Kindeva‘s sponsor seminar, “Balancing Patient Needs and Sustainability in Inhaled Therapies: Looking Forward to the Next Generation of pMDIs,” reviews possible new propellants as well as the possibility of reducing propellant using lower valve volumes where possible, reducing plastic, and the use of smart devices to improve adherence.
In regards to HFA 152a, Kindeva’s Phil Cocks notes that HFA 152a has higher GWP than some of the other proposed propellants, which could leave MDIs vulnerable to further changes in future, but says that “even with this in mind, this is currently the most realistic option for reducing the environmental impact of the pMDI product in the medium to long term.” In the longer term, he suggests that HFO 1234 “looks like one to watch,” and he teases a possible presentation of data later this year at DDL 2020 about feasibility work performed at 3M on a non-synthetic, novel, ultra-low GWP propellant that “has already started to show some promise.”
In his talk on “F-Gas Regulations and Beyond: Clinical and Economic Factors that will Drive Propellant Transition,” John Pritchard agrees that HFO 1234 “is clearly the most attractive propellant because it has a global warming propellant that is less than CO2; however,” he cautions, “it is a higher cost, so that might present problems when it comes to trying to develop replacements for older genericized products, particularly reliever medication.”
Pritchard also notes that the cost of existing medical grade propellants is likely to rise as non-medical uses are reduced and suggests that 2025, when a 40% reduction in use of HFAs is scheduled under the Montreal Protocol, may be “a tipping point” that could lead to a possible 5-6 fold increase in medical propellant cost. As a result, he warns, companies that are not currently investing in alternative propellants may already be too late.
Greg Anderson of Pharmacentric Solutions mentions pressures from payers and patients in his presentation titled, “The Sustainable Smart Inhaler Challenge: Learning from Non-Pharma Industry Trends and Drivers.” He suggests that the drive for more sustainable OINDPs needs to come from top down to align the various companies involved and to set standards for things like materials, recycling strategies and, in the future, common app interfaces.
Calling propellants “the elephant in the room as far as sustainability is concerned,” Anderson cites the potential for increased tax on devices if industry does nothing. He also emphasizes the need for better inhaler use strategies such as audio-guided delivery, saying, “Poor adherence is never green,” and advises development of a training strategy in parallel with device development.
