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1、2009Diabetes M E D I C I N E S I N D E V E L O P M E N T F O R Report P R E S E N T E D B Y A M E R I C A S P H A R M A C E U T I C A L R E S E A R C H C O M P A N I E Srw ina id flLjnMmq iaMv MI ETT灯 t to h *Laii 町耳唄可#nhh 4 II fi dfeiplf- .iBTB fhagfUMHfl Mfhi dkahakM 连 hal|p Adtai 事打 di -h ar-4 r
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7、| idliE*iaiL.Tn J L*in lrfe .ji nIH| iFKiln iwiv刪 . i nprrm rw rnmllnGiin( (;片恂ri Ht-*祜 p 聞“hW I4jari| j| TL- Biopharmaceutical Compa nies Develop ing Record 183 Medicines to Treat Diabetes and Related Conditions话曲舟 HintYl r|i朋RH wurti di 忆he kv :rnr fc|r*v- HKA*. JrvriiiiY Piri Nt lpf -fhflMM Ph jv
8、 t |诃肿 缚I*i4l bJUll *1 审鼻幺|U !戸.T Gkiwih mail I LnJunj( (4r P.ri, M lpi J rlHfvfen 怜rw” UMl EMI fLhjAanilKliftr fi* ki * 并猜“ R|M J II dHdi IQWWE 6TNHEJ MIP A iPCn解 P,ri Ml 冈芦 J ibbPta* 冷 F Jritfl U94ri MEFTX Jt hfv 4 iLiwkF 怜* i U |K*|l|ra hipAjraJ l|M 1 kJfirtWK MA AJIMM- 4dmii 壬、111 JUrdpri-l k4!k
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10、*1序fi 币E HI .尿4 rm卵 应W LfMMKd t丄關 E n rttribatn 出aw ” Wl 144 Wf AhMS Ixll &神* Cf-uurd 1 . iBUWv-i VKprN -kti-fci +i- ICMH AMK4 J J1: rin fanUMi r i 4 !*|w -J rtafwlMi tiMfw li wiii -H-inn rBwAMftJtalik I K| 3 IIMHHK HMw-ll Aril 4M1 rU.1.1 WG b f 皿 u_-| J 111 I.尸 1屮 1 ihMv* 粕 |MP Pt 2 Z” wa MKV.4
11、U5 Of 从gm 5 十, ASWW WMd 仲ns RH e w rww it WCFIl All W1 Ufl(M*Ch4 Tww nwv 4g w? Rw I 叫 gHJ? urn HMW. * I,I $V2 2JU) air MH rum cvTh |jn| Hal WUJHW. A 财曲 fv A3n|.rtWh 0 1! J! rwwi| HTWi】K裤订 j| .Ak -luvl J ilvp Rwwu、 lAkhriib呻!li -= J rvp* * djtMM HUM 1 (ilMR-pl 丿 la 1 IV 4-1 Ji F 卜 *|li 山 nhrf*yJ-T- *
12、n*anwldi jladvlv WWL JI M l Z-屮 kfprf ammwiw 岀 h m jrliilH. i| WAkU Hww i RUFMI 尽i -Riii hW fM呵 A lilBI !BT _ *! f AflfAi HumKAMi Jlfr IW# J |a*W1Flll|i Aw- lA JW tup 2 轉*. |HVI .NMWWI W* X J Alli. HV4| W 咤 E F 4 rintH-irip- r; 1 j|W-iii 巧i 切屮叭 !( 沾 A ; J- 1IH 3FV|U d hilHy 8BI lbx 阻 1白屈 *W / 齐 r- f
13、WM L luta v WsMf 3 Qnf匚& iiiifiv fhf HVtillJ JJId wpnfeL冋 M# MJTMOi. i Ml U3-4110 *r巧币 k B:g強-! I*I ii Ihlith1 IWfW *1w 1 l*iii种5 t岂网 s . al- : 1 . J . 3 a 1* 須 F V RB rfeM! 4MH4JU iitap.llgjl li IWXMWW W GlMW 1 B S4M ilb l H 2 ! 阿* IP f J jMhri BrlM- iM.ll AA ?i WLIUHI GLP-1Emisphere Tech no lo
14、gies type 2 diabetes Phase I (oralCedar Kn oils, NJ(973 532-8000 GLP-1 FC Eli Lilly type 2 diabetes Phase II Indianapolis, IN(800 545-5979 GLP-1 PEG Eli Lilly type 2 diabetes Phase I Indianapolis, IN(800 545-5979 HDV-i nsulin Diasome Pharmaceuticals type 2 diabetes Phase II Con shohocke n, PA(609 92
15、3-9443 HE3286Hollis-Eden type 2 diabetes Phase II Pharmaceuticals(858 587-9333 San Diego, CA HSD016Wyeth Pharmaceuticals diabetes Phase I Collegeville, PA(800 934-5556 IL-1 an tibody Eli Lilly type 2 diabetes Phase I In dia napolis, IN(800 545-5979 INCB-137391 ncyte type 2 diabetes Phase II Wilmi ng
16、to n, DE(302 498-6700 INCB-19602I ncyte type 2 diabetes Phase II Wilmi ngto n, DE(302 498-6700 INCB-20817I ncyte type 2 diabetes Phase II Wilmi ngto n, DE(302 498-6700 INGAP peptide Kin exum Metabolics type 1 diabetes, type 2 diabetes Phase II insulin inhalation Baxter Healthcare diabetes Phase I De
