Affairs of the Heart

  • by: |
  • 11/06/2007
Lots of info coming in about drugs in development then and now showing the (Critical) path forward is towards retargeting, retooling, repositioning drugs to specific groups and for monitoring risks and benefits post market...

1. Research from the studies showing that while Lilly's Prasugrel proved better able to prevent heart attacks than Plavix, the drug led to excess life threatening bleeding compared to Plavix at a statistically significant level in patients with acute coronary syndrome. But Lilly, consistent with a commitment to pharmacogenomics and targeted therapeutics has identified subgroups that are most likely to have that risk. The PI of the study, Dr. Elliot Antman, said that most of the bleeding was driven by two groups -- patients with a history of stroke or transient ischemic attacks and elderly, frail patients (older than 75 weighing less than 60 kg) -- who comprised 20% of the total population.

"For the remaining 80% of the patients, which I would say represented eight of 10 patients undergoing stenting, the drug works very well," Dr. Antman said in an interview.

Moreover, among one high-risk group -- diabetics -- "there was no excess bleeding and a 30% reduction in MIs compared with clopidogrel."

Wall Street sniffs that the market will be minimal. But Plavix goes off patent in 2011 while Lilly's drug could get a Pgx label with improved safety and benefit profiles. How minimal is that?

2. The CETP trilogy. Efforts to raise good cholesterol is the holy grail of the cardiovascular world Pfizer's drug sent torcetrapib chills down the spine of others developing drugs based this target. But further analysis shows that increased blood pressure and changes in electrolytes (which caused the heart attacks in Pfizer's drug study) signal the potential activation of the renin-angiotensin-aldosterone system (RAAS) by torcetrapib. The greater RAAS activation may weaken the benefit of raising HDL."

Translation: if your drug (Merck and BMS) doesn't activate the RAAS pathway or you can develop a blood test that predict who won't or will have that effect you might be able to bring other HDL drugs to market.
It's biomarker based research at it's best. Good news for patients. Bad news for Merrill Goozner and others who want to claim biomarkers are just a tool for making drugs unsafe.

Center for Medicine in the Public Interest is a nonprofit, non-partisan organization promoting innovative solutions that advance medical progress, reduce health disparities, extend life and make health care more affordable, preventive and patient-centered. CMPI also provides the public, policymakers and the media a reliable source of independent scientific analysis on issues ranging from personalized medicine, food and drug safety, health care reform and comparative effectiveness.

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