enhancing the drug discovery pipeline – a perspective on cv drugs patrick vallance head of drug...
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Enhancing the drug discovery pipeline – a perspective on CV drugs
Patrick Vallance
Head of Drug Discovery, GSK
Scientific publications in biomedicine
A disconnect between discovery and invention?
New Medicines
Source: Burrill & Company; US Food and Drug Administration.Note: NMEs do not include BLAs
26 2522
28
53
39
30
35
2724
17
21
31
18 18
14
$12 $13 $13$15
$17$19
$21$23
$26
$30$32 $33
$39 $39
$43
$54
0
10
20
30
40
50
60
0
5
10
15
20
25
30
35
40
45
50
$55
New Drug Approvals (NMEs) PhRMA Member R&D Spending
New
Dru
g App
rova
ls (N
MEs)
Pha
rma
R&
D ($
billi
ons)
92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07
R&D Productivity Gap
The realities of having the best pipeline
0.0x 0.1x 0.2x 0.3x 0.4x 0.5x 0.6x 0.7x
Lehman Brothers PharmaPipelines (Sept 2007)Pharma Replacement Power – NPV
Pipeline renews 60% of sales
LB Method: [NPV of recent launches (06-07) + NPV of pipeline opportunities from ‘08-’13] / NPV of products marketed before 2006.
GlaxoSmithKlineMerck
Bristol Myers Squibb
Novartis
Johnson & Johnson
Sanofi-Aventis
AstraZeneca
Pfizer
Wyeth
Eli Lilly
Roche
Abbott Labs
Schering Plough
AVERAGE
R&D for a New Medicine: 10+ years, $1 bn+
Sources: Drug Discovery and Development: Understanding the R&D Process, www.innovation.org; CBO, Research and Development in the Pharmaceutical Industry, 2006
IndefiniteIndefinite
Drug Drug DiscoveryDiscovery PreclinicalPreclinical Clinical TrialsClinical Trials
RegulatoryRegulatoryReviewReview
Scale-Up to Scale-Up to ManufactureManufacture
Post-Post-MarketingMarketing
SurveillanceSurveillance
1Approved
NewMedicine
0.5 – 2 0.5 – 2 YearsYears6 – 7 Years6 – 7 Years3 – 6 Years3 – 6 Years
Number Of Patients / Subjects
PhasePhaseII
PhasePhaseIIII
PhasePhaseIIIIII
55250250~ 5,000 – ~ 5,000 – 10,00010,000
CompoundsCompounds
Pre
-Dis
cove
ryP
re-D
isco
very
20 – 100
100 – 500 1,000 – 5,000
IND
Sub
mitt
ed
ND
A S
ubm
itted
… … a big challenge for addressing both developed and developing world diseasesa big challenge for addressing both developed and developing world diseases
Reintroduce Scientific Judgement
CEEDD
Evolution From Monolith
Virtualization of Drug
Discovery
External
Internal
CEDD/DPUs
Pharma
CentralizedControl/Management
De-CentralizedControl/Management
The Market
Source: Pharma Pipelines – Strategic Analysis and Conclusions 2006 – Lehman Brothers
The Lehman Brothers analysis of predicted global sales for 2006 does not include generic drugs and estimates that their database captures 80% of branded drug sales.
Diabetes, cancer and inflammation projected to be the biggest growth opportunities
2006 Estimated Global Sales
18,
808
43,
928
15,
337
11,
549
65,
275
17,
793
76,
850
26,
875
19,
481
39,
910
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
Diabet
es
Cance
r
Infla
mm
atio
n
Derm
atolo
gy
Met
abolis
m/E
ndocrin
ology
Drugs
Genito
-Urin
ary
Haem
atolo
gy
Sexual
Dys
funct
ion
Imm
une Sys
tem
Ophthal
mic
Dru
gs
CNS
Respira
tory
2005 - 2010 Market Growth p.a.
