Posts Tagged ‘medicine’

Top 10 UK Medicines

January 6, 2012

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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

Pharmaceutical Sales – A spark of interest

April 23, 2010

Having embarked on a career as a medical representative in 1987, I still reflect on the route that led me to the pharmaceutical industry.  Being a Pharmaceutical Sales Representative doesn’t often appear in the list of careers that we aspire to as teenagers hence it is invariably something people come across coincidently.  For me I spent five years in a hospital Biochemistry Dept completing post graduate studies and developing a strong clinical understanding of various diseases and illnesses.  It was here I met Sales Representatives selling laboratory diagnostics and equipment which sparked an interest in sales (I have to admit to being initially impressed by the suit, car and perceived flexibility of their job).  In fact what did appeal to me about a sales role was the inherent challenges working towards targets and ultimately being rewarded (bonus) and recognised for exceeding goals (working in the NHS could not fulfil that need) as well as selling products which genuinely make a difference to people’s lives.

Hence I started buying the New Scientist and Daily Telegraph; there was no internet job searching in those days! Quite quickly I secured two interviews for Laboratory Territory Manager positions before seeing an advertisement for Trainee Medical Representatives with a major pharmaceutical company.

Have to confess at that stage that pharmaceuticals was a bit of a mystery to me, but my Dad said that company was great (blue-chip), and there was a number to call to apply.  Two interviews later, including being flown to head office, I was offered a GP/Hospital Representative position.

Looking back I do wonder how I got that job as these days we expect entry level candidates to know so much more about the day to day practicalities of the role, the NHS and how the business works.  Clearly the company were looking for the basic ingredients which they could then train, develop and mould to reflect their values and culture in the eyes of their customers;  GP, Nurses, Pharmacists, Consultants, Registrars, SHO etc.

Over twenty years later in a different NHS landscape I still believe this to be true so what are some of those basics;

Personal Qualities – An inner drive, self-starter, the ability to work on your own initiative, enthusiasm, can-do attitude, tenacity, the ability to problem solve, good interpersonal skills, the willingness as well as aptitude to learn.

Clinical Foundation – This means an interest in medicine, the ability to learn and apply technical information.  You will need to communicate this knowledge to customers of all levels.  ‘A’ level standard Biology should help with ABPI. 

Business & Selling Skills – Understand you are there to increase sales; it is a sales job & not a promotional or educational position.  Have a consultative selling style, i.e. probe to understand the customer needs and agenda before offering solutions. Key Account Management & Networking Skills. Understanding local NHS politics, targets, agenda and how these may impact on your business.

Clearly a lot of clinical and business skills can be taught as long as you have the right positive attitude. In summary I would describe the role of a Medical Sales Representative, whether that be GP, GP/Hospital, Hospital or Generics as the opportunity to run your own local business.

I have enjoyed a varied, challenging and satisfying career in the pharmaceutical industry. I also know others, who embarked on their career at the same time, who have had similar experiences and taken their careers in to different functions in the industry including: Marketing, Senior Sales Management, Training, Consultancy as well as others who are now Senior Representatives such as Hospital Specialist Representative or Healthcare Development Manager.

If this sparks an interest in you fantastic!  To discuss your background and transferable skills then contact 20:20 Selection Ltd on 0845 026 2020 or visit www.2020selection.co.uk . We have current opportunities Nationwide with hot-spots in London, Kent, Sussex, Essex, Somerset, Wiltshire, East Anglia.

Interview Guidance

February 4, 2010

Interview Guidance

PRIOR TO the Interview

Research

  • Look committed and find out as much as possible about the company.

 

  • Visit their web site for more information on the company.

 

  • Find out who will your competitors be and as much as possible about the market/customers you will be selling to 

 

Job Description

  • Make sure you are fully aware what the role is you are being interviewed for.  Your consultant at 20:20 Selection Ltd will have fully briefed you on this. 

 

  • Be confident that you are technically qualified to do the job.  We would not have spoken to you about the role if we didn’t think your profile matched the client’s criteria!

 

  • Have examples from your previous roles to demonstrate your ability to do this job and evidence in your brag file to back this up

 

FOR THE INTERVIEW

Personal Presentation

  • Look your smartest and show your most professional side during the interview. A company is more likely to employ someone who is well presented and who will therefore best represent their company to customers. 

 

Punctuality

  • Arrive to start the interview on time (be early if possible)

 

  • Obtain clear directions for the location of the interview and plan your journey, allowing plenty of time to arrive.

 

INTERVIEW DO’S

  • Introduce yourself courteously (first impressions last!)

 

  • Express yourself clearly.

 

  • Show tact, manners, courtesy, and maturity at every opportunity.

 

  • Be confident and maintain poise. The ability to handle your nerves during the interview will come across as confidence in your ability to handle the job.

 

  • Be prepared to show how your experience would benefit the company.

 

  • Ask questions concerning the company or products and the position for which you are being interviewed for. An interviewer will be impressed by an eager and inquisitive mind. You will also be able to demonstrate that you can contribute to the company or industry if you show an interest in its products and/or services.

 

  • Take time to think and construct your answers to questions to avoid rushing into a vague and senseless reply.
  • Demonstrate that you are sufficiently motivated to get the job done well and that you will fit in with the company’s organisational structure and the team in which you will work.

 

  • Show willingness to start at the bottom and work up.

 

  • Anticipate questions you’re likely to be asked and have answers prepared in advance. Uncertainty and disorganisation show the interviewer that you are unprepared and unclear what your goals are.

 

  • Be assertive without being aggressive (ensure you close – remember you are a sales person & ‘you’ are your product)

 

  • Thank the interviewer for their time

 

Interview Don’ts

  • Be late for the interview. Tardiness is a sign of irresponsibility or disorganisation and the employer could take it as what to expect in the future.

 

  • Arrive unprepared for the interview.

 

  • Say unfavourable things about previous employers.

 

  • Make excuses for failings.

 

  • Give vague responses to questions.

 

  • Show lack of career planning – no goals or purpose could convey the impression you’re merely shopping around or only want the job for a short time.

 

  • Show too much concern about rapid advancement.

 

  • Overemphasise money. Your interviewing goal is to sell yourself to the interviewer and to get an offer of employment. Salary discussion is secondary.

 

  • Show any reservations you may have about the role/company. You can always turn down second interviews and job offers after you have had time to appraise your concerns in the cold light of day.

 

  • Express strong prejudices or any personal intolerance.

 

  • Leave your mobile phone on during the interview.

 

These are general tips that can be applied to any interview situation.  Part of the service we offer at 20:20 Selection Ltd is to help you prepare for specific client interviews.  We have key account managers specifically working with clients & members of the team who come from a pharmaceutical sales management background so you will get personalised expert advice relating to your interview!  To find out more about 20:20 Selection Ltd visit www.2020selection.co.uk

Nurse Advisor and similar roles within the Pharmaceutical Industry

July 20, 2009

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