Maybe it's flashbacks from vaccinations at the pediatrician's office. Perhaps it's some innate desire to not be pierced by sharp objects. No matter what the reason, it seems most people have -- to varying degrees -- an underlying case of trypanophobia, the fear of needles.
Fortunately, most medication is taken orally, but there are a few diseases whose only treatments require drugs that need to be injected. Here's how to make some money off society's general disdain for needles through next-generation drugs.
What are you in for?
When figuring out what drugs might be able to supplant injected drugs, it's important to factor in the disease that the drug treats.
At one extreme, you have cancer drugs. Many chemotherapy drugs that have to be infused are still in wide use. That's because the chemotherapy drugs work, and no one is going to go for an oral drug just because they don't like needles when their life is on the line. The oral medications that are widely used are prescribed because they work, not because they're taken orally.
Multiple sclerosis is almost at that extreme. The disease isn't as immediately life-threatening, but the progressive nature of the disease means controlling the disease now is important.
Last week, the Food and Drug Administration signed off on the first oral treatment to stop the progression of multiple sclerosis, Novartis' Gilenya. All the other treatments from Bayer, Merck KGaA, Pfizer
There are some patients whose disdain for needles is so strong they're unwilling to take any drug. Clearly, doctors will be more than willing to prescribe Gilenya to them; something is better than nothing. But Gilenya offers some unknowns, including a checkered side-effect profile, which might make doctors more likely to stick with the injectable drugs unless patients complain loud enough.
At the other extreme is rheumatoid arthritis. It's a painful disease for sure, but not exactly life threatening. Patients often start with a generic drug called methotrexate, but if that doesn't help, they have to progress to anti-inflammatories -- Abbott Labs'
Pfizer and Rigel Pharmaceuticals
And then there are the diabetics
I've separated out the diabetics because I don't understand them. I'd think injecting insulin would be something to be avoided, but diabetics didn't seem all that interested in inhalable insulin the first time around. Pfizer's Exubera, which it licensed from Nektar Therapeutics, managed a paltry $12 million in the first nine months it was on the market.
Maybe the gene that gives you a propensity to become diabetic is linked to the gene that makes you unafraid of needles. Maybe pricking their fingers to get blood glucose levels daily allows them to laugh in the face of needles. Whatever the case, one has to wonder how the next generation of inhaled insulin will fare.
Injecting uncertainty into the market
There's a commonly held belief that an oral drug with the same efficacy and side effects will always win against an injectable drug. In the long run, that's likely true, but the adoption rate will be determined by the patients' desire to not be stuck and doctors' willingness to switch from the entrenched drugs they have experience with. Investors should keep those two in mind when predicting the success of next-generation oral drugs.
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