Washington Post Staff Writer
Monday, June 29, 2009
In the high-stakes, high-risk, high-failure business of developing
drugs, there are two events that test an executive's intestinal
fortitude. One: The first time a drug is tried by a human. Is he still
alive? Two: Getting results of final-stage testing. Please, let it
have worked.
Around eight years ago, Human Genome Sciences survived the first
event, when patients were first given the firm's experimental lupus
treatment. Sometime in July, and many hundreds of millions of dollars
later, they will gather in a hotel conference room to see how they
endured the second crucial event -- final human testing results. David
Stump, the firm's head of drug development, is hoping the first
PowerPoint slide the biostatistician shows will say success.
"You work yourself into a zone of contemplation," Stump said. "It is
one of those acquired skills you develop in this business. You have to
make your peace with success and failure. If you can't make your peace
with failure, then this isn't the business you should be in."
And plenty of people on Wall Street predict that the Rockville company
will fail. Lupus, a complicated autoimmune disease in which the body
attacks its organs, is known as the drug industry's black hole, where
even the world's top scientists go to fail. There hasn't been a new
lupus drug approved in 50 years. Not long ago, biotech behemoth
Genentech stumbled with its own candidate.
"No one has any real conviction that HGS's drug is going to work,"
said Geoffrey Porges, a Sanford C. Bernstein analyst. "Nothing has
really ever worked in lupus. It's a very difficult disease." In
downgrading the stock recently, Lazard Capital Markets analyst Terence
Flynn told investors, "We continue to believe that the probability
that this drug succeeds is extremely low."
The difficulty in going after lupus is that the disease waxes and
wanes, heightening the possibility of a placebo effect. Also, because
many organs are involved, it is difficult to measure success because
the disease is a moving target. In cancer, drug developers generally
target stationary tumors with a laser focus. Treating lupus is like
trying to corner a hyper cat.
In key mid-stage testing in 2005, HGS fell short of the goal line. But
when executives took a closer look at the data, they saw that their
drug, now called Benlysta, was successful in treating a subset of
patients who had biologic indicators in their blood showing that the
disease was active. Wall Street analysts generally dismiss such
retrospective analysis.
"It's changing the rules of the race," Porges said. "We lost the
marathon, but if it had been a half marathon, we would have won."
Nonetheless, in the final stage of testing, HGS, with the agreement of
federal regulators, only enrolled that subset of patients in the
study. Stump said that if what happened in the retrospective analysis
of the earlier failed study repeats itself, "We will have very
favorable results." But there is still room for doubt, he said: "The
patient variability component is still there." Translation: The cat is
always on the move.
HGS chief executive H. Thomas Watkins said Wall Street's reservations
did not bother him. He pointed to recent positive results from an
extension of the last study, which showed that for patients who stayed
on the drug, after four years there was sustained improvement in the
disease.
"The consensus out there may be that we shouldn't count on it working,
but that doesn't change the prospect of it working," Watkins said.
"Our chances of success are independent of what the market thinks."
Later in the interview, he said, "It will succeed, it will succeed,"
almost like a mantra.
The stakes for HGS and lupus patients are enormous. For the company,
it would be a significant validation of the founding principles of
genomic medicine, but more importantly it would provide a much-needed
source of revenue for a firm whose only product on the market is a
treatment for anthrax. A lupus drug has the potential to become a
billion-dollar drug. HGS is also working on a treatment for hepatitis
C, though that drug has also been criticized by some analysts.
Hanging over HGS's head: About $400 million in convertible debt due in
2011 and 2012 if the company's shares don't trade for more than $15.
HGS shares are currently trading for under $3. Analysts who are less
negative about the company's prospects for success in lupus say a
positive study result could send the shares over $20. "In our view,
this could be a tremendous opportunity if the data is positive,"
Citigroup analyst Yaron Werber recently told investors.
Then there's the lupus patients, who haven't had a new drug in five
decades and who currently take a combination of drugs with serious
side effects. "The patients are very excited," said Sandra Raymond,
president of the Lupus Foundation of America. "They have waited a long
time, so this is a very exciting prospect. I believe we will have a
new medication for lupus, and it will start with this drug."
Stump, the drug development chief hoping for that positive first
PowerPoint slide, said: "Heaven knows these patients need something
different." Everyone will know soon.