Replies to post #41989 on Biotech Values

[Biowatch]

>MNTA has designed a heparin variant called M118 from the ground up that works on both FXa and FIIa, is reversible, and doesn’t have the monitoring and reliability problems of ordinary heparin. If it works as advertised, it will be a monumental blockbuster, but it’s still very early in development.<

Naive question: Is MNTA working on a single isoform of heparin, or a carefully designed and reproducible set of the multiple forms found in vivo? The wide range of heparin forms found in vivo might imply variability is useful.

How do you decide what is best?

[dewophile]

yup - definitely room for improved agents in this class
treatment in pregnancy (where i have some first hand experience) is increasingly common and particularly challenging:
1. pregnancy is a prothrombotic condition
2. there is an increasing appreciation that clotting in the placenta may be a predisposing factor to many complications of pregnancy, including miscarriage
3. there are more and more genetic screens for heritable thrombophilias, increasing the total size of the market for prophylaxis in pregnancy
4. coumadin is teratogenic and not an option
5. peripartum bleeding is always a concern, and managing anticoagulation at term is vexing to say the least
6. the half-life of unfractionated heparin usually requires multiple daily dosing (not to mention onerous monitoring), and hence LMW heparins have largely replaced heparin..although limited reversibility is a drawback as you point out

if mnta (or anyone else) can improve the treatment options its a blockbuster in the making imo

[quantumdot]

Re: Complexities of the coagulation cascade

Dew - where does fondaparinux fit into this? My understanding was that as a selective FXa inhibitor it was superior to enoxaparin in treating ACS and DVT/PE. Plus it is entirely synthetic.

(See http://content.nejm.org/cgi/content/short/354/14/1464 and http://content.nejm.org/cgi/content/abstract/345/18/1305 amongst others.)

Sales have not exactly taken off but Arixtra is finally gaining some momentum (sales just exceeded $100MM in 2006). Given the growing body of superior head to head trial results against Lovenox why is it having such a hard time gaining share?

My particular interest in this is because a small Aussie company Alchemia (ALC.AX) has the front running for a generic fondaparinux - perhaps on market in 2008 - and greater uptake of Arixtra would certainly benefit them.