New Role Just In – Hospital Sales Specialist ( NE, Yorks, East Mids)

January 31, 2012

Hospital Sales Specialist – Basic to £45k, OTE £60k++

Many more live vacancies can be viewed at http://www.2020selection.co.uk

An opportunity to develop your talents working for a leading global Healthcare Company. Our client is currently looking for a Sales Specialist to develop the business in key hospital accounts throughout the North East,YorkshireandEast Midlands. Although a large geographical area this is a focused and targeted role with an emphasis on key account management.

This organisation has built an enviable portfolio of products and services that push back the frontiers of medical care and ultimately ensuring a better quality of life for people everywhere.

This opportunity for a Sales Specialist is an integral part of a specialty sales team reporting to the National Sales & Marketing Manager. You would be fully supported by internal functions such as marketing, customer services, logistics and shared services; YOU would be the interface of the company and the customer. With a drive for increased Patient Safety, in the NHS, when administering medication, our client is an excellent position to develop partnerships in hospital trusts. This role will involve selling new  as well as some established products and services.

Key responsibilities would include:

– Developing and implementing appropriate strategies for agreed customer targets with the objective of driving sales results and achieving or exceeding budgets.

– To identify key finance and clinical decision makers within Consortia, Hospitals and Units and arrange meetings to promote relevant products and services

– Gathering intelligence on customer plans and purchasing intentions and recommend responsive, timely and appropriate action.

– Maintaining a high level of knowledge of the therapy area and related products

– In conjunction with the National Sales Manager and wider commercial management team, provide informed input into/manage the tender process.

– Calling on key customers as per your business plan (Clinical/Aspectic/Purchasing Pharmacists, Procurement, Clinicians, Specialist Nurses)

To be considering for this exciting opportunity you are likely to have

– Previous hospital sales experience (2 years)

– Knowledge/Experience of NHS structure & buying processes

– Life sciences degree, nursing qualification, business degree (or equivalent experience inUKhealthcare market for minimum of 2 years)

– ABPI qualification and/or willing to study if required.

In return for your expertise if successful you will be offered a competitive salary & excellent benefits package including an uncapped bonus scheme. You will also receive first rate training and ongoing development.

To discuss this role in more detail please contact us on 0845 026 2020 or alternatively please submit your details by emailing administrator@2020selection.co.uk

20:20Selection Ltd promises to treat your application as important and will review your profile against our client’s requirements. However, if you have not heard from us within 7 days please assume that on this occasion you have not been successful.

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Trainee Recruitment Consultant – A Day In The Life Of Chris

January 26, 2012

Last week I started a training contract within an established Medical Sales recruitment company  As a virgin to the industry I prepared myself as best I could for what I was about to undertake. I did all my reading around the career area and the company itself and eventually it came down to taking the plunge and accepting a 2 week trial in a very unpredictable time period for a recruitment consultant, the 2 weeks preceding the Christmas break. This is obviously an odd time in the industry as our Clients will be in one of 2 camps, the 1st of which being the “lets get the most out of our budget spend before the end of the year before its taken away from us in January”, and the 2nd being, “I’ve done all I can this year, lets start again in 2012”.

My 1st day was, as expected, the birth by fire. This is how we operate, take in as much as you can and see if you can keep up. This gave me a great insight into the speed, efficiency, and accuracy required from a consultant. If you’re not 1st, you’re last. This ethos opens up possibilities for huge success but at the same time great falls. After all we are competing against several other companies with differing approaches to achieving the same goal, luckily for me I’m working on the basis of quality rather than quantity. But that doesn’t mean quantity doesn’t get it right some times.

The harsh reality of the other side of recruitment fast became apparent. You really have to shine to get noticed in the current climate and the vast array of approaches that candidates use to attain this is eye opening. The role itself is very diverse. Admin is air tight, and has to be. It can be the difference between placing and missing out, a point regularly re-enforced during my training thus far. Combine admin with confident selective telephone manner, excellent knowledge of your clients and candidates, and the foresight to combine the two and you may have what it takes to take on the world of recruitment.

