Archive for July, 2007

Pricing and the incentives to innovate

Thanks to Derek Lowe for bringing to my attention Arnold Relman’s long-winded answer in the New Republic (reg. required) to Richard Epstein’s book on the drug industry, Overdose, published last year.  I thought I’d spend far less space than Dr. Relman illuminating some of the ‘facts’ he uses in his arguments against Epstein and the industry.  I will also note out of fairness to Dr. Relman that I find myself in agreement with much of what he argues against.  I am in particular agreement with his views about the need to regulate the sale and marketing of drugs and the myth that drug prices are directly tied to R&D costs, as many of my prior posts will attest.  Relman’s words words are italicized; mine plain text.

Adding to the obscurity of these estimated research and development costs are a number of other inconvenient facts. First, most new drugs entering the market these days are not new molecular entities….

Industry critics frequently cite the decline of innovation since the mid-1990’s as evidence of the industry’s ills; they support this assertion with the suggestion that the decline of new molecular entity (NME ) approvals is symptomatic of a larger trend towards development of what are perjoratively termed ‘me-too’ drugs and away from ‘truly innovative’ drugs (Relman calls ‘me-too’ drugs an “inconvenient fact.”  While it may be more convenient to speak only of NMEs when discussing drug-industry innovation, follow-on drug products have important therapeutic and economic benefits that must be discussed in order to understand the total value of drug-industry innovation; too bad there are few within the industry who feel compelled to extoll their virtues).  Please refer to my article published a couple years ago in NRDD and available through the PGS website, which presents some of the information I will refer to.  The primary source of drug-approval information in the U.S. is provided by FDA and is freely available.  There is no question that productivity, as defined by the cost of R&D per dollar-value of approved drugs has been in decline.  The productivity decline appears much more pronounced when productive output is defined by the number of new molecular entities approved per dollar of R&D spent.  It is also true that most new drugs entering the market these days are not NMEs, and that the proportion of NDAs approved by the FDA that are NMEs has declined since 1990, as shown below (data derived from FDA tables).  NMEs make up a higher proportion of drugs when only NMEs and follow-on drug NDAs are counted (range 22%-88%), but the time trend is similar to what is shown.  So far, Relman and I are in agreement over the facts about NME approvals.

NME approvals 1990-2007

…and therefore they [follow-ons] are less costly to develop and to test than the new molecules for which cost estimates are made.

So much for our agreement.  I am aware of no published data that purport to show that costs to develop a follow-on product are lower than the costs to develop an NME, all else held equal.  Indeed, DiMasi and Paquette’s study on the economics of follow-on drug development, while not directly demonstrating the equivalency of costs of development for pioneering versus follow-on drugs, does support this proposition that follow-on drugs are no cheaper to develop than pioneers.  The authors eloquently demonstrate that the distinction between pioneering and follow-on drugs has become blurred by the quickening race to market.  Improvements to existing drugs are a different story.  It is reasonable to assume, for instance, that the cost of developing a new formulation of a previously approved active ingredient will be less costly than the original formulation.  If that is what Relman meant, it is not what he said. Read the rest of this entry »

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Ariad v Lilly: when will the insanity end?

I’ve been following along with the circus that is Ariad v Lilly for over a year now (see 2006 posts May 5, June 28, June 6), and, as I find it fascinating, I’m going to keep writing about it.  If patent decisions bore you, read no further.  The latest news is significant: Ariad has prevailed in a bench trial held in Massachusetts federal court.  The prior jury award, giving Ariad entitlement to 2.3% of revenues from sales of Xigris and Evista (valued at ~$65 million at the time of the award), stands for now.  Lilly has not yet commented on the Court’s decision.  At the same time Ariad was getting this bit of good news, they received word from the USPTO that the patent claims upheld by the Massachusetts Court were nullified for now.  Ariad will appeal the USPTO decision, which will take one to two years to be finally decided.  In the meantime, the award against Lilly will stand unless appealed.

