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Dozens of illegitimate online pharmacies are selling imatinib, an oral chemotherapy drug for chronic myeloid leukemia (CML), putting patients at risk for toxicities and treatment failures, researchers found.

Of 44 online pharmacies selling the drug to U.S. customers, 52% of which were classified as "rogue," 30% as "unapproved," and 11% as "unclassified," 13 didn't require a prescription for imatinib, and only three asked about patients' health status, reported Sachiko Ozawa, PhD, MHS, of the University of North Carolina at Chapel Hill, and colleagues.

Of the three websites that were considered "certified," only one asked patients to fill out a health-related questionnaire, and most of the 44 websites (77%) did not provide a way for patients to consult with a pharmacist, they noted in the .

"We were struck by just how easy it is to buy an oral chemotherapy medication online, as imatinib is not a benign drug," said Ozawa .

The tyrosine kinase inhibitor can in CML when managed correctly. But even if the imatinib dispensed from online pharmacies is authentic, patients still need medical professionals to evaluate their medical history and other medications for potential drug interactions to avoid treatment failures, wrong doses, or toxicities, the authors noted.

"Given the need to dose-adjust imatinib for drug-drug interactions and organ dysfunction, taking the standard 400 mg daily amount may be life-threatening for some patients," they added.

Of note, 70% of the rogue websites and 60% of the unclassified websites did not impose any quantity control on how much imatinib patients were allowed to order at a time, Ozawa and team said, and 23% of the online pharmacies had no drug-related warnings on their websites.

Patients may turn to online pharmacies because of the cost of the drug, the authors noted. For imatinib's brand-name version, Gleevec, the median price available with a GoodRx coupon was $10,513.66 (range $9,968.87-$10,515.08) per month. For the rogue websites reviewed in the study, the median price for 30 pills was $2,704 (range $195-$4,597.99), and unapproved websites had a median price of $2,697.50 (range $1,682-$4,463).

"The exorbitant price of oncology drugs is a major barrier to optimal therapy of many malignancies, including CML," said Bernard Marini, PharmD, BCOP, of the University of Michigan College of Pharmacy, who was not involved in the study, in the press release.

But turning to online pharmacies, which can be hard to distinguish from legitimate pharmacies, can be risky at best, and life-threatening at worst.

Co-author Benyam Muluneh, PharmD, BCOP, CPP, also of the University of North Carolina at Chapel Hill, urged patients to consider speaking with a medical provider or financial advisor for help obtaining the expensive drug, noting that some foundation grants can also help patients with the cost.

For this study, Ozawa and team used the search term "buy imatinib online" on Google, Bing, Yahoo!, and DuckDuckGo and looked at the first 10 pages of results for each. Websites were included in the analysis if they were active, sold imatinib for shipment in the U.S., and were free to access.

Using LegitScript, which evaluates online pharmacies' compliance with regulations and laws, the researchers classified the online pharmacies from most to least safe.

The "rogue" classification meant that they were selling counterfeit, expired, misbranded, or fake products; selling drugs without prescriptions; and operating without valid pharmacy licenses.

The "unapproved" category meant they had some compliance or legal issues, like operating legally in one location but not in another, while "unclassified" meant that they weren't classified in LegitScript's database.

Because Ozawa and colleagues used only some search results, they estimated that the market is actually much larger than just the 44 pharmacies they found.

"Healthcare providers need to be aware of the prevalence of illegitimate online pharmacies and the dangers patients may face by utilizing them," they wrote.

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