>If NM283 were to be limited to the role of replacing ribavirin it would still likely be a major market success because, at present and probably for some time going forward, ribavirin is an important part of therapy. As you said, it has some nasty sides, so a more tolerable substitute would be great. Cost/benefit analysis will be particularly important in this case<
We’re on the same wavelength here. A dirty little secret of HCV standard treatment is that ribavirin’s side effects are as bad as—or even worse than—interferon’s, yet it’s interferon that gets most of the bad press.
>As to comparing the incremental .2 log drop of riba to the 1.0 log drop of NM-283, I would also question how the comparison was made, but I'm not impressed with 1 l-log drops unless you're talking about patients with 1-log viral loads.<
I mentioned the incremental reduction in viral load to refute Werber’s assertion that NM283 is no better than ribavirin. There are so many efficacy metrics commonly used to measure HCV treatment that one can usually find some metric where a favored drug looks good in comparison to a rival. That’s why I like to look at the mean log reduction, which (similar to the mean “late loss” in coronary stent treatments) is the “purest” metric in a mathematical sense. Based on this, it seems that ribavirin doesn’t quite measure up despite the multiple MoAs that you cited.
>…so I doubt that riba would be displaced entirely…<
NVS and IDIX will be testing NM283 with riba and peg-interferon between now and the start of phase-3. If it turns out that the NM283 phase-3 protocols have ribavirin playing a major role, then (and only then) will I concede that NM283 is a flop. Regards, Dew
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