The industry requires you to effectively sit on a knife edge, the whole game is in balance, continually changing as both clients and candidates change their ‘requirements’, which can either push you right to the top or plunge you back to square one. This makes for a very exciting work environment as we are challenged with the task of keeping the balance in our favour right until the very last minute and then if all goes to plan, we can tip the scales and reap the benefit.

The team currently have the task of not only managing business but also managing me. As a fresh starter I am as keen and eager as you’d expect. I want to get my hands dirty and dive straight in but my lack of experience leaves me blind to the consequence. I am effectively stood on top of a diving board blindfold, trusting my team for direction and timing so I land on soft success rather than the hard ground of misconception. Time will tell……

Which Recruitment Agency?

January 18, 2012

Despite the global recession and credit crunch, one of the UK’s leading pharmaceutical recruitment agencies , 20:20 Selection Ltd has gone from strength to strength. How have they acheived their organic growth in these difficult times?

The team have over 50 years of combined, actual experience in the pharmaceutical and healthcare sales arenas in the UK.

Managing Director Karen Forshaw formed the company in 2002, after a successful career in medical sales (both primary and secondary care) and medical sales management (at both area and national sales manager level). She is passionate about providing an unirivaled service to both clients and candidates. The 20:20 Selection maxim of “perfect vision: not hindsight” extols the company virtues down to a tee. By carefully selecting their  candidates, 20:20 Selection ensure that when one goes before a client for an interview then they have an excellent chance of actually getting hired.

Using the experience and advice from Karen’s team, 20:20 Selection will ensure that you are only ever put forward for roles which you really understand and want to do. They only send your CV to clients with your full permission. Should you get an interview, then Karen and the team will keep you fully briefed and ‘prepped’ during the entire process. They have an enviable reputation within the industry as a recruitment company that really cares about both clients and candidates. One of the prime motivating factors is that individual consultants are not bonussed on just their own performance, but on the performance of the whole company. As a result you will not find yourself being forced or coerced into going for a role just to make up the sales figures of the consultant that you are dealing with.

So if you are interested in a role in UK pharmaceutical, medical or device sales then please contact us at administrator@2020selection.co.uk or visit our website http://www.2020selection.co.uk to find out more about the company.

Please note that in order to reach our minimum standards you will need to be qualified to work in the UK, have a full UK driving licence with not more than 6 points and be educated to degree level or be of graduate calibre.

Good Luck in your career.

Top 10 UK Medicines

January 6, 2012

Read the rest of this entry »

Monoclonal Antibodies

January 3, 2012

MABS / CYTOKINE MODULATORS / ANIT- TNF AGENTS AND MORE

 

A medication ending with the stem ‘mab’ indicates that it is a monoclonal antibody. This is the internationally recognised nomenclature for the naming of monoclonal antibodies.

Nomenclature has become somewhat confusing though as the BNF includes ‘mabs’ under the heading of cytokine modulators and anti-lymphocyte monoclonal antibodies in several chapters.

Monoclonal antibody production for medical use was first discovered by Milstein and Kohler in 1975, but it was confined mainly to diagnostics until Vilcek and Li approached Centacor (now part of Johnson & Johnson) to help them produce ‘mabs’ against TNFα.

Tumour necrosis factor-alpha (TNFα) is a cytokine (an immunomodulating agent) produced by monocytes and macrophages, two types of white blood cells. It mediates the immune response by increasing the transport of white blood cells to sites of inflammation, and through additional molecular mechanisms which initiate and amplify inflammation. Inhibition of its action by ‘mabs’ reduces the inflammatory response which is especially useful for treating autoimmune diseases.