I’m going to walk through the judge’s reasoning in this case.  If you read this and think you can successfully defend the logic of Judge Zobel, which I shall try my best to impugn, please do so, and more fool me.  The judge’s verbatims are indented.  The Court begins with a succinct summary of the case and his ruling:

Plaintiffs Ariad Pharmaceuticals, Inc., Massachusetts Institute of Technology, the  Whitehead Institute for Biomedical Research, and the President and Fellows of  Harvard College (collectively “Ariad”), owners and assignees of U.S. Patent No.  6,410,516 (“the ‘516 patent”), “Nuclear Factors Associated With Transcriptional  Regulation,” complain that defendant Eli Lilly & Co. (“Lilly”) infringed it. Following a  fourteen-day trial in April 2006, a jury found that the four asserted claims were valid  against anticipation, enablement and written description defenses, and that use of  Lilly’s Evista and Xigris products infringed the patent. The jury awarded plaintiffs  damages in excess of $65 million.  The parties agreed that certain additional defenses were to be tried to the court.  Lilly asserts that the ‘516 patent is invalid because it attempts to claim non-patentable  subject matter under 35 U.S.C. § 101. Even if the patent is valid, Lilly argues (1) that it  cannot be enforced because of inequitable conduct by plaintiffs during the prosecution  of the patent, or in the alternative; (2) that plaintiffs are estopped from recovering for  any infringement because they unreasonably delayed prosecution of the patent.  Following a second trial focused on these issues, I find that: (1) the four claims asserted are patentable; (2) Lilly has not proven inequitable conduct during patent  prosecution; and (3) Ariad did not unreasonably delay prosecution of the ‘516 patent.  Accordingly, the jury award stands.

The Court describes the extent of the claims allowed by the ‘516 patent:

The allowed claims broadly cover a method of inhibiting the expression of a  gene whose transcription is regulated by NF-κB in a eukaryotic cell.8 The only step  required to practice the broadest patented method is to “reduc[e] NF-κB activity in the cell such that the expression of said gene is inhibited.”9 No particular agent or substance need be used, nor any particular step(s) performed, to reduce NF-κB activity in order to practice the invention.

Skipping to specifics of Lilly’s assertion that the ‘516 claims aren’t patentable (because they attempt to claim inventorship of a natural phenomenon):

In Lilly’s view, the ‘516 patent claims subject matter not allowed under 35 U.S.C.  § 101 and is therefore invalid. Specifically, it contends that the claims encompass the NF-κB-IκB autoregulatory loop (the “Autoregulatory Loop”), a natural process in cells that operates to reduce the activity of NF-κB. Because natural phenomena are excluded from patentable subject matter, it argues that any ‘516 claims encompassing  the Autoregulatory Loop are invalid and cannot be enforced.  Ariad’s response is that the ‘516 patent does not claim a natural phenomenon because, inter alia, (1) the patent claims a process, subject matter specifically allowed  by statute; and (2) the Autoregulatory Loop is only a theory and has not been proven to  exist in human cells in vivo. (Docket # 398 ¶ 618). While not all processes are patentable, I find that Lilly has failed to show that the proposed model of the Autoregulatory Loop actually exists in nature and thus that a natural phenomenon is encompassed by the ‘516 patent’s claims. 

Judge Zobel explains his reasoning for rejecting Lilly’s arguments about the naturalness of the Autoregulatory loop

Ariad’s expert, Dr. Jeffrey Ravetch (“Ravetch”), objected to Latchman’s [Lilly’s] conclusion that the Autoregulatory Loop has been proven to exist in living cells. (Trial Tr. Day 3, 10:17-21.) He described the Autoregulatory Loop as a simplified model that poorly explains the experimental data. (Id. at 17:13-18:7.) In his opinion, there are multiple positive and negative regulatory loops operating in cells which, in the aggregate, create the results seen in experimental assays such as those conducted by Hoffman et al. Ravetch rejected the view that just one loop explains the activity of NF- κB in the cell. (Id. at 9:2-12.) The patent claims a reduction of NF-κB in cells, which Ravetch sees as encompassing the net effect of all events, both positive and negative, which occur when a stimulus influences the cell. (Trial Tr. Day 3, 16:2-21.)…Therefore, I credit Dr. Ravetch’s testimony that the Autoregulatory Loop is “an incomplete model . . . subject to a significant amount of ambiguity and inconsistency” (Trial Tr. Day 4, 50:2-6) and find that Lilly has failed to prove by clear and convincing evidence that the Autoregulatory Loop exists in living cells in a way that is encompassed by Ariad’s claims.