17、erfield, IL(800 422-9837 in sulin in halati on MicroDose Tech no logies diabetes Phase I completed Monm outh Jun ctio n, NJ(732 355-2100 in sulin nasal spray MDRNA type 2 diabetes Phase II Bothell, WA(425 908-3601 completed Harper s Ferry, WV(3043 in sulin oral Emisphere Tech no logies type 2 diabet
18、es Phase l/ll Cedar Kn oils, NJ(973 532-8000 in suli n oral Gen erex Biotech no logy type 1 diabetes Phase Ill Toro nto, Can ada(416 364-2551 in sulin tran sdermal Dermis onics type 1 diabetes, type 2 diabetes Phase l Irvine, CA(888 401-3376 INT-1311 nteKrin Therapeutics type 2 diabetes Phase ll Los
19、 Altos, CA(650 941-5501 In tesuli n? Coremed diabetes Phase l in sulin oral Lake Bluff, IL(847 772-6868 ISIS 113715lsis Pharmaceuticals type 2 diabetes Phase II Carlsbad, CA(comb in atio n therapy(800 679-4747 ISIS-SGLT2rx Isis Pharmaceuticals type 2 diabetes Phase I Carlsbad, CA(800 679-4747 JTT-65
20、4Akros Pharma type 2 diabetes Phase I Princeton, NJ(609 919-9570 DlARf VES. Tvrr 1 ANO T VFf 2 4M* rvjw i own rw u . : r Ci MM* tlT fjM. Mf twli nn 2 丄 2? W4 X ZZI W w r.w 54sm mu FKiM CZ1ZI 1W.4C11I ft A A r ! M l 72X0 rw i 純”,Z4W 4U 7-U|Bi ft A A II V JKHO MH JMU MIOHI Mmt Mm. 小fi M 严十 4LAW * Dl A
21、Hf f ts, Tvet 1 AND TVFC 2 Mua”; Gift W aio j.kMm J.I*| 4M-KTI HEM M fV6 . *K 兰出ZE上独 FMwl v n* J IOIO 1)1 A8f If S, T YF r 1 AND T Y f f 2 加厶.j - - 14 R tMAM ITMXlIia rw CMZ CAjtw ril f nrii3i$-un 1 J # 二二 : ? MAM. M nn rt SUW M rM i “UM - 1 *6. MMM II IMX ruuuii ORV*VW *W1M皿 Dl ARf V t$4 TVPt 1 AND
22、 Ttet 2 2 儿儿- *no HUM 511 J 4 Z IM Ill) rww Arwofa MMWIM IM 5 心6 .M.IW Hit* y SMg SI n etricji SACniOM ,rr%巒 e 釧 iz *TT 4 M r*?iM DlAilt I t S RtlAl1 C IM I IONS IWWW Wit . . . nUvuM MMH I 他十 UaiMMa %UCM ofmakrw LHtai f C4 HIMU iam w ” t ww v tr IW v* m hm Wwvt itwaWi * * aa wwrw vd lta *KAP IvaV* *
23、 Re iMwrWftf * AfH Z,. 2099. !p rw, 2,3r 艸! *il fnlM,t 44IK HwM HR ”W” XB WI 3 Ma* K CA HvwN iW 号 m-*ii *MM 1WIM0 14沁儿3 rwaWtM . G pat Ma v4 l4ta * (传* W.+r yupMfi cuM&vteiaja* C-A * SxMCtrnCA tSIU 40I440 MK,S5 Di Avt 1Tire 1 AND T V PI 2 ew*. ew*. Utotr MMMIW UUKIMI.* m wii I1IO4vw* 愤丿 OlABI tt
24、$-Rll At t D C O K D I VI O S S 3 a M1 4JJ-4T4I 2科 rM* Wtvtb fl Uuk 2科 AtG-5 rwwl nw Wwl HW Hwll WM ia rws 补 tx |MR HI _ Kbte MH miann Ef Wg 4UM fvUvew 4 applicati on submitted An applica-ti on for market ing has bee n submit-ted by the compa ny to the Food and Drug Admi nistrati on (FDA. diabetes A
25、 chronic disease in which the body does not produce or properly use in suli n, a horm one that is n eeded to convert sugar, starches and other food into en ergy needed for daily life. Symptoms may include excessive thirst, hunger, urination and weight loss. The cause of dia-betes con ti nues to be a
26、 mystery, although both gen etics and en vir on-men tal factors such as obesity and lack of exercise appear to play roles. Type 1 diabetes, the more severe form, results from the body s failure to produce insulin, which “ uni ocks ” the cells of the body, allow in gqglue to en ter and fuel them. It