The ‘mab’ that Vilcek and Li discovered become known as Infliximab (Remicade) and it became an important treatment for severe Crohn’s disease, including the fistulating variety. It has subsequently been used to treat other auto-immune system  diseases such as psoriasis and rheumatoid arthritis. Infliximab became known as ‘Kwik Fiximab’ in medical circles due to it’s clinical success in treating otherwise unresposive patients.

There are two types of TNF receptors: those found embedded in white blood cells that respond to TNF by releasing other cytokines, and soluble TNF receptors which are used to deactivate TNF and blunt the immune response. In addition, TNF receptors are found on the surface of virtually all nucleated cells. Red blood cells, which are not nucleated, do not contain TNF receptors on their surface.

A ‘mab’ neutralises the biological activity of TNFα by binding with high affinity to the soluble (free floating in the blood) and transmembrane (located on the outer membranes of T cells and similar immune cells) forms of TNFα and inhibits or prevents the effective binding of TNFα with its receptors. Infliximab and adalimumab (another TNF antagonist) are in the subclass of “anti-TNF antibodies” (they are in the form of naturally occurring antibodies), and are capable of neutralising all forms (extracellular, transmembrane, and receptor-bound) of TNFα. Etanercept, a third TNF antagonist, is not a ’mab’ and it is in a different subclass (receptor-construct fusion protein), and, because of its modified form, cannot neutralize receptor-bound TNFα. Etanercept is sometimes referred to as a ‘non-biologial’ agent to distinguish it further from the ‘mabs’ Additionally, the anti-TNF antibodies adalimumab and infliximab have the capability of lysing cells involved in the inflammatory process, whereas the receptor fusion protein apparently lacks this capability. Although the clinical significance of these differences have not been absolutely proven, they may account for the differential actions of these drugs in both efficacy and side effects.

Infliximab has high specificity for TNFα, and does not neutralise TNF beta (TNFβ, also called lymphotoxin α), an unrelated cytokine that uses different receptors from TNFα. Biological activities that are attributed to TNFα include: induction of proinflammatory cytokines such as interleukin (IL) 1 and IL 6, enhancement of leukocyte movement or migration from the blood vessels into the tissues by increasing the permeability of endothelial layer of blood vessels; and increasing the release of adhesion molecules.

A range of newer agents which act against these other cytokines have subsequently been developed.

Tha table below summarises the anti- TNF mabs available in the UK currently. None-mab anti-TNF agents are also included for comparison

MOLECULE BRAND CLASS DERIVATION INDICATION NICEAPPROVED
Adalimumab Humira (Abbott) Anti-TNFα Recombinant human ‘mab’From hamster ovary RAPJIA

PA

AS

CD

P

 

YesNo

Yes

Yes

Yes

Yes

Anakinra Kineret (Swedish Orphan) Anti-IL-1 Recombinant human ‘mab’From E Coli RA No 
Alemtuzumab MabCampath (Genzyme) Anti-lymphocyte Recombinant human ‘mab’ from hamster ovary CLL Yes 
Certolizumab Pegol Cimzia (UCB Pharma) Anti-TNFα Recombinant human ‘mab’From E Coli RA Yes
Golimumab Simponi (Schering-Plough)  Anti-TNFα Recombinant human ‘mab’ from murine cell line RAPA

AS

YesNo

No

Infliximab Remicade (Schering-Plough) Anti-TNFα Recombinant human ‘mab’ RACD

UC

AS

PA

P

 

YesYes

Yes

Yes

Yes

Yes

 

Ofatumumab Arzerra (GSK) Anti-lymphocyte Recombinant human ‘mab’ from murine cell line CLL No
Rituximab MabThera (Roche) Anti-TNFα Recombinant human ‘mab’ from hamster ovary RACLL

NHL

 

YesYes

Yes

 

Tocilizumab RoActemra (Roche) Anti-IL-6 Recombinant human ‘mab’ from hamster ovary RA Yes 
Ustekinumab Stelara (Janssen-Cilag) Anti-IL-12/23 Recombinant human ‘mab’ from murine cell line P Yes 
           