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
Diabet
es
Cance
r
Infla
mm
atio
n
Derm
atolo
gy
Met
abolis
m/E
ndocrin
ology
Drugs
Genito
-Urin
ary
Haem
atolo
gy
Sexual
Dys
funct
ion
Imm
une Sys
tem
Ophthal
mic
Dru
gs
CNS
Hormone
Control
Cardio
vasc
ular
Respira
tory
Gastro
inte
stin
al
Anti-In
fect
ives
Hormone
Control
Cardio
vasc
ular
Gastro
inte
stin
al
Anti-In
fect
ives
Glo
bal
Sal
es
$m
Separately, composite median lead project interval duration times by phase of development for CV&M are as follows
1.5
2.0
1.1
1.2
1.2
0.8
1.9
2.2
0.8
2.2
2.0
1.3
2.3
4.4
1.6
1.8
1.7
1.5
0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0
CV
Cardiac therapy
Lipid lowering
Metabolics
Diabetes
Obesity
Median Project Interval Duration Times in Years, 2001-2005
Phase 1 Phase 2 Phase 3
Source: CMR International, 2006 Global R&D Performance MetricsProgramme Report, May 2006
R&D for a New Medicine: 10+ years, $1 bn+
Sources: Drug Discovery and Development: Understanding the R&D Process, www.innovation.org; CBO, Research and Development in the Pharmaceutical Industry, 2006
IndefiniteIndefinite
Drug Drug DiscoveryDiscovery PreclinicalPreclinical Clinical TrialsClinical Trials
RegulatoryRegulatoryReviewReview
Scale-Up to Scale-Up to ManufactureManufacture
Post-Post-MarketingMarketing
SurveillanceSurveillance
1Approved
NewMedicine
0.5 – 2 0.5 – 2 YearsYears6 – 7 Years6 – 7 Years3 – 6 Years3 – 6 Years
Number Of Patients / Subjects
PhasePhaseII
PhasePhaseIIII
PhasePhaseIIIIII
55250250~ 5,000 – ~ 5,000 – 10,00010,000
CompoundsCompounds
Pre
-Dis
cove
ryP
re-D
isco
very
20 – 100
100 – 500 1,000 – 5,000
IND
Sub
mitt
ed
ND
A S
ubm
itted
… … a big challenge for addressing both developed and developing world diseasesa big challenge for addressing both developed and developing world diseases
11
Role of Lipoprotein-Associated Phospholipase A2 (Lp-PLA2) in
Atherosclerosis and its Potential as a Therapeutic Target
Elevated Lp-PLA2 is Consistently Associated with Increased Risk for Cardiovascular Disease
Packard (WOSCOPS) – CAD2000
Blake (WHS) – CAD 2001Blankenberg (AtheroGENE) – CAD 2003Ballantyne (ARIC) – CHD (LDL < 130) 2004Winkler – CAD 2004Oei (ROTTERDAM) – CAD 2005Brilakis (Mayo Heart) – CAD 2005Ballantyne (ARIC) – Stroke 2005Oei (ROTTERDAM) – Stroke 2005Winkler (LURIC) – CAD 2005Khuseyinova (HELICOR) – CAD 2005Koenig (KAROLA) – CVD 2005May (Intermountain Heart) – CAD 2006Caslake (PROSPER) – CVD 2006Jenny (CHS) – MI 2006Daniels (Rancho Bernardo) – CAD 2006Elkind (NOMAS) – Stroke 2006O’Donoghue (PROVE IT) - CVD 2006Corsetti (THROMBO) - CAD 2006Gerber (Olmsted Cty) – Death post MI 2006Oldren (GUSTO/FRISK) – ACS 2007Sabatine (PEACE) – CVD 2007Persson (Malmo) – CVD 2007Möckel (NOBIS-II) – CVD 2007Hatoum (NHS) – CVD 2007
0.5 4.51 1.5 2 2.5 3 3.5 4CorsonCorson et al. et al. Am J Cardiol. 2008;101(suppl):41F-50F.Am J Cardiol. 2008;101(suppl):41F-50F.
