In IPF, it seems likely that the Fibrogen drug works only in a subset of patients (maybe 25%), but when it does work, it works really well. So that complicates trial design some, and if you add another drug in combination things get even more complex.
What would make a dramatic difference is is if they could somehow figure out which patients it works on. Perhaps IPF is actually a bunch of different diseases with some common symptomatology, or perhaps there are some genetic differences.
At one stage they had hoped that it was the less advanced patients where it worked best, but really that didn't seem to pan out when they expanded the trial to include only such less-advanced patients.
Getting a lung biopsy is a big deal, so you can't simply do repeated biopsies to try to figure out what is happening in individual patients.
Peter
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