Kortenberg, 12 november 2023

Dear Sir, Madam,

With this letter we would like to reiterate our concern regarding the unavailability of Zypadhera on the Belgian market.

Zypadhera is a long-acting, injectable antipsychotic used to keep persons with chronic, severe psychotic illness stable. These patients have great difficulty maintaining a daily structure, their cognitive abilities are strained, and adherence to necessary treatment is an ongoing challenge. In many cases, Zypadhera is the only way to keep these psychologically very vulnerable, care-averse patients stable. Other injectable antipsychotics often lack efficacy, or produce unacceptable side effects in terms of movement. Peroral administration of the drug is not a valid alternative.

In the hospital, Zypadhera is initiated to achieve stable plasma concentration and psychological recovery so that patients can be oriented home. In the home setting, peroral intake requires intensive supervision by home nurses, which is not feasible in practice. It is likely that many psychotic patients will experience relapse, resulting in untold psychological, physical and financial suffering. The unavailability of the drug also causes enormous anxiety in many patients, which can be a trigger for decompensation.

It should be clear that Zypadhera is an essential and vital drug, and in that way similar to other medications for chronic diseases in somatic medicine such as diabetes and epilepsy, which we all believe should always be available to patients. It is unacceptable to patients, family members, and all mental health professionals that not everything possible is being done to keep this product available.

In your letter we read that the reasons for the unavailability for Zypadhera must be sought in challenges in logistics worldwide. Those same challenges were there when the company Lilly was market authorization holder. During that period, we never faced unavailability. We are shocked by the message in your mail that production capacity is limited, yet you encourage orders to be placed. How are we to understand this contradictory message?

The two largest associations for psychiatrists in Belgium, the Flemish Association for Psychiatry (VVP) and the Société Royale de Médicine Mental de Belgique, absolutely insist that you do everything you can to bring the necessary supply of Zypadhera up to date in the short term, so that our patients do not suffer any disadvantage due to the unavailability of the drug.

Kind regards,

Kirsten Catthoor, president Vlaamse Vereniging voor Psychiatrie

Juan Tecco, président Société Royale de Médicine Mental de Belgique