Abatacept Orencia (Bristol-Myers Squibb) T-cell modulator Fused protein formed by recombinantDNAtechnology RAPJIA YesNo

 

Etanercept Enbrel (Wyeth) Anti-TNFα(soluble receptor specific) Fused protein formed by recombinantDNAtechnology from hamster ovary RAPJIA

PA

AS

P

 

YesYes

Yes

Yes

Yes

 

KEY

RA = Rheumatoid arthritis

PJIA = Polyarticular juvenile idiopathic arthritis

PA = Psoriatic arthritis

AS = Ankylosing spondylitis

CD = Crohn’s disease

P = Psoriasis

CLL= Chronic lymphocytic leukaemia

NHL= Non-Hodgkin’s lymphoma

NICEapproval status correct as of July 2011. Please refer to NICEwebsite for latest guidance http://www.nice.org.uk/

Sources:NICE, manufacturers Summaries of Product Characteristics, and BNF vol 61

Primary Care Medical Sales Representative

January 3, 2012

Primary Care Representative

A Primary Care Representative is an ABPI qualified Medical Sales Representative who concentrates their efforts in the primary care setting, with customers who work in the primary care arena.

The Primary Care setting consists of local GP surgeries/ Health Centres/ Medical Centres/  Walk-in-Centres/ Community Pharmacies/ Primary Care Trusts(PCTs) and Clinical Commissioning Groups(CCGs). These locations will house the customer base for the Primary Care Representative – for instance: GPs, practice nurses, practice managers, dieticians, practice pharmacists, non-medical prescribers, community pharmacists, PCT personnel ( medicines management team, medical director, prescribing lead).

A Primary Care Representative is responsible for business planning, budgetary planning and targeting, to make sure that they sell to the ‘right people and see them the right number of times’. It is the role of the Primary Care Representative to build trusted working relationships  with their customers  and to implement the marketing plan in their area. They work closely with colleagues in their team, such as Hospital Specialists and NHS Liaison Managers, sharing relevant information so that customers receive excellent service from the company, and so that product sales grow optimally.

Typically, a Primary Care Representative will be a graduate with a science based background, although graduates in the Humanities, Commerce or Law fields are also employed.  Occasionally, non-graduates with a good academic background and relevant background in sales may also be employed as Primary Care Representatives.  Nurses, pharmacists and other health care professionals can also make excellent sales representatiives if they have good commercial acumen and selling skills also. The most important qualities that an employer will be seeking in any potential Primary Care Representative are positive attitude, resourcefulness, commercial focus, good work ethic, ability to work autonomously, excellent planning and organisational skills, good time management skills and above all exceptional communication skills.

What is the typical working day of  a Primary Care Representative ? Having already planned the day several days or more in advance, they tend to see GP’s either during or after surgery in the morning, and see retail pharmacists and practice nurses in the afternoons.Their role is to build relationships with practice staff, doctors, nurses and retail pharmacists, to ensure that they create an environment where their products are most likely to be prescribed more frequently. These meetings will take the form of one-to-one discussions during which the Primary Care Representative will seek to understand the health care professional’s needs through appropriate questioning and enagement in a two way communication to sell the benefits of their product portfolio for the customer and for the patients. Promotional materials may be used to remind a reinforce product benefits of the Primary Care Representative’s visit but the nature of it’s content and the format is tightly controlled by the ABPI.

Alternatively, the Primary Care Representative could hold a structered meeting witht a wider audience which usually involves delivering a presentation during a luch time break at a GP surgery or to a larger audience perhaps at an after hours educational meeting led by Key Opinion Leaders. A meeting or appointment may be subject to change at short notice as the healthcare professional who the Primary Care Representative is going to visit may have to attend to the clinical needs of their patients, so it is always prudent to have several back-up plans and contingencies for each days work.

