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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