27、is estimated that 5 perce nt to 10 per-ce nt of America ns who are diag-no sed with diabetes have type 1, which requires insulin treatment. Type 2 diabetes results from insulin resistance (a condition in which the body fails to properly use insulin, combined with relative insulin defi-cie ncy. Most
28、America ns who are diag no sed with diabetes have type 2, which in most cases can be con-trolled by a comb in ati on of dietary measures, weight loss, and oral medicati on. diabetic peripheral n europathy- Nerve damage in the arms, han ds, legs, and feet caused by diabetes. The con diti on develops
29、slowly and worse ns over time. Depe nding on the types of n erves invo Ived, one or more sig ns and symptoms may be prese nt in diabetic peripheral neu-ropathy. Sensory neuropathy results in numbness or tingling in the feet or pain or discomfort in the feet or legs, in cludi ng prickly, sharp pain o
30、r bur ning feet. Motor n europathy invo Ives muscle weak ness and loss of muscle tone in the feet and lower legs, loss of bala nce, or cha nges in foot shape that can lead to areas of in creased pressure. Aut ono mic n eu- ropathy results in dry feet and cracked skin. The loss of sen sati on and oth
31、er problems associated with n erve damage make a patie nt prone to develop ing skin ulcers (ope n sores that can become in fected and may not heal. This serious complica- ti on of diabetes can lead to the loss of a foot, a leg, or eve n a life. diabetic ret ino pathy The most com mon diabetic eye di
32、sease and a leadi ng cause of bli ndn ess in American adults. It is caused by cha nges in the blood vessels of the retina, the light-sensitive tissue at the back of the eye that is n ecessary for good visi on. In some people with diabetic reti no pathy, blood vessels may swell and leak fluid. In oth
33、ers, abno rmal new blood vessels grow on the surface of the reti na. Over time, diabetic ret in opathy, which usually affects both eyes, can worse n and cause visi on loss. The con diti on has four stages: 1 mild non proliferative retinopathy, the earliest stage duri ng which microa neurysms occur i
34、n the retina s tiny blood vessels; 2 moderate non proliferative reti no pa- thy, duri ng which some blood vessels that no urish the reti na are blocked; 3 severe non proliferative reti nopathy, whe n many more blood vessels are blocked and deprive several areas of the ret ina with their blood supply
35、; and 4 proliferative reti nopathy, the adva need stage when sig nals sent by the reti na for no urishme nt trigger the growth of new blood vessels, which grow along the ret ina and the surface of the clear, vitreous gel that fills the in side of the eye. If those thi n, fragile blood vessels leak b
36、lood, severe visi on loss and eve n bli ndn ess can result. Up to 45 perce nt of America ns diag no sed with diabetes have some stage of diabetic ret in opathy. macular edema- A con diti on in which fluid can leak into the center of the macula, the part of the eye where sharp, straight-ahead visi on
37、 occurs. The fluid makes the macula swell, thus blurri ng visi on .It can occur at any stage of diabetic retinopathy, although it is more likely to occur as the disease progresses. About half of the people with proliferative reti nopathy also have macular edema. Phase Safety testi ng and pharmacolog