I’ll stop right there, as the decision so far contains enough head-scratching material to warrant some derision, er, analysis.  According to the Court, Ariad has patented a theoretical process, not a natural phenomenon, which wouldn’t be patentable.  Not all nonnatural processes are patentable, but this one is.  The nonnatural process is inhibition of nuclear factor kappa B-regulated gene expression.  This nonnatural process is not man-made, that is, it has not been manufactured by Ariad; rather, it is theoretical.  As with any theoretical process, it may or may not exist in nature, but Ariad asserts that it does not exist in nature (i.e. it’s of their own conjuring), and Lilly has not proven convincingly that it exists in nature.  As the burden of proof lies with Lilly, the Court has decided that this is indeed a patentable, theoretical process.  Ariad’s inventorship of this gene regulation process gives it rights to earn royalties on sales of any products that influence this theoretical process. 

Still with me?  Let’s restate the situation.  Ariad has claimed ownership of a theoretical process.  They claim to have invented a process that they’ve imagined will work, and can therefore claim ownership to actual inventions that do work through this theoretical mechanism.  Their theoretical process is really a simplification of a much more complicated natural process of gene regulation.  In other words, their process can’t really account for observed natural phenomena; at best it’s incomplete but it’s perhaps entirely fanciful.  Restating, Ariad claims ownership of an incomplete or entirely incorrect, imaginary process that bears little resemblance to anything that might be observed in nature.  Well, bully for them!!  Give those gentlemen a patent by all means.  Let’s see them sell their imaginary process.

Ah, but remember, according to this Court, Ariad need not sell this incomplete or entirely fanciful process they have imagined in order to make good money from it.  Instead of having to pound the pavement with charts and expert opinions touting their imaginary, incomplete, perhaps entirely fanciful process, Ariad may charge others (like Lilly) a fee for using their imaginary, incomplete, possibly entirely fanciful process by, for instance, asking critically ill septic patients to buy their medicines, the mechanisms of action of which somehow (perhaps through some weird quantum entanglement between drug and gene) make use of this imaginary process.  It matters not that Lilly’s drugs were invented before Ariad invented their imaginary, incomplete, possibly entirely fanciful process, Lilly still must pay Ariad; apparently Ariad’s process is so effective that, unlike all known natural processes, it acts on events that have happened earlier in time (even beyond quantum weirdness, eh?).

Okay, enough irony.  I’ll gladly listen to rational arguments to the contrary, but this decision strikes me as utterly silly.  I now hold out hope that the recent USPTO reexamination decision rejecting Ariad’s prior-allowed ‘516 claims stands and Lilly uses the disallowance to prevail in appellate court.

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ClinPage corrects its story on Pfizer site recruitment strategy

On June 29th, I discussed a story originally published in ClinPage that Pfizer was signing investigators to exclusive contracts.  The story was picked up by several blogs, and had the potential to become mainstream news (but didn’t).  After that post, I received a confidential note from a Pfizer employee indicating that the story was flawed; that, in fact, Pfizer was NOT asking clinical investigators to sign exclusive contracts.  I didn’t report on this email, as its sender asked me not to for some reason.  ClinPage has now “clarified” its coverage of the presentation made by Andy Lee of Pfizer at DIA (see Pfizer Site Strategy).  As they are now reporting, Pfizer did not attempt to get investigators to sign exclusive sponsor contracts but rather asked investigators who were not recruiting for a particular study to serve the study or the project otherwise (as an advisor, for instance).

