Just curious on how we went from no cure to multiple medicines that cure Hep C in such a short time? Seems too coincidental that multiple pharmaceutical companies figured out how to combat this virus so close to each other? Was there joint research performed that entitled all parties to use the knowledge? Any pharmacists / MDs out there with the straight dope?
When a family member had HCV in the early 1990’s, there was a cure, though it didn’t work for the majority of people–interferon.
When a family member had HCV in the early 2000’s, there was a better cure that worked for more people–pegylated interferon and ribavirin.
There’s been a recent increase in number of HCV treatments, as well as better success rates, but it’s not as if we went from no treatments to multiple treatments immediately.
A brief history of the drugs:
I was under the impression that interferon was a treatment and not a cure. Two very different things. And it seems that “cures” have popped up.
No, interferon was curative for up to 40% of patients. I treated a number of them with interferon and ribavirin back in the day. And even cured a few.
And the new drugs certainly did not pop up. They were the results of years of research. I remember reading updates on their development while using interferon. I also remember the hope we had for telaprevir when it was released, years before the current generation of HCV drugs. It cured more, but it had such horrible side effects and had to be taken with 3 grams or so of fat with each dose. You try to eat 3 tablespoons of peanut butter twice a day when you’re already sick from the infection and the med side effects . . .
I’m glad those new drugs, with their 98+% cure rates and their minimal side effects came out. I hate that they are priced so high that I can only treat the sickest of my patients with them. That’s a whole 'nuther story though.
But these new drugs were developed just like other typical drugs, using time, expertise, and patience. And a lot of money.
Love this place, I always learn something.
But I know that drugs just don’t pop up. I was “interested” in the idea that somehow multiple pharmaceutical companies successfully bring to market what are essentially near identical products. It’s like when in Hollywood, someone comes up with what appears to be a new film idea and within weeks another studio has a similar movie, thus diluting the market.
Are we to expect more direct targeted anti-virals in the near future?
when you patent something like a drug you have to disclose what the drug is made of. So then other drug companies can look for similar treatments.
There are a lot of cases where several drugs come out around the same time for a disease. That can be based on basic research or it can be based on drugs that are used to treat different diseases and they are changed to treat a new disease.
Interesting that this thread showed up, because there was a story in my local paper yesterday about a heart transplant recipient who met his donor’s family. The story added that the donor had Hep C and this was the first time such a heart had been transplanted into someone who didn’t have it, so I’m assuming it was some kind of rare blood and/or tissue type, and the recipient was treated for it afterwards.
These Hep C, etc. drugs are closely related to some of the drugs that are used to treat AIDS.
That’s it in a nutshell. A drug that’s effective against a disease usually has one part of the compound as the active section. The rest of the molecule may have some other effect: stabilization of the molecule or reduction of side effects or better absorption by the body or maybe no function but just easier to make with than without. So these molecules can be modified in small ways that don’t change the active section but make the molecule different enough to be considered a different drug as far as patenting goes. And they often have different side effects. They may or may not cure the disease better.
During development, once a drug is found that has the desired effect of inhibiting/destroying a pathogen or slowing development of cancer or whatever, the drug maker usually explores such modified molecules and selects the best one for further development. But there are many ways to modify molecules and they can’t explore every one of them. So their competitors will find modifications that may be marginally better in some aspect. Presto, another overpriced drug.
Even more suspiciously, multiple drug companies are said to be working on generic versions of hepatitis C drugs, lowering prices (and about time).
We all know that Big Pharma wants to keep us sick and on drugs permanently rather than cure anything, so there’s got to be some really evil ulterior motive behind development of bona fide hepatitis cures. :rolleyes::dubious::smack:
Not really. The trigger is, as was noted (or at least hinted at) upstream in the thread, academic research.
The whole thing about research funding, publications, scrabbling for cites and so on would hijack the thread, so I’ll skip that if I may. But the point is that academic research isn’t secret - it is published and pharma companies monitor it. Closely. There is a constant scanning for “targets” - perhaps an enzyme whose function in a disease process has been elucidated, thus providing a new way to attack the disease, for example. This is pounced on by pharma companies, and that’s why they are often simultaneously working on similar approaches to treat the same disease.