38、ical profili ng of new drugs in small nu mbers of huma ns. Phase I Effective ness testi ng and iden tificati on of side effects of new drugs in huma ns. Phase III Exte nsive cli nical trials in huma ns to verify effective ness and mon itor adverse reacti ons of new drugs. polyn europathy A diffuse p
39、eripheral n erve disorder that is bilaterally symmetrical and thus not confined to the distributi on of a sin gle n erve or a sin gle limb. Electrodiag no stic tests are done to classify the n erve structures invo Ived, their distribu tion, and the severity of the disorder in order to help ide ntify
40、 the cause. Some polyn europathies, such as those caused by lead toxicity or tick bite, affect primarily motor fibers. Others, such as those caused by diabetes or AIDS, affect primarily sen sory fibers. Diabetic n europathies 13 I;尸 ci ATJ An. ia._ rvir Ki irni i A. ifz-br 円旦* 卅了、八 3*阻 和 inc iHa tKc
41、i 也 If thzxiia th can also affect cranial n erves. S H I nt) FA rs ABOUT DI ABI I t S IN V HI UNITID STATES1 1 * te9 i H I* * w tah dfv. 4.1X* |a v * JU? *W CM* 穴 swv i p c0 * jo ct Mkt Il lta C*4#* (臥 *MK 4f MWNI I 倆4 w Wai %円 I eh yn 12-H Ww 尸*1 4 AmMyi f Ml JAnaKm W7 |w m. 3 . 5v iw * 8 d3 ? “ I
42、fVOWV, 2a* Aw) ) w 4gr E 4vl MA ) IIJ | T 3.MMv4rv tarf ”4心M IWw4h Ww H MUH * V * p a* U.S o 22 Mwh *U * S4“ e WB. 0 V *M , 4 aMkMM MW7 W ) * O X* Z V VE lH y M* (Mevl *5,O) .3X*7 IXjtMM M f rm MS UM . *Ura H * 4tft iw W to 占 j M 4Z |BWr. * M* rWI Mirf f 2. 4MPE IUW4 环 tMh El * SA1 * a Wh*、 iMW a W
43、o ikn alrx M*“* * Z 44m /严* 心 w *4 m 4 f d eMatfO H ar* WVWIM| ito IlFt % Mtoe AM cMwm itvvft tSI taOm to* ek “r* rrnMef ciMw WtMwl twt mutarw ttawvtMtwn BMMTX utf.fKtK 4kMl*UM MMW4 * Ma Mt IV p * 川 ajA d J4.1 dlci M IXT, fwa 4 ? 4 rr4t*M mn *w 14.J Mlkae * HMV Tlr * Mkv* tafM _M 气“.WMX” f aM MMtvc
44、VXII 4w i-o*M! #*”)、 * .4“*3 Ml E.d. Oav MH d %wv ltr rw fec vwiMf* uttv 4ly wrf # * m vw i ID JV* kaftM* 柚 JMMM! a .X. 15 T H E DRUG DEVELOPMENT AND APPROVAL PROC he U.S. system ot new drug approvals is perhaps the most rigorous in the world It takes 10-15 years, on average, tor an experimental dru
45、g to travel from lab to U.S. patients, according to the Tutts Center for the Study of Drug Development, based on drugs approved from 1 994 through 1998 Only five in 5,000 compounds that enter preclinical testing make it to human testing. And only onm of those five is approved for sale. On average, i
46、t costs a company $1.3 billion to get one new medicine from the laboratory to U.S. patients, according to a 2007 study by the Tutts Center for the Study of Drug Development. Once a new compound has been identified in the laboratory, medicines are developed as follows: Preclinical Testing. A pharmace
47、utical company corv ducts laboratory and animal studies to show biological * * MM I * * HT I MWWMI rvhM AnVcc T Clinical Trials, Phase I. These tests involve c to 100 normal, healthy volunteers. The tests drugs safety T he U.S. system of new drug approvals is perhaps the most rigorous in the world.
