Anticancer medicines prescribed to study participants
| Sr. No | Medicine and dose | ATC code | f (n=10103) %* | Trend† | OB (manufacturer/importer) | f‡ (n=6566) | Per-month cost (US$) | LPG (manufacturer/importer) | f§ (n=3537) | Per-month cost (US$) |
| (A) Non-biologics (96.3%, n=9729) | ||||||||||
| (i) Alkylating agent (10.6%, n=1026) | ||||||||||
| 1 | Cyclophosphamide 500 mg inj | L01AA01 | 877 (19.6) | High | Cyclomide (Pharmedic) | 619 (13.8) | 50.9 | Cyclophosphamide (S. Ejazuddin) | 258 (5.8) | 27.2 |
| 2 | Ifosfamide 1 g inj | L01AA06 | 71 (1.6) | Low | Ifosfamin (Pharmedic) | 44 (0.9) | 108.7 | Fosfamin (CCL) | 27 (0.6) | 108.7 |
| 3 | Temozolomide | L01AX03 | 4 (0.1) | Temoside (A. J. Mirza) | 4 (0.1) | 561.7 | NA | NA | NA | |
| 4 | Dacarbazine 200 mg inj | L01AX04 | 74 (1.7) | Low | Duticin (Al-Habib) | 36 (0.8) | 24.5 | Darbazine (Pharmedic) | 38 (0.9) | 22.7 |
| (ii) Hormone antagonist (4%, n=388) | ||||||||||
| 5 | Tamoxifen 20 mg tab | L02BA01 | 71 (1.6) | Low | Tamox (Pharmedic) | 49 (1.1) | 5.4 | Tamooxe (Al-Habib) | 22 (0.5) | 4.1 |
| 6 | Bicalutamide 50 mg tab | L02BB03 | 109 (2.4) | Low | Casodex (ICI) | 67 (1.5) | 114.5 | Calutide (A. J. Mirza) | 42 (0.9) | 39 |
| 7 | Anastrozole 1 mg tab | L02BG03 | 71 (1.6) | Low | Anastrozole (Novartis) | 43 (0.9) | 54.4 | Femizet (Atco) | 28 (0.6) | 46.5 |
| 8 | Letrozole 2.5 mg tab | L02BG04 | 71 (1.6) | Low | Femara (Novartis) | 52 (1.2) | 79 | Letara (A.J. Mirza) | 19 (0.4) | 46.2 |
| 9 | Cyproterone Acetate 50 mg tab | G03HA01 | 66 (1.5) | Low | Androcur (Bayer) | 66 (1.5) | 32.5 | NA | NA | NA |
| (iii) Antimetabolite (21.5%, n=2089) | ||||||||||
| 10 | Pemetrexed | L01BA04 | 11 (0.3) | Low | Alimta (Eli Lilly) | 11 (0.3) | 1712.3 | NA | NA | NA |
| 11 | Mercaptopurine 50 mg tab | L01BB02 | 111 (2.5) | Low | Mercaprine (Pharmedia) | 87 (1.9) | 6.7 | Purinetone (Al- Habib) | 24 (0.5) | 5.7 |
| 12 | Fludarabine phosphate 50 mg inj | L01BB05 | 180 (4.0) | Low | Fludara (Sanofi aventis) | 98 (2.2) | 600.8 | Fludakebir (Oncogene) | 82 (1.8) | 420.4 |
| 13 | Cytarabine 100 mg inj | L01BC01 | 342 (7.6) | Medium | Cytosar (Pfizer) | 113 (2.5) | 24.5 | Cytarabine (Highnoon) | 229 (5.1) | 16.2 |
| 14 | Fluorouracil 500 mg inj | L01BC02 | 502 (11.2) | High | Pharmauracil (Pharmedic) | 361 (8.1) | 17.6 | Secouracil (S. Ejazuddin) | 141 (3.1) | 1.6 |
| 15 | Gemcitabine 1 g inj | L01BC05 | 685 (15.3) | High | Gemzar (Eli lilly) | 402 (8.9) | 580 | Gemita (Atco) | 283 (6.3) | 377.4 |
| 16 | Capecitabine 500 mg tab | L01BC06 | 258 (5.8) | Medium | Xeloda (Roche) | 258 (5.8) | 226.5 | NA | NA | NA |
| (iv) Cytotoxic antibiotics (11.9%, n=1155) | ||||||||||
| 17 | Dactinomycin 0.5 mg inj | L01DA01 | 71 (1.6) | Low | Dactinomycin (Al-Habib) | 12 (0.3) | 259.3 | Dactinofin (Pharmedic) | 59 (1.3) | 213.1 |
| 18 | Doxorubicin 50 mg inj | L01DB01 | 385 (8.6) | Medium | Adriblastina (Pfizer) | 213 (4.8) | 40.7 | Doxorubicin (Al- Habib) | 172 (3.8) | 28.7 |
| 19 | Daunomycin 20 mg inj | L01DB02 | 111 (2.5) | Low | Daunoblastina (Pfizer) | 79 (1.8) | 61.2 | D-Blastin (Pharmedic) | 32 (0.7) | 51.6 |
| 20 | Epirubicin 50 mg inj | L01DB03 | 427 (9.5) | Medium | Farmorubicin (Pfizer) | 223 (4.9) | 120.2 | Anthracin (Atco) | 204 (4.6) | 86.2 |
| 21 | Idarubicin | L01DB06 | 5 (0.1) | Low | Zavedos (Pfizer) | 5 (0.1) | 273.4 | NA | NA | NA |
| 22 | Mitoxantrone 20 mg inj | L01DB07 | 43 (1.0) | Low | Mitoxantrona (Atco) | 43 (1.0) | 36.2 | NA | NA | NA |
| 23 | Bleomycin 15 mg inj | L01DC01 | 42 (1.0) | Low | Bleomycin (Pharmedic) | 31 (0.7) | 90.2 | Bemocin (Atco) | 11 (0.3) | 72.5 |
| 24 | Mitomycin 10 mg inj | L01DC03 | 71 (1.6) | Low | Mitocin (Pharmedic) | 42 (0.9) | 20.4 | Mitomycin (S.Ejazuddin) | 29 (0.7) | 2.1 |
| (v) Plant alkaloids (20%, n=1949) | ||||||||||
| 25 | Vinblastine 10 mg inj | L01CA01 | 42 (1.0) | Low | Velbastine (Al-Habib) | 19 (0.4) | 37.7 | Vinblas (Pharmedic) | 23 (0.5) | 25.4 |
| 26 | Vincristine 2 mg inj | L01CA02 | 522 (11.6) | High | Pharmacristine (Pharmedic) | 304 (6.8) | 14.3 | Vincristine Gador (Seignior) | 218 (4.8) | 10.2 |
| 27 | Vinorelbine 50 mg inj | L01CA04 | 71 (1.6) | Low | Vinelbine (Atco) | 36 (0.8) | 303.3 | Vinkebir (Oncogene) | 35 (0.8) | 303.3 |
| 28 | Etoposide 100 mg inj | L01CB01 | 1219 (27.2) | High | Etoposide (Pfizer) | 714 (15.9) | 64.8 | Lymphoside (CCL) | 505(11.3) | 44.9 |
| 29 | Paclitaxel 260 mg inf | L01CD01 | 71 (1.6) | Low | Intaxel (Atco) | 55 (1.2) | 313.5 | Paclixil (A.J. Mirza) | 16 (0.4) | 313.5 |
| 30 | Docetaxel 80 mg inj | L01CD02 | 18 (0.4) | Low | Taxotere (Sanofi aventis) | 6 (0.1) | 688.6 | Docekebir (Oncogene) | 12 (0.3) | 674.1 |
| 31 | Cabazitaxel | L01CD04 | 6 (0.1) | Low | Jevtana (Sanofi aventis) | 6 (0.1) | 3085.5 | NA | NA | NA |
| (vi) Other antineoplastic agents (31%, n=3007) | ||||||||||
| Platinum compounds | ||||||||||
| 32 | Cisplatin 50 mg inj | L01XA01 | 2276 (50.8) | High | Cisplasol (Pfizer) | 1584 (35.3) | 28.1 | Platosin (Pharmachemie) | 692 (15.4) | 15.9 |
| 33 | Carboplatin 150 mg inj | L01XA02 | 206 (4.6) | Low | Carpsol (Pfizer) | 114 (2.5) | 60.5 | Carboplatin (Atco) | 92 (2.1) | 27.2 |
| 34 | Oxaliplatin 100 mg infusion | L01XA03 | 288 (6.4) | Medium | Oxitan (Atco) | 202 (4.5) | 543.6 | Eloxatin (Sanofi aventis) | 86 (1.9) | 475.7 |
