Over the last few weeks, I’ve noticed several online discussions about Combination Therapies. Having supported a client a few years back in developing a strategic framework to assess combination therapies, I find this topic particularly interesting.
Classic questions are :
- How do we assess what will be commercially successful?
- Where are the main hurdles (regulatory, development, commercial)?
- How do we apportion value?
But what I find even more fascinating is pushing the paradigm on how we identify truly valuable combinations. It’s not just about overall success rates or commercial achievement; it’s about a synergistic effect to truly alter the disease course.
Here’s a concrete example:
In neurodegenerative diseases like Alzheimer’s, some autoimmune disorders, and others, pathogenic deposits (proteins, immunoglobulins) cause damage through inflammation.
Even a “disease-modifying” therapy that addresses the underlying cause of disease by reducing production of or reabsorbing pathogenic deposits may not stop the progression of disease immediately. Why? Because the existing circulating pathogenic elements are still present, continuing to cause harm until the body clears them.
This begs the question: Could we more aggressively pursue combination therapies that take a dual-pronged approach?
- A “source” therapy that treats the underlying cause (e.g., stopping production of the harmful protein).
- A “mop” therapy that mops up existing pathogenic elements in the body, halting damage in its tracks.
After all, if you had a leak in your bathroom, once it was fixed up, would you not mop the floor?
