The pharmaceutical company, Cephalon Inc, is going through the motions of legitimizing the sale of Sparlon for the treatment of ADHD even though its active ingredient, modafinil, has been heavily promoted and sold under the name Provigil, for off-label treatment of ADHD by Cephalon for years.
Last October, the FDA sent an "approvable" letter to Cephalon for the pediatric use of Sparlon pending a March 23, 2006, meeting of the Psychopharmacologic Drugs Advisory Committee to review the drug’s approval.
Modafinil-based Provigil is currently only approved for narcolepsy, sleep apnea and shift work sleep disorder, according to the FDA. However, it is estimated that half of all Provigil prescriptions are written for off-label use.
"Doctors now prescribe it to treat everything from attention deficit hyperactivity disorder (ADHD) to fatigue associated with multiple sclerosis and depression," according to the November 1, 2004 Business Week Online.
Cephalon gets nearly half of its $1.2 billion in annual sales from modafinil. Its original patent ran out in December 2005. However, in a sweetheart deal, Cephalon agreed to pay 4 generic drug makers, including Mylan Laboratories and Teva Pharmaceutical, over $200 million to postpone marketing generic versions of the medication until October 2011, GoozNews reported on March 17, 2006.
In addition, the Cephalon will get a 6-month extension of that agreement if it wins a pediatric approval for the drug, according to documents filed with the Securities and Exchange Commission.
With Sparlon's application to FDA approval, Cephalon claimed 3 studies involving more than 600 children aged 6 to 17, found the drug to be more effective than a placebo.
Which says what? What does it mean to be more effective than a placebo? The question is, how many trials did it take to get the drug to win out over a placebo three times?
Each of the Sparlon studies lasted only 9 weeks and the most common side effects listed were mild insomnia, headaches and loss of appetite. Sparlon was "generally well-tolerated," Cephalon reported.
What does "generally well-tolerated," mean? Tolerated better than what? A placebo?
One study of 248 patients was published in December 2005 issue of Pediatrics, and said Sparlon's effectiveness and safety profile, along with its low potential for abuse, may offer doctors and parents a new option for children and adolescents with ADHD.
However, because the study only lasted 9 weeks, the authors said they did not know if "the initial benefits will be sustained over longer periods of time," and called for more research to assess the "longer-term efficacy and safety."
Dr DuBose Ravenel, MD, who will testify on behalf of the International Center for the Study of Psychiatry and Psychology at the advisory committee hearing on March 23, makes the point that although “48% of drug treated subjects at final follow-up were "much" or "very much" improved clinically, 52% were not.”
“This is a substantially lower response rate than has been reported for traditional stimulants,” the doctor notes.
Dr Dubose Ravenel is a pediatrician with 25 years experience in private practice with a heavy emphasis upon behavioral issues, including diagnosing and managing ADHD.
In addition, he notes, with regard to potential conflicts of interest, itemized conflicts for each of the Pediatric study’s authors are numerous.
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