| Others | ||||||||||
| 35 | Hydroxyurea 500 mg cap | L01XX05 | 43 (1.0) | Low | Hydra (Medinet) | 22 (0.5) | 10.9 | Hydrine (Al-Habib) | 21 (0.5) | 10.6 |
| 36 | Topotecan | L01XX17 | 13 (0.3) | Low | Hycamtin (GSK) | 2 (0.04) | 2122.5 | Topokebir (Oncogene) | 11 (0.2) | 906 |
| 37 | Irinotecan 100 mg inj | L01XX19 | 181 (4.0) | Low | Campto (Pfizer) | 74 (1.7) | 1209.3 | Irinocan (Pharmedic) | 107 (2.3) | 645.5 |
| (vii) Other immunosuppressants (1.2%, n = 115) | ||||||||||
| 38 | Thalidomide 100 mg cap | L04AX02 | 43 (1.0) | Low | Thalido(Atco) | 43 (1.0) | 54.4 | NA | NA | NA |
| 39 | Methotrexate 10 mg tab | L04AX03 | 72 (1.6) | Low | Emthexate (Pharmachemie) | 53 (1.2) | 7.4 | Unitrexate (Al-Habib) | 19 (0.4) | 3.7 |
| (B) Biologics (3.7%, n=374) | ||||||||||
| Protein kinase inhibitors (94.3%, n=353) | ||||||||||
| 40 | Imatinib mesylate 400 mg tab | L01XE01 | 67 (1.5) | Low | Glivec (Novartis) | 67 (1.5) | 1268.4 | NA | NA | NA |
| 41 | Erlotinib | L01XE03 | 7 (0.1) | Low | Tarceva (Roche) | 7 (0.1) | 1514.2 | NA | NA | NA |
| 42 | Sunitinib 50 mg cap | L01XE04 | 67 (1.5) | Low | Sutent (Pfizer) | 67 (1.5) | 3557.3 | NA | NA | NA |
| 43 | Sorafenib 200 mg tab | L01XE05 | 43 (1.0) | Low | Nexavar (Bayer) | 43 (1.0) | 4218.3 | NA | NA | NA |
| 44 | Lapatinib 250 mg tab | L01XE07 | 43 (1.0) | Low | Tykerb (GSK) | 43 (1.0) | 1826.9 | NA | NA | NA |
| 45 | Nilotinib 200 mg cap | L01XE08 | 43 (1.0) | Low | Tasigna (Novartis) | 43 (1.0) | 4131.4 | NA | NA | NA |
| 46 | Pazopanib 400 mg tab | L01XE11 | 67 (1.5) | Low | Votrient (GSK) | 67 (1.5) | 1600.6 | NA | NA | NA |
| 47 | Ruxolitinib | L01XE18 | 16 (0.4) | Low | Jakavi (Novartis) | 16 (0.4) | 4014.7 | NA | NA | NA |
| Monoclonal antibodies (5.6%, n = 21) | ||||||||||
| 48 | Rituximab | L01XC02 | 3 (0.1) | Low | Mabthera (Roche) | 3 (0.1) | 6668.2 | NA | NA | NA |
| 49 | Trastuzumab | L01XC03 | 8 (0.2) | Low | Herceptin (Roche) | 8 (0.2) | 3805.2 | NA | NA | NA |
| 50 | Cetuximab | L01XC06 | 10 (0.2) | Low | Erbitux (Merck) | 10 (0.2) | 3356.7 | NA | NA | NA |
US$1=110.8 Pakistani rupees.
*Percentages given with respect to the total sample size of patients.
†Low prescribing trend (prescribed to <5% of the selected patients), medium prescribing trend (prescribed to ≥5% of the selected patients but <10%), high prescribing trend (prescribed to >10% of the selected patients).
‡Number (percentage) of patients prescribed OB.
§Number (percentage) of patients prescribed LPG.
ATC, anatomical therapeutic chemical; f, frequency; inj, injection; LPG, lowest price generic; NA, not available; OB, originator brand; tab, tablet.