Foreword.qxp 15/1/09 3:35 pm Page 3
Foreword
Future Directions in Neurology
a foreword by
Nicole Yost
Head of Marketing, BTG
W
elcome to the 2009 edition of the Touch Briefings and BTG neurology report. With an aging population, neurological
diseases are projected to increase rapidly in the coming years. The market for central nervous system (CNS) drugs is
worth £55 billion (US$85 billion); with 8% growth in 2007, it is likely to become the number one target for drug development
during the next decade. New drug development is extremely challenging. A recent article in the Financial Times noted that it takes
an average of US$1.2 billion over 10–12 years to develop any new drug, meaning that most biotech companies need funding from
investors or big pharma input to develop their novel products through to the market and reach patients. With the economic
downturn, risk-averse investors and challenging markets are making drug development in smaller companies more difficult than
ever. While larger companies and big biotech will ride the wave and survive the turbulent times, smaller companies will either be
bought up for their novel drugs or die out because of lack of funds. Despite the gloom, a number of biotech and pharma
companies have reported positive news in the neurology arena in recent months. In Alzheimer’s disease (AD), companies including
Elan, Lilly, Debiopharm, Newron pharma, Memory Pharmaceuticals and others have made progress in clinical studies, while in
multiple sclerosis (MS) Genzyme published positive data from a phase II study with Campath
®
(alemtuzumab) in relapsing–remitting
MS, comparing the antibody compound with Pfizer/Merck Serono’s Rebif
®
(interferon beta 1-α). Meanwhile, Biogen Idec,
Genentech and Roche began a phase II study in MS with ocrelizumab.
In this BTG and Touch Briefings special supplement, experts comment on the status and prospects for the treatment of neurological
disorders including AD, MS, dementia, chronic pain, migraine headache and sleep apnoea. In his article on symptomatic treatments
for AD, David Knopman, MD, of the Mayo Clinic reviews the currently available therapies – such as the cholinesterase inhibitors –
and welcomes new, improved AD treatments that address the underlying mechanisms of the disease and offer new hope for AD
patients and carers. There are a number of novel AD drugs in development. For example, a recent deal between Austrian-based
Affiris and GlaxoSmithKline saw Affiris license its AD vaccine candidates to the pharma giant in a deal potentially worth up to
US$580 million in up-fronts and milestone payments. Last September, Pfizer paid large sums (including US$225 million up-front)
to San Francisco biotech Medivation to co-develop and market Dimebon, an investigational drug for the treatment of AD and
Huntington’s disease. The challenges facing clinical trials for MS are addressed in the article by Helmut Butzkueven, MBBS, PhD,
and Anneke van der Walt, MBChB. While numerous studies in relapsing–remitting disease continue to make headway, the authors
argue that the development of disease-modifying therapies is more challenging. In the future, a greater number of therapies will
be available for relapsing–remitting MS; while this is a positive move in terms of greater treatment choice, the authors suggest
these new treatment options may also come with a host of new side effects and possible complications. In addition, many drugs
in development do not undergo comparative head-to-head studies, which provides a challenge in the development of evidence-
based treatment strategies. The effective and tolerable treatment of chronic pain is something of an unmet medical need. In their
article, Wahida Rahman, PhD, and Anthony Dickenson, PhD, of University College London discuss emerging therapies for chronic
pain, including sodium channel blockers, N-nitrosodimethylamine (NDMA) receptor antagonists, potassium channel blockers,
monoamines and others.
Migraine headache is a common and disabling disease, with a one-year prevalence of 12% in Western countries. As well as its
impact on the individual sufferer, migraine headache is associated with significant costs in terms of lost days of work. Alan Rapoport,
MD, of the David Geffen School of Medicine and Christina Sun Edelstein, MD, of The New York Headache Center note in their
article on emerging treatments in headache that while the triptans have made a huge impact on the disease, some patients do not
tolerate these drugs because of side effects, and others report a delayed or incomplete response. Novel therapies in development
for migraine, including the calcitonin gene-related peptide (CGRP) antagonists, neuromodulators and others, are discussed.
There are currently more than 1,000 drugs in development for CNS disorders, according to MedTrack data. With advances in
medical science, a greater understanding of the aetiology of these conditions and continued research and development, there is
continued hope for the treatment of unmet needs in these areas. ■
© TOUCH BRIEFINGS 2008
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