If this tachyphylaxis argument is correct, then there is potentially another risk for AKBA/GSK - changing response to the drug over time (months not weeks). What is worse, such enzyme-linked changes tend to be quite variable across different patients. And because it is a negative feedback situation, increasing the dose further might well produce diminishing returns.
So bottom line I really don't know if this is going to be an issue for AKBA or GSK or not, but does certainly add to the risk profile. It is perhaps interesting that GSK tested very high doses of their drug before choosing one of the lowest doses they had tested for their Ph III.
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