REG - GSK PLC - Statement: Zantac (ranitidine) litigation

GSKAnnouncement

12/08/2022 07:01

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RNS Number : 7855V  GSK PLC  11 August 2022

Issued: 11 August 2022, London UK

 

 

 

Statement: Zantac (ranitidine) litigation

 

·   FDA and EMA have concluded there is no evidence of a causal association
between ranitidine therapy and the development of cancer.

·   Substantial scientific evidence supports FDA/EMA conclusion.

·   Plaintiff litigation inconsistent with the scientific consensus, GSK
will vigorously defend all claims.

 

 

 

In response to recent speculative commentary regarding U.S. Zantac litigation,
GSK plc (LSE/NYSE: GSK) today issued the following statement regarding Zantac
(ranitidine) and N-nitrosodimethylamine (NDMA).

 

There have been no material developments to what has been previously
disclosed.

 

GSK, independent cancer researchers, the U.S. Food & Drug Administration,
and the European Medicines Agency, have all undertaken extensive reviews of
available data and conducted numerous investigations into this issue since
2019.

 

Based on these investigations and experiments, GSK, the FDA, and the EMA have
all independently concluded that there is no evidence of a causal association
between ranitidine therapy and the development of cancer in patients.

·      In November 2019, the FDA determined that levels of NDMA in
ranitidine products are similar to levels in common foods like grilled and
smoked meats, and that it would conduct tests to fully understand if
ranitidine forms NDMA in the human body.

·   In September 2020, the EMA's comprehensive review of epidemiological
and post marketing data concluded there is "no evidence of a causal
association between ranitidine therapy and the development of cancer in
patients."

·      In June 2021, the FDA reported that its testing did not support
that ranitidine is converted to NDMA in a general, healthy population, and
after reviewing the epidemiological studies found that "…no consistent
signals emerged across studies, and studies with comparison to active controls
found no association between ranitidine and overall or specific cancer
risk."

These conclusions pertain to all forms of cancer, including but not limited to
bladder, breast, colorectal, esophageal, kidney, liver, lung, pancreatic,
prostate, and stomach.  Even epidemiologic experts hired by the
Multi-District Litigation (MDL) Plaintiffs' Steering Committee concluded in
their expert reports that the "evidence was not sufficient to support an
opinion that use of ranitidine can cause breast, prostate, kidney, lung, or
colorectal cancer."

 

Scientific Research

 

Since the issue concerning the presence of NDMA in ranitidine arose in 2019,
the scientific community has actively focused on understanding whether there
is a link between ranitidine and cancer. There have been 11 epidemiological
studies conducted in that time looking at human data regarding the use of
ranitidine.

 

The resulting scientific consensus is that the totality of the reliable
evidence does not support that ranitidine increases the risk of any type of
cancer:

 

·     Adami et al. (2021): "If a causal association existed, we would
expect to observe stronger associations with a larger number of prescriptions
and, most likely, with longer follow-up, yet such patterns were not evident."
"Our results, which do not support any carcinogenic effect on esophagus,
stomach, liver or pancreas, should be reassuring for millions of concerned
past users of ranitidine."

·   Cardwell et al. (2021): " T here was little evidence of difference in
bladder cancer risk when directly comparing ranitidine users with users of
non-ranitidine histamine-2 receptor agonists," but "…the use of ranitidine
particularly long term use was associated with an increased risk of bladder
cancer [compared to non-use or PPIs]."  Further studies are necessary to
attempt to replicate this finding.

·      Norgaard et al. (2021): Compared to H2RAs and compared to PPIs,
"we did not observe any consistent or substantial increase in risks of bladder
cancer and we consistently across sub-analyses observed no increased risk  of 
kidney cancer in ranitidine users," and "we found no dose-response association
[with bladder cancer] when restricting to persons who redeemed at least five
and persons who redeemed at least 10 prescriptions," and "starting follow-up
time 10 years after the 10(th) prescription did not suggest any associations
[with bladder cancer]."

·     Iwagami et al. (2021): "…we found no evidence of an increased risk
of cancer in people receiving ranitidine and nizatidine compared with people
receiving other H2 blockers overall, by follow-up length, by cumulative dose,
or by cancer site.  These results may alleviate concerns of patients exposed
to ranitidine/nizatidine, although further research with longer follow-up and
including older people may be needed."

·    Kantor et al. (2021): "Ranitidine use was not associated with overall
cancer risk . . .  or  with risk of common cancers (lung, breast, prostate,
and colorectum). . . . Compared to non-use, ranitidine use was positively
associated with liver cancer; however, this association was attenuated when
directly compared to omeprazole, which may reflect residual confounding by
indication (or another jointly-related factor)."