48、It takes 10-15 years, on average, for an experimental drug to travel from lab to U.S. patie nts, accord ing to the Tufts Cen ter for the Study of Drug Developme nt, based on drugs approved from 1994 through 1998. Only five in 5,000 compo unds that en ter preclinical testing make it to human testing.
49、 And only one of those ?veis approved for sale. On average, it costs a company $1.3 billion to get one new medicine from the laboratory to U.S. patie nts, accordi ng to a 2007 study by the Tufts Cen ter for the Study of Drug Developme nt. Once a new compound has been identified in the laboratory, me
50、dicines are developed as follows: Precli nical Testi ng. A pharmaceutical compa ny con -ducts laboratory and animal studies to show biological activity of the compound against the targeted disease, and the compo und is evaluated for safety. Inv estigati onal New Drug Applicati on (IND.After complet
51、ing precli ni cal test ing, a compa ny ?les an IND with the U.S. Food and Drug Admi nistrati on (FDA to beg in to test the drug in people. The IND becomes effective if FDA does not disapprove it within 30 days. The IND shows results of previous experiments; how, where and by whom the new studies wil
52、l be con ducted; the chemical structure of the compo und; how it is thought to work in the body; any toxic effects found in the ani mal studies; and how the compo und is man -ufactured. All clinical trials must be reviewed and approved by the Institutional Review Board (IRB where the trials will be
53、con ducted. Progress reports on cli nical trials must be submitted at least annu ally to FDA and the IRB. Clinical Trials, Phase I.These tests involve about 20 to 100 normal, healthy volunteers. The tests study a drug s safety profile, including the safe dosage range. The studies also determ ine how
54、 a drug is absorbed, distributed, metabolized, and excreted as well as the duration of its action. Cli nical Trials, Phase ll.ln this phase, con trolled trials of approximately 100 to 500 volunteer patients (people with the disease assess a drug s effectiveness. Cli nical Trials, Phase III.This phas
55、e usually in volves 1,000 to 5,000 patie nts in cli nics and hospitals. Physicia ns mon itor patie nts closely to con?rm ef?cacy and ide ntify adverse eve nts. New Drug Applicati on (NDA/Biologic Lice nse Applicatio n (BLA.Followi ng the completi on of all three phases of cli ni cal trials, a compa
56、ny an alyzes all of the data and files an NDA or BLA with FDA if the data successfully dem on strate both safety and effec -tive ness. The applicati ons con tai n all of the scie ntific in formatio n that the compa ny has gathered. Applications typically run 100,000 pages or more. The average review
57、 time for the 24 new therapeutics approved by the FDA in 2008 was 17.8 mon ths. Approval.O nee FDA approves an NDA or BLA, the new medici ne becomes available for physicians to prescribe. A company must continue to submit periodic reports to FDA, in clud ing any cases of adverse reacti ons and appro
58、priate quality-c on trol records. For some medicines, FDA requires additional trials (Phase IV to evaluate longterm effects. Discoveri ng and develop ing safe and effective new medic ines is a long, difficult, and expe nsive process. Pharmaceutical compa nies in vested an estimated $65.2 billi on in
59、 research and developme nt in 2008. Shari ng Miracles Televisi on Program Features In spirati onal Stories of Real Diabetes Patie nts S hari ng Miraclea 30-minute public affairs televisi on program- tells the compelling and inspirational stories of real patients. Two recent episodes focused on patie
60、 nts who suffer from diabete Leave It to Beaver star Jerry Mathers and professi onal basketball star Domi nique Wilki ns. Mathers is an America n icon, best known for his portrayal of the mischievous Theodore “ Beaver ” Cleaver. Currently shown on TV Land and in coun tries throughout the world, Leave It to Bea
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