The success of a Primary Care Representative is largely measured by the sales of the products that they have in their portfolio. Sales data is usually collected by the amount of product that is sold into the pharmaceutical wholesalers and by the number of prescriptions that are processed by the NHS Business Services Authority who are the government agency responsible for reimbursing pharmacies for the NHS prescriptions that they have dispensed.

The Primary Care Representative may find themselves either employed directly by a manufacturer of a pharmaceutical product i.e. in what is known as a ‘headcount’ role or possibly as a part of a team of contract sales representatives, as either a dedicated or syndicated sales team.

Contract teams are run by organisations which specialise in putting sales teams into pharmaceutical companies who maybe wish to run a sales campaign for a limited period of time or want to assess the uptake of their product before they employ a large ‘headcount’ sales team. The pharmaceutical industry is held in very high regard for the excellent level of training that it gives it’s employees and for the ethical manner in which they work.

Clinical Commissioning Groups

December 13, 2011

A Clinical Commissioning Group (CCG) is a group of GPs and other clinicians who have chosen to come together to commission (buy) health services for their local communities. From early 2013, Clinical Commissioning Groups will be responsible for commissioning NHS services for patients inEngland. All GPs will need to be part of a CCG. They will replace Primary Care Trusts (PCTs). CCGs will be responsible for commissioning hospital services (elective, acute and emergency) and most community health services (for example district nurses), and mental health services. The 151 PCTs have already been organised into 51 clusters in preparation for the change. There will be a period of dual functioning as CCGs mature and PCTs delegate more responsibility to CCGs.

 

The governing bodies (Boards) of the CCGs will have, in addition to GPs, a least one registered nurse and a doctor who is a secondary care specialist. Groups will have boundaries that will not normally cross those of local authorities.

Some CCGs have been given authority by central government to test new models of clinical commissioning and to lead in their development – the term ‘pathfinder’ is used to describe such groups.

 

Commissioning is the term used in the public sector for buying services. It is a structured way of deciding how public money should be spent. In the case of the NHS, commissioning relates to the provision of health services. Commissioning healthcare and health services is the process of examining:

  • the healthcare needs of the area
  • the way in which healthcare services are delivered
  • ways in which healthcare resources will offer the best overall value for money

 

Health services, such as GPs and community and hospital services have historically been commissioned by PCTs. This way of buying in services has meant that GPs and other clinicians, who are the best placed to advise on their patients needs, have been too far removed from the process.

 

The health White Paper: Equity & Excellence: Liberating the NHS was published in July 2010. The White Paper reinforces this view, and in time, much of the responsibility for commissioning health services will be given over to clinicians including GPs.

 

The CCGs will be overseen by the newly formed independent NHS Commissioning Board which will make sure that CCGs have the capacity and capability to commission services successfully and to meet their financial responsibilities. The NHS Commissioning Board will become fully operational from April 2012. Its senior structures should contain a range of healthcare professionals, and it will have a Medical Director and a Chief Nursing Officer on its board.

The NHS Commissioning Board will also be responsible for directly commissioning:

  • Pharmacy services
  • General Practice
  • Dentistry services
  • Specialist services (specialised services that are required by a limited number of people)

At a local level, new Health and Wellbeing Boards will be set up in local authorities to ensure that CCGs are meeting the needs of local people. The membership of these boards will include representatives from:

  • Clinical Commissioning Groups
  • Directors of public health
  • Children’s services
  • Adult Social Services
  • Elected councillors
  • Health watch (representing the views of patients, carers and local communities)

 

These boards will be in place in shadow form April 2012.    

 

 

For further information

More information on the health White Paper: Equity & Excellence:

Liberating the NHS see the Department of Health website:

http://www.dh.gov.uk/en/Healthcare/LiberatingtheNHS/index.htm

 http://www.2020selection.co.uk

Redundancy: How to make this an opportunity

July 22, 2011

 

Redundancy in the pharmaceutical industry has been a recurring theme in recent years. Yes the current global economic crisis has compounded matters but the affects we are seeing are more driven by the changing NHS, market access challenges, product pipelines and the drive for profitability.