I can’t say I know a lot about antivirals, but to provide an example I’ll pick something I know a bit about. There was a point when it became evident that what had previously just been called Cyclooxygenase was more than one molecule. All of a sudden there was huge interest by a number of companies in finding out what the effects of specifically inhibiting COX II would be and how it could be done - leading to the near simultaneous launch of several related drugs.
In the case of the new antivirals. it appears that there was also a huge unmet need. “Unmet need” is a phrase that makes pharma execs salivate. So you put two things together - unmet need and new results from academic research - and the race is on.
The motive is making money. There’s no need to overcomplicate it.
This is what the NHS says:
COX-2 inhibitors were thought to be the next wave of pain and arthritis therapy, until they were taken off the market, one after another, because of side effects that were not detected in Phase II or III studies, usually involving a few hundred people. Vioxx is the best known of these, although there was also some fraud going on with that drug. :mad: I was off work the day Vioxx was pulled from the worldwide market, and boy, was I glad I wasn’t there that day!
The newest generation of cancer drugs involve something called targeted therapy, because many cancers have assorted genetic or metabolic markers, which these drugs target (hence the name) and they are only useful for these patients. Some have proven very beneficial, others less so.
First bit: true* but not really relevant to what I was saying. I was simply providing a pretty well known example of a drug class, and trying to (very!) briefly explain the link between academic research and the eventual launch of a wave of medicines based on that research (identification of COX -II). Not a recommendation on my part.
Second bit - not true. No drug expected to have wide exposure is authorised on the basis of studies involving “a few hundred people”. The figure at time of US licensing appears to be just over 3500 exposed to Rofecoxib - see https://www.accessdata.fda.gov/drugsatfda_docs/nda/99/021042_52_vioxx_medr_P1.pdf page 7, Rofecoxib columns. (In fact the true total will be slightly higher, as this appears to exclude the very early, uncontrolled studies).
Now, if the argument is that there was a fundamental problem with the study programs (for the COX-IIs) because not enough patients were exposed for long enough periods, that’s a whole different issue. And a very long debate about scale of pre-licensing studies versus post marketing follow up, acceptable levels of risk and the cost implications (passed on to patients) of the various possible approaches.
- though so far as I can see Celebrex is still available in the UK, for example. Didn’t check the other drugs or territories. https://www.medicines.org.uk/emc/product/5533/smpc
Further info: just as an interesting aside, see the Wiki page for Rofecoxib, Possible return to the market.
Without which, there’d be no drug research other than what the Government, universities, and charities support. Which, while a lot, has not been, and is still not, enough.
Well, yes. That was the point of my admittedly sarcastic comment. :smack:
Celebrex is still in the U.S. market.
I do wonder if those hep C drugs were originally tested as treatment for AIDS, and found to work for this instead.
Certainly the drugs used to control chronic Hepatitis B viral infection were developed as a result of anti-retroviral drugs for HIV - in many cases, they are the same drug at different doses. They are classed as nucleotide analogue reverse transcriptase inhibitors (nRTIs)
The drugs used to treat HepC seem to have come about from a different research direction, and are classed as Direct Acting Antivirals, containing a prodrug nucleotide analog which (after metabolic processing) acts as a defective substrate for NS5B (non-structural protein 5B), required for the HepC viral RNA transcription.
Of course, identification of a new vector to interfere with viral RNA replication may provide new opportunities to revisit other viral diseases.
As for the cost of such drugs, they need to help cover the extremely high cost of research, development and testing of a new drug, as well as the many, many failed ones. In addition, that cost needs to be weighed against the other available treatments - in the case of HepC, that generally means a liver transplant and the remaining lifetime cost of immunosuppressants.
Also the high cost in established markets can help subsidise the cost of the drugs in some emerging markets where the rate of disease growth is extremely high - for HepC, this means that generic and/or cost subsidised drugs are provided in India and Egypt where new HepC infection rates are very high.
Speaking of self-interested behavior: Mrs. J., an astute observer, pointed out to me that having drugs to cure hepatitis C means people will live longer, acquiring chronic diseases requiring numerous other drugs, so Big Pharma profits even more.
Shoulda thunk of that. :smack: