Investigation of the Cost Impact of Chirality Status of the Most Commonly Consumed Drugs in Turkey

Chirality is among the factors impacting drug activity in terms of therapeutic or adverse effects. Pure enantiomeric drugs, presumed to offer greater benefits in accordance with this concept, have been recommended for new drug development. We aimed to analyse the chirality status of the commonly consumed drugs in Turkey and assess their cost implications. We evaluated top-selling 200 active substances using nationwide sales data from IQVIA Turkey, identifying chirality status of 173. These were categorized into “chiral mixtures”, “achiral”, and “pure enantiomers”, and their distribution and mean cost per unit (CPU) values by chirality status were examined. To examine the impact of chiral switching on expenses, CPUs of chiral-switched mixtures and resulting pure enantiomers, were compared. Among 173 compounds, 35.8% were achiral, 22.0% were chiral mixtures and 42.2% were pure enantiomers. Total cost was $2.09b, with pure enantiomers accounting for 46.4% and chiral mixtures 22.0%. Mean CPUs for pure enantiomers ($2.8±3.5), achiral drugs ($2.3±2.5), and chiral mixtures ($1.7±0.9) were similar (p>0.05). For drugs that underwent chiral switching, mean CPU of chiral mixtures ($1.4±0.4) was similar to that of pure enantiomers ($1.7±1.2), (p>0.05). Half of the chiral pairs that underwent switching had higher CPU for chiral mixture, while the other half had higher CPU for pure enantiomer. We demonstrated that pure enantiomers occupy a significant portion of top-selling drugs in Turkey. The observed cost similarity between commonly used pure enantiomers and chiral mixtures suggests that pure enantiomers may continue to gain preference in the market.