So what do you need to do if you are told you are ‘on consultation’ or are actually redundant? Firstly do not panic. Then try not to take the news as personal, remember it is the job that is redundant, even if you feel unhappy about selection criteria for redundancy your HR Department will be ensuring that the process is fair and lawful.

It is normal to go through a whole raft of emotions which may include anger, relief, frustration, even sadness. The difficult aspects are often related to the fact that one day you had an interesting, respectable, well paid job with company car to suddenly being unemployed. Once you have digested this, and dealt with any immediate personal or financial implications, then please be positive so you use the situation as the opportunity it is to review your career goals and aspirations.

We know there are fewer jobs in medical/pharmaceutical sales than in the boom of 1995 – 2005 but the positive news is that roles are evolving, becoming more account management focused and often more specialist in nature presenting superb opportunities for strong sales professional to further develop their skills. It is fair to say that some people may see redundancy as a chance to move out of the sector, we are well trained by pharmaceutical companies and your transferable skills are marketable if you decide to explore that route.

Based on our experience there are some key tips which will be crucial in securing the right next position; you don’t want to jump in to a job if it’s not right. We do see too many people coming in six months post redundancy saying “I took my current job as I was redundant but realise now I took it because it was a job”; this doesn’t look good on a CV.

  1. Ensure you have all the data/evidence you need to sell yourself at your next interview. Too many candidates claim the information has been lost or still on the company PC which has now gone back. If you are competing against someone else with a good Brag File you could miss out on that perfect job. Find all your sales data, business plans, appraisals, field visit report, examples of additional projects, formulary letters etc
  2. Refer to this information when you are updating your CV; you need to have your CV as achievement focused as possible, these should be specific. Contact us (20:20Selection Ltd) for advice
  3. Find an agency that understands the industry and how best to sell your skills
  4. Do not log your CV as open access on recruitment websites as you need to retain control of your personal information
  5. Do keep a log of where you have sent your CV and track progress of your applications.
  6. Consider how a Recruitment Consultant can help you prepare for interviews i.e. interview practice, presentations, attending assessment centres or just a sounding board
  7. Be open to roles and companies you may not have heard of; there some interesting positions available.
  8. Ensure you attend interviews you have committed to as it is a very small world.
  9. Before an interview ensure you fully research the company and therapy area/products; the manager will expect you have done this as well as expect you can sell yourself for her/his specific position
  10. Be prepared to work on feedback after an interview as it will help at second stage or if unsuccessful help for your next interview.

This is not an exhaustive list of tips but hopefully it may give you some help and/or inspiration. Getting the right job does take a lot of time but things can happen for a reason, even though you may not know the reason at this moment!

To discuss your own situation in more detail contact our team on 0845 026 2020 or visit the website to view a selection of our current nationwide opportunities www.2020selection.co.uk

Are you eligible? Having your documents ready for your job search.

July 7, 2011

Embarking on a search for a new job can be daunting however like all things in life it can go more smoothly with forward planning. This short article is aimed at ensuring you have the relevant factual information at hand. This is important as agencies (like20:20 Selection Ltd) and importantly employers do need to check your legal, employment and academic documentation. Hence if you have all this in order, then when it comes to you being made that perfect job offer the contract/job offer letter is likely to be with you more quickly.

 

The following checklist should help you with your preparation:

  • Passport & Visa (if applicable) – an employer can be fined for employing individuals who are not eligible to work in theUK
  • Driving Licence – you will need the paper and photo card parts. For field based positions you will need a validUKdriving licence with no more than 6 penalty points. It is important you make clear declarations about your driving history when asked as employers will check this with the DVLA.

If you have a nonUKlicence holder and need to convert your licence the following link will give you some guidance:

http://www.direct.gov.uk/en/Motoring/DriverLicensing/DrivingInGbOnAForeignLicence/DG_4022562

  • A recent payslip. This will validated your current basic salary and your National Insurance number. If you are in receipt of other monthly benefits such as a car allowance this will also be verified on the payslip.
  • ABPI certificate – if you have sat and passed the examination you will need to produce your certificate if you are offered employment with a pharmaceutical company. If you have misplaced this, the following link may help

https://extranet.abpi.org.uk/web/abpi/exams.nsf/pages/duplicate_certificate_request

  • Highest education certificates (degree, nursing, A levels etc)
  • For nursing roles you will need your current NMC PIN number and date of expiry. Plus you will also be asked about the date of your last CRB check however your new employer will need to undertake a fresh check.
  • For sales positions you should also put together your ‘Brag File’ or portfolio of successes which should include Sales Data, other performance against KPIs, recent appraisal documents; in fact anything that you can use to sell you and differentiate you in the marketplace.

 

If you are not facing redundancy, timing your job search is also something to consider. For example,

  • We do come across people who may be tied in to car schemes. You are advised to carefully calculate the costs involved to you in walking away from your current agreement, as not all employers offer car opt-out schemes.
  • If you are going to jeopardise any bonus/incentive payments pay by leaving before a certain date.
  • If you have significant holiday commitments it is important you flag these. A job offer may be subject to you attending a training course on a specific date for a fixed time, however discussing these with your Recruitment Consultant early in the process may mean this can be negotiated. Also remember that holiday entitlement will be prorated depending at what stage of the leave year you commence work.

 

At 20:20Selection, we are here to help and guide our candidate along the process. Our specialist team can be contacted on 0845 026 2020 from08:30 – 18:00weekdays.

MABS / CYTOKINE MODULATORS / ANIT- TNF AGENTS AND MORE

May 19, 2011

A medication ending with the stem ‘mab’ indicates that it is a monoclonal antibody. This is the internationally recognised nomenclature for the naming of monoclonal antibodies. 

Nomenclature has become somewhat confusing though as the BNF includes ‘mabs’ under the heading of cytokine modulators and anti-lymphocyte monoclonal antibodies in several chapters.

 Monoclonal antibody production for medical use was first discovered by Milstein and Kohler in 1975, but it was confined mainly to diagnostics until Vilcek and Li approached Centacor (now part of Johnson & Johnson) to help them produce ‘mabs’ against TNFα.

Tumour necrosis factor-alpha (TNFα) is a cytokine (an immunomodulating agent) produced by monocytes and macrophages, two types of white blood cells. It mediates the immune response by increasing the transport of white blood cells to sites of inflammation, and through additional molecular mechanisms which initiate and amplify inflammation. Inhibition of its action by ‘mabs’ reduces the inflammatory response which is especially useful for treating autoimmune diseases.

The ‘mab’ that Vilcek and Li discovered become known as Infliximab (Remicade) and it became an important treatment for severe Crohn’s disease, including the fistulating variety. It has subsequently been used to treat other auto-immune system  diseases such as psoriasis and rheumatoid arthritis. Infliximab became known as ‘Kwik Fiximab’ in medical circles due to it’s clinical success in treating otherwise unresposive patients.

There are two types of TNF receptors: those found embedded in white blood cells that respond to TNF by releasing other cytokines, and soluble TNF receptors which are used to deactivate TNF and blunt the immune response. In addition, TNF receptors are found on the surface of virtually all nucleated cells. Red blood cells, which are not nucleated, do not contain TNF receptors on their surface.

