Friday, April 23, 2010

Tigecycline Bittersweet

I recently attended a large infectious diseases meeting in Europe.  There I saw a booth advertising for “Pfizer’s” tigecycline.  On my way to the posters, I stopped by the booth .  To my chagrin, I saw nobody I recognized.  And no one there knew me.  As some of you may know, I helped direct the preclinical and clinical development of tigecycline through Ph. II and into early Ph. III during the time I ran infectious diseases at Wyeth (now part of Pfizer).  I am still very proud of tigecycline because I think, now as back then, that it offers an important therapeutic alternative to patients with serious infections who have little other choice.  Some, possibly many, might say that tigecycline has so far failed to prove its efficacy in the most serious infections like hospital acquired and ventilator associated pneumonia.  I don’t argue with this.  Nevertheless, there is precious little else available for those with the most resistant infections and such patients can almost never be included in any significant numbers in our usual non-inferiority trials of antibiotics. 

I also saw a number of old colleagues from Wyeth who have scattered to the four winds.  Our last colleague standing from infectious diseases finally retired last month.  A number have found positions in the Pfizer/Wyeth vaccine group.  Luckily, my friends told me that, in fact, a few of the old Wyeth tigecycline people were actually at the meeting and that I just didn’t stop by the booth at the right time.  So I stopped again, and sure enough, several of the old tigecycline folks from the early 2000s were there and were working for Pfizer.

I happened to see an old colleague and friend from France at the meeting.  He always gives me a hard time about tigecycline.  He’s not a big fan.  He said that it is not used in France.  I responded that tigecycline brought in about $400 million last year – without France.  Like most antibiotics, tigecycline has had a slow uptake in the marketplace, but there is no arguing that it will be a commercially important product.

So the meeting brought me bittersweet reminders of tigecycline and the pharmaceutical industry in general.  I was reminded that tigecycline is an important product for patients and their physicians.  At the same time, it is achieving reasonable commercial success.  But most of the team who worked so hard and fought the good fight against all the naysayers in order to bring this product to the market in the first place, are long gone and are certainly under-appreciated by the new Pfizer/Wyeth.

For those interested in some of the history of tigecycline, Steve Projan wrote a wonderful reminiscence of Frank Tally’s days at Wyeth when he developed the concept for tigecycline and when the first compound related to tigecycline was tested in the clinic.
Clin Infect Dis. 2010 Jan 1;50 Suppl 1:S24-5.
Francis Tally and the discovery and development of tigecycline: a personal reminiscence.

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