RE:RE:RE:RE:RE:RE:RE:RE:RE:Financing, etcIt's not clear to me what Torpedoman is getting at with his "disruptive technology" comment. T tried to clarify by stating "Any technology or invention that replaces and supplants older inventions or traditional ways of doing things." However, this is too general of a statement to know what T is getting at. Here are a few discussion points if anyone cares to continue this conversation:
1) Epigenetic drugs. No BET inhibitor, let alone any epigenetic drug, has made it to market. Unlike drugs that target a specific enzyme (i.e. statins inhibiting HMG-CoA reductase, anacetrapib inhibiting CETP), apabetalone effects a family of proteins involved in mRNA transcription and thus effectively alters a large number of mRNA transcripts and proteins. A drug that alters the activity of a transcription factor is going to likely elicit many more biological changes than a drug that targets a specific enzyme. Therefore, oen must proceed with caution and acknowledge that one may be eliciting deleterious effects along with the desirable ones.
2) What is apabetalone supplanting or replacing? Apabetalone is being used in BETonMACE in diabetic patients with a high risk of cardiovascular disease. Inclusion criteria include documented diagnosis of type 2 diabetes and history of taking diabetes medication. I looked at the clincialtrials.gov site again and it is unclear if patients are allowed to continue taking their diabetes meds during BETonMACE or if they are required to stop taking them. A secondary outcome of the trial is following changes in fasting glucose, insulin and HbA1c. But it is unclear to me if apabetalone is being used as an add-on to prior diabetes medication(s) or being used as a replacement in BETonMACE. As for cardiovascular disease, all patients in BETonMACE are required to be on a statin. Therefore, apabetalone is not being touted as a statin replacement but an add-on to statins for the management of cardiovascular disease. Some diabetes meds (SGLT inhibitor Jardiance in EMPA-REG Outcome trial, GLP1-receptor agonist Victoza in LEADER trial) on the market have recently been shown to reduce 3-point MACE events in diabetics. So perhaps apabetalone could "replace" or "supplant" these therapies in terms of magnitude of reducing CVD risk. However, apabetalone operates in a completely different mechansim of action it's primary effect is not glucose control like Jardiance or Victoza. So kind of like apples and oranges here. Diabetics will likely still need a primary glucose control agent even if they are taking apabetalone.
3) Improved pharmacology, pharmacokinetics, and safety. Even with an established drug that inhibits a particular enzyme or pathway, an improved drug may come around that has improved efficacy, better safety, better pharmacology, more convenient dosing, etc. So an improved drug can replace or supplant an old drug in the same class.
I'm happy to continue discussing these clarifications of "disruptive technology" if anyone cares to.
BearDownAZ