Rituxan, which is primarily a treatment for a form of blood cancer, is also approved as a second-line treatment for rheumatoid arthritis, meaning that it should only be used if other treatments fail. That restriction limits its sales. Rituxan has a risk of serious side effects including a profound suppression of the patient's immune system and a devastating brain condition called PML. Mary Merrick received Rituxan as a first-line treatment in 2009 and died of PML the same year. Her family alleged that she would not have received the drug if Genentech were not promoting it off-label.
Rumors of off-label Rituxan promotion have dogged Genentech for years. Some examples:
- The company received a Department of Justice subpoena for Rituxan documents in 2004. Genentech said "the civil matter is still ongoing" in 2008 (see page 101), just before it was acquired by Roche.
- When the subpoena was first disclosed it was widely regarded as a probe into off-label selling.
- Genentech has been sued by one of its own employees alleging Rituxan was promoted off-label.
- And the Missouri federal case is not the only one filed by a patient alleging off-label Rituxan promotion.
- There's also plenty of research interest in off-label Rituxan use.
- And Genentech's employees gossip about the issue on Cafe Pharma, the anonymous bulletin board for pharmaceutical company employees.
... Plaintiffs assert only that, based on information they obtained through the Genentech website, "it is hard to believe as the Senior Oncology Clinical Coordinator that [Guccione] is not involved in the marketing, administration, and sale of a drug prescribed by oncologists."As the plaintiffs didn't bring forward any actual evidence alleging off-label activity, the case was dismissed.