The natural history of a new drug is to start off expensive, capture some market share, collect billions of dollars while it is patent protected from competition, and finally to bow off the stage gracefully and make way for lower priced generic copies of the medication. The colchicine to Colcrys transformation has been just the opposite of the normal scenario. The FDA took an inexpensive generic medication with a lengthy track record and replaced it with an expensive brand-name product. The Colcrys drug representative tried his best to explain to me the value of the new product and the greatly enhanced information available about pharmacokinetics and drug/drug interactions. The new product’s package insert is much longer and much more detailed than the old colchicine insert.
I appreciate that and hate to make myself sound ancient, but I prescribed "unapproved colchicine" for over 20 years without having any problems. Patients never complained about the cost of the medicine. No one had to grovel for drug company handouts. I know the FDA has people on staff who are brighter than me, but I really wish they had resisted the temptation to tamper with success. They should have remembered the golden rule of medicine: First do no pharm!
Dr. Greenbaum is a rheumatologist who practices in Greenwood, Ind. This column, "Inside Rheum," appears regularly in Rheumatology News, a publication of Elsevier.