Monday, June 16, 2014

Idenix and Merck!

I have been traveling in Italy (for pleasure) for the first time in a long time.  Coincidentally, I heard the news about Merck and Idenix just before leaving. When I worked for Idenix I was responsible for an anti-viral drug screening group in Sardinia, Italy and traveled there very regularly. That group has long since been disbanded. Some of the approaches to drug discovery initiated by the Idenix team in Sardinia and improved and continued by the Idenix team in Cambridge, MA, helped lead to the Hepatitis C drugs that, in turn, led to the purchase of Idenix by Merck that was announced last week. One big regret is that I no longer have any Idenix stock!

Unlike HIV and Hepatitis B, Hepatitis C is a curable infection.  Yes cure!  The right drugs taken for the appropriate length of time (anywhere from 6 to 24 months) can actually cure the disease with no need for further therapy. Today, therapies have efficacies that are improving on the paltry 50% cure rates with interferon/ribavirin.

As we all know, the Holy Grail for the treatment of Hepatitis C infection is to completely replace the toxic combination of ribavirin and interferon, both of which target host functions, with specific and non-toxic anti-viral drugs.  We are now very close to having achieved that goal and the race is on to see which combination of drugs will ultimately win.  The purchase of Idenix by Merck shows how important winning is to pharmaceutical companies.  Even though HCV is a disappearing disease in many parts of the world, the numbers of previously infected patients requiring treatment remain very large.  With non-toxic treatments, many more patients would probably be candidates for therapy since now, only those with progressive disease are treated with the unpleasant and sometimes dangerous therapies currently available. The Gilead HCV drug has apparently had a world record launch in sales (dollar volume) in spite of its price of over $80,000 per course of therapy. This is a glimpse of the future.

In comparing the excitement about the revolution in Hepatitis C therapy, I can only be chagrined by the lack of a similar excitement about antibacterial drugs.  I can see new and exciting approaches to antibiotics targeting resistant pathogens in the very near future. I see the regulators adjusting to this new world and making these new approaches possible. I see antibiotics that specifically hit only a single pathogen and I can see those antibiotics being used by physicians.  This is a world that I would not have thought possible just a few years ago, but it is a world that is surely coming. Yet we still have to worry about companies abandoning antibiotics research. We still have executives at large companies who lack this sort of vision.  We have small companies, like Idenix, with vision and drive who die for lack of funds.  Investors look at what large pharma is doing and shy away.  If it hadn’t been for Cubist, we could have given up hope altogether.  Their purchase of both Optimer and Trius last year buoyed the hopes of investors and of other small companies and privately funded biotechs. If only AstraZeneca was more like Cubist!

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