Kolodgie et al Arterioscler Thromb Vasc Biol. 2006:26:2523
Lp-PLA2 is greatly up-regulated in high risk coronary artery lesions
Lp-PLA2
IHC
H&E
staining
B. Two animals from Darapladib-treated
A. Two animals from Control group
Two worst proximal LAD Lesions
Darapladib Reduced Complexity of Coronary Lesions in DM/HC Swine
NC NC
▪ No/little necrotic core▪ Smaller lesions▪ Intact media▪ Reduced macrophages
▪ Large necrotic core (NC)▪ Medial destruction (arrow)
15
Darapladib HL/DM Porcine Study: Plasma Lp-PLA2 Activity
Month
0 1 2 3 4 5 6 7
Pla
sm
a L
p-P
LA
2 a
cti
vit
y
0
20
40
60
80
100
120
Control (n=17)
SB480848 (n=20)
Induction Treatment Diabetes +Hypercholesterolemia
16
Direct inhibition in plaque with an Lp-PLA2 inhibitor
Pre-surgical dosing (14 days) in patients undergoing carotid endarterectomy
placebo low dose high dose
Pla
qu
e L
p-P
LA
2 A
cti
vit
y
(nm
ol/m
in/m
g p
rote
in)
0
0.2
0.4
0.6
0.8
1A. Lp-PLA2
n=30 n=29n=30
*
*
Baseline
Follow-up
3.59 mm2, 54%0.56 mm2,
9%
1.94 mm2, 30%
0.42 mm2,7%
5.18 mm2, 68%
1.74 mm2, 23%
0.56 mm2, 7%
0.16 mm2, 2%
Placebo: Necrotic Core Progression
Lp-PLA2 : The current evidence
PRECLINICAL: reduces coronary atherosclerosis (DM/HC pig)
HUMAN ATHEROMA:
downregulates plaque Lp-PLA2 activity
SYSTEMIC EFFECTS:sustained inhibition of Lp-PLA2
activity on background of intensive statin therapy
FUNCTIONAL:higher plasma Lp-PLA2 levels coronary endo dysfunction
PATHOLOGY:
upregulation of Lp-PLA2 in TCFA and ruptured VP
EPIDEMIOLOGY: higher plasma levels predict CV events
OBJECTIVE
Reduction in CV events with an Lp-PLA2
inhibitor
CORONARY IMAGING:
IBIS-2
Association studies
OUTCOMES TRIALS:
High risk 2o prevention population
Intervention with darapladib
oxLDLLp-PLA2oxLDLLp-PLA2oxLDLLp-PLA2
R&D for a New Medicine: 10+ years, $1 bn+
Sources: Drug Discovery and Development: Understanding the R&D Process, www.innovation.org; CBO, Research and Development in the Pharmaceutical Industry, 2006
IndefiniteIndefinite
Drug Drug DiscoveryDiscovery PreclinicalPreclinical Clinical TrialsClinical Trials
RegulatoryRegulatoryReviewReview
Scale-Up to Scale-Up to ManufactureManufacture
Post-Post-MarketingMarketing
SurveillanceSurveillance
1Approved
NewMedicine
0.5 – 2 0.5 – 2 YearsYears6 – 7 Years6 – 7 Years3 – 6 Years3 – 6 Years
Number Of Patients / Subjects
PhasePhaseII
PhasePhaseIIII
PhasePhaseIIIIII
55250250~ 5,000 – ~ 5,000 – 10,00010,000
CompoundsCompounds
Pre
-Dis
cove
ryP
re-D
isco
very
20 – 100
100 – 500 1,000 – 5,000
IND
Sub
mitt
ed
ND
A S
ubm
itted
… … a big challenge for addressing both developed and developing world diseasesa big challenge for addressing both developed and developing world diseases
ScientificOpportunity
ScientificOpportunity
Patient needPatient need
Market sizeMarket size
How should we choose where to invest discovery effort?
External Internal
Pipeline strength
Organisationalstructure
Scientific publications in biomedicine
A disconnect between discovery and invention?
New Medicines
The opportunity has never been greater