A ‘mab’ neutralises the biological activity of TNFα by binding with high affinity to the soluble (free floating in the blood) and transmembrane (located on the outer membranes of T cells and similar immune cells) forms of TNFα and inhibits or prevents the effective binding of TNFα with its receptors. Infliximab and adalimumab (another TNF antagonist) are in the subclass of “anti-TNF antibodies” (they are in the form of naturally occurring antibodies), and are capable of neutralising all forms (extracellular, transmembrane, and receptor-bound) of TNFα. Etanercept, a third TNF antagonist, is not a ’mab’ and it is in a different subclass (receptor-construct fusion protein), and, because of its modified form, cannot neutralize receptor-bound TNFα. Etanercept is sometimes referred to as a ‘non-biologial’ agent to distinguish it further from the ‘mabs’ Additionally, the anti-TNF antibodies adalimumab and infliximab have the capability of lysing cells involved in the inflammatory process, whereas the receptor fusion protein apparently lacks this capability. Although the clinical significance of these differences have not been absolutely proven, they may account for the differential actions of these drugs in both efficacy and side effects.

Infliximab has high specificity for TNFα, and does not neutralise TNF beta (TNFβ, also called lymphotoxin α), an unrelated cytokine that uses different receptors from TNFα. Biological activities that are attributed to TNFα include: induction of proinflammatory cytokines such as interleukin (IL) 1 and IL 6, enhancement of leukocyte movement or migration from the blood vessels into the tissues by increasing the permeability of endothelial layer of blood vessels; and increasing the release of adhesion molecules.

A range of newer agents which act against these other cytokines have subsequently been developed.

Tha table below summarises the anti- TNF mabs available in the UK currently. None-mab anti-TNF agents are also included for comparison

MOLECULE BRAND CLASS DERIVATION INDICATION NICEAPPROVED
Adalimumab Humira (Abbott) Anti-TNFα Recombinant human ‘mab’

From hamster ovary

RA

PJIA

PA

AS

CD

P

Yes

No

Yes

Yes

Yes

Yes

Alemtuzumab MabCampath (Genzyme) Anti-lymphocyte Recombinant human ‘mab’ from hamster ovary CLL Yes
Certolizumab Pegol Cimzia (UCB Pharma) Anti-TNFα Recombinant human ‘mab’

From E Coli

RA Yes
Golimumab Simponi (Schering-Plough) Anti-TNFα Recombinant human ‘mab’ from murine cell line RA

PA

AS

No

No

No

Infliximab Remicade (Schering-Plough) Anti-TNFα Recombinant human ‘mab’ RA

CD

UC

AS

PA

P

Yes

Yes

Yes

Yes

Yes

Yes

Ofatumumab Arzerra (GSK) Anti-lymphocyte Recombinant human ‘mab’ from murine cell line CLL No
Rituximab MabThera (Roche) Anti-TNFα Recombinant human ‘mab’ from hamster ovary RA

CLL

NHL

Yes

Yes

Yes

Tocilizumab RoActemra (Roche) Anti-IL-6 Recombinant human ‘mab’ from hamster ovary RA Yes
Ustekinumab Stelara (Janssen-Cilag) Anti-IL-12/23 Recombinant human ‘mab’ from murine cell line P Yes
           
Abatacept Orencia (Bristol-Myers Squibb) T-cell modulator Fused protein formed by recombinantDNAtechnology RA

PJIA

Yes

No

Anakinra Kineret (Swedish Orphan) Anti-IL-1 Recombinant human ‘mab’

From E Coli

RA No
Etanercept Enbrel (Wyeth) Anti-TNFα

(soluble receptor specific)

Fused protein formed by recombinantDNAtechnology from hamster ovary RA

PJIA

PA

AS

P

Yes

Yes

Yes

Yes

Yes

 

KEY

RA = Rheumatoid arthritis

PJIA = Polyarticular juvenile idiopathic arthritis

PA = Psoriatic arthritis

AS = Ankylosing spondylitis

CD = Crohn’s disease

P = Psoriasis

CLL= Chronic lymphocytic leukaemia

NHL= Non-Hodgkin’s lymphoma

NICEapproval status correct as of May 2011. Please refer to NICEwebsite for latest guidance http://www.nice.org.uk/

Sources:NICE, manufacturers Summaries of Product Characteristics, and BNF vol 61