID perspective it has some significant benefits for those in hospital. You've got to feel for that.

"But I suppose the issue is the people who rely on this in New Zealand, who are regular users, to suddenly have their medication changed or are not sure of what medication they're going to go to, obviously that's of significant concern."

Tocilizumab was developed in the early 2000s, and licensed to Roche in 2003. In June the US FDA approved its use on COVID patients, and in July it became just the second treatment recommended for COVID-19 by the World Health Organization

Médecins Sans Frontières immediately called for Roche to give up its patent on the drug and share its know-how with other pharmaceutical companies. Roche responded by saying it wouldn't enforce its patents in low- and middle-income countries for the duration of the pandemic, and India this week announced approval for a generic version of the drug

New Zealand doesn't fall into that category.

Williams said Pharmac had funded tocilizumab for some COVID-19 patients here, and would continue to "work closely with Roche and DHB hospitals to manage tocilizumab supplies to enable continued use for people who are at high risk without treatment, including those in hospital with COVID-19". 

"We have sought advice from clinical experts and are now exploring possible alternative treatments and how we can preserve the stock we have. In the meantime, we will be asking prescribers to not start any new patients on tocilizumab." 

Kearney said few patients would want to switch medications, but there probably little choice with New Zealand being just a small market. 

"You're on something because it's working, so to change because the supply has gone is obviously going to be somewhat upsetting. People don't like to change their medication because they're used to it, and you don't know what potential issues might be with any replacement. I can understand it is helping those with COVID as well, but this is very disconcerting for a number of our patients."

He said taking tocilizumab to use on COVID-19 patients was "almost robbing Peter to pay Paul". 

"With Roche, [Pharmac] may have just been told 'you're not getting it, it is being supplied somewhere else'. They may not have a choice." 

The only other medication the WHO has recommended for use in COVID-19 patients is dexamethasone. The WHO currently has a recommendation against ivermectin, an anti-parasitic that has found favour with some people online despite, and a strong recommendation against hydroxychloroquine, a treatment favoured by former US President Donald Trump and his supporters.