A couple thoughts, first I’m glad for the industry that Pfizer is not using a risky sponsor-exclusivity arrangement to improve recruitment.  This aggressive strategy would have made them and, by way of association, the entire industry look mean and greedy–you know, like they look now, only more so.  Still…now that the idea has been floated, publicly without making headlines I wouldn’t be surprised to see another sponsor actually try it, particularly in a niche therapeutic area crowded with several sponsors.

The other thought is that we who blog, including this part of we, need to be careful how we write our stories that rely on second-hand reporting.  I wasn’t at the DIA to hear Andy Lee’s talk.  I relied on what someone else heard, and I didn’t properly caution readers to be skeptical of the controversial story’s accuracy.  My analysis of the recruitment strategy would have been the same, but the impetus for my analysis wasn’t accurate, and it’s doubtful that I would have ever written the analysis had the story not appeared.  In the future, I’ll wait for independent confirmation before propagating any first-person information coming from ClinPage.  I’ll likewise raise doubts about the accuracy of any story, from any source, whose subject matter is controversial and not independently confirmed.  I don’t hold myself out as a source of news, but I do want my readers to trust that my analyses are based on accurate descriptions of the state of affairs about which I’m opining.

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News of NPY blockers’ demise greatly exaggerated by me?

The AOP of the July Nature Medicine contains the article “Neuropeptide Y acts directly in the periphery on fat tissue and mediates stress-induced obesity and metabolic syndrome” by Kuo et al from Georgetown U.  I’ve only read the abstract and stories so far (like this one from the Scientist and the press release from GU), but it’s enough to have me feeling elated at the discovery.  Congratulations to the Georgetown group.

Recall my post back in October 2006, when I used the failure of orally administered MK-0557, Merck’s NPY anatagonist, to discuss the state of pharma R&D knowledge transfer.  At the time, I implied that the development of NPY antagonists was all but dead.  Seems I may have spoken too soon.  Actually, I stick by my call regarding orally adminstered NPY antagonists, but if Kuo et al’s discovery of the role of NPY in glucocorticoid-mediated fat accumulation holds up to further scrutiny, I’ll be happy to revise that pronouncement as follows:  NPY anaagonists will have no role as systemically administered drugs aimed at influencing feeding behavior and thus obesity, but they might have a role as localy administered drugs aimed at controlling accumulation of local fat depots. 

The stories linked above describe some of the potential therapeutic uses of local NPY antagonist (and agonist) therapy.  Cosmetic uses are likely to be the first attempted, as it’s easy to approach the subcutaneous space and assess drug response.  Later uses could include non-surgical ablation of visceral fat (N.B. the omental fat dual-source blood supply may approached transcutaneously or intrarterially by experienced vascular interventionalists), which could very well treat metabolic syndrome. 

Intriguingly, activation of the peripheral NPY system may explain in full or part why glucocorticoids cause accumulation of fat in selected anatomical locations, including viscerally.  Although this explanation isn’t needed to enjoy the benefits of blocking the regeneration of cortisol from cortisone (via inhibition of 11-betahydroxysteroid dehydrogenase 1), as is being attempted with AMG221, Amgen’s 11 HSD1 inhibitor, it might help explain a failure of this or a similar drug to have the desired effects on visceral fat.  For instance, CT-guided skinny needle biopsies of visceral fat may be used to determine adipose tissue NPY and NPYR expression in the presence and absence of 11HSD1 inhibitor.  As far as I know, Amgen hasn’t released efficacy findings with this drug, and I’m not suggesting that it will fail to have desired clinical benefits.  Of course, the NPY mechanism might also be used to judge the effectiveness of such drugs before they ever get into humans too–a no-go for drugs that don’t block NPY upregulation in stressed mice fed ad libitum? 

Bottom line; this newly discovered peripheral NPY mechanism has great promise in metabolism drug discovery, as both a biomarker and as a drug target. 

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