·      Kim S. et al. (2021): "We found no significant difference in
terms of gastric cancer development among the three study groups (control,
other histamine-2 blockers, and ranitidine), suggesting that the intake of
ranitidine, even if it contains NDMA, may not be associated with an increased
risk of developing gastric cancer."

·      Kumar et al. (2021): " O ur results . . . demonstrate that the
true gastric carcinogenic impact of NDMA 1  containing ranitidine in persons
in the US with HP (H. pylori) is likely minimal to nonexistent, providing
reassurance to those who have taken ranitidine . . . . In time-specific
analyses, there was no period in which ranitidine was associated with future
GC [gastric cancer], suggesting there is no discernable difference in
formulation of the medication over time." "There is no demonstrable
association between ranitidine use and future gastric cancer among individuals
with HP on long-term acid suppression."

 

·   Liu et al. (2020): "Our results revealed a marked increase in the
prescription of acid-suppression medications immediately before gastric cancer
diagnosis suggesting the role of reverse causation."

 

·   Kim YD et al. (2021): "Use of ranitidine was not associated with an
increased odds of developing gastrointestinal malignancies compared to
omeprazole or famotidine use."

·     Yoon et al. (2021): "We found no evidence that exposure to NDMA
through ranitidine increases the risk of cancer."

·   McDowell et al. (2021): "Only two medicines were significantly
associated with an increased risk of pancreatic cancer [metronidazole and
ranitidine]. However, neither exhibited strong evidence of an
exposure-response relationship with cancer risk."

 

Litigation status

 

GSK has been named as a defendant in approximately 3,000 filed personal injury
cases in federal and state court and numerous unfiled claims registered in a
census established by the Court presiding over the Zantac Multidistrict
Litigation (MDL) proceeding. Class actions alleging economic injury and a
third-party payer class action also have been filed in federal court.

 

In the MDL, plaintiffs were required to identify the types of cancer that they
wished to pursue and identified 10 different types. In November 2021,
plaintiffs withdrew from consideration breast cancer and kidney cancer,
reducing the number of types of cancer from 10 to 8. In January 2022, the MDL
plaintiffs withdrew from consideration colorectal, prostate, and lung and will
proceed only as to the following five types of cancer: bladder, esophageal,
gastric, liver, and pancreatic, although plaintiffs in state courts continue
to pursue these claims.

 

On 6 February 2020, the US product liability litigation was assigned MDL
status in the Southern District of Florida. The Group has filed several rounds
of Motions to Dismiss in the MDL resulting in the following position: 1) the
Court ruled in favour of the Group's motion on innovator liability; that issue
is on appeal; 2) the Court ruled in favour of Defendants with respect to the
Third Party Payor Class Action; Plaintiffs opted not to replead their action
and these issues are now on appeal; 3) the Court dismissed RICO claims from
the Economic Loss Class Action but allowed the class to move forward on
plaintiffs misbranding theory; and 4) the Medical Monitoring and Economic Loss
class actions are allowed to move forward. Generics, retailers, and packagers
have been dismissed from the cases.

 

Outside the US, there are several class actions and in excess of 100 personal
injury cases pending against GSK in Canada, along with a class action in
Israel. Among the state court cases naming GSK, a trial in California is
currently scheduled to begin 13 February 2023 and trials in Madison County,
Illinois are to proceed on 22 August 2022 and February 2023.

 

Whilst GSK has served Haleon with notice of potential claims in relation to
possible liabilities connected to OTC Zantac under the relevant
indemnification provisions, contained in the documentation relating to the
formation of the Consumer Healthcare JV, it is not possible, at this stage, to
meaningfully assess whether the outcome will result in a probable outflow, or
to quantify or reliably estimate what liability (if any) that Haleon may have
to GSK under the relevant indemnities.

 

The overwhelming weight of the scientific evidence supports the conclusion
that there is no increased cancer risk associated with the use of ranitidine.
Suggestions to the contrary are therefore inconsistent with the science, and
GSK will vigorously defend itself against all meritless claims alleging
otherwise.

 

About GSK

GSK is a global biopharma company with a purpose to unite science, technology,
and talent to get ahead of disease together. Find out more at gsk.com/company
(https://www.gsk.com/en-gb/company/)

 

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Cautionary statement regarding forward-looking statements

GSK cautions investors that any forward-looking statements or projections made
by GSK, including those made in this announcement, are subject to risks and
uncertainties that may cause actual results to differ materially from those
projected. Such factors include, but are not limited to, those described in
the Company's Annual Report on Form 20-F for 2021, GSK's Q2 Results for 2022
and any impacts of the COVID-19 pandemic.

 

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