In case you didn’t get the memo, Gilead is bet­ting that a cock­tail ap­proach will win them a cov­et­ed place in the NASH show­down.

A day af­ter draw­ing at­ten­tion to pos­i­tive proof-of-con­cept da­ta around its cilofex­or/fir­so­co­stat ther­a­py, the Big Biotech says it’s kick­ing off an­oth­er clin­i­cal tri­al in col­lab­o­ra­tion with No­vo Nordisk in which semaglu­tide will be added to form a three-drug reg­i­men.

A block­buster fa­vorite among up-and-com­ing di­a­betes drugs, semaglu­tide is a GLP-1 ana­logue that not on­ly stim­u­lates se­cre­tion of in­sulin but al­so is thought to im­prove glu­cose me­tab­o­lism in the liv­er and in­crease fat­ty acid ox­i­da­tion. Giv­en that more than 40% of NASH pa­tients have di­a­betes and more than 80% of them are al­so liv­ing with obe­si­ty (No­vo Nordisk’s num­bers) — an­oth­er tar­get in­di­ca­tion for semaglu­tide — the Dan­ish drug­mak­er has called its in­ter­est in the dis­ease a “nat­ur­al ex­pan­sion.”

For Gilead, this will be an op­por­tu­ni­ty to for­ti­fy a grow­ing NASH port­fo­lio as well as flex its sci­en­tif­ic mus­cles. The part­ner­ship al­so cov­ers a po­ten­tial col­lab­o­ra­tion on pre­clin­i­cal re­search to bet­ter un­der­stand an ail­ment of­ten dubbed a silent dis­ease.

With car­diopul­monary sales wan­ing — caused by loom­ing gener­ic en­try and il­lus­trat­ed by a round of lay­offs an­nounced this week — the hep C op­er­a­tions shrink­ing, HIV un­der as­sault and the bold new CAR-T ven­ture slow to im­press, Gilead is pressed to find a new area in which it can es­tab­lish as for­mi­da­ble a pres­ence as it had in the an­tivi­ral realm.

It took a hit when selon­sert­ib flopped in a close­ly-watched Phase III, out­per­formed by the place­bo at the low dose, dash­ing hopes for a vault to the lead po­si­tion as a flock of small play­ers take turns to present their own late-stage re­sults.

As ri­vals — in­clud­ing In­ter­cept, Gen­fit, Madri­gal and NGM Bio, which is part­nered with Mer­ck — crowd in, Gilead has been pick­ing up ear­ly-stage as­sets in pur­suit of a sus­tain­ing fran­chise. In fact, cilofex­or came from the buy­out of Phenex Phar­ma and you might re­mem­ber fir­so­co­stat as GS-0976, which Gilead paid Nim­bus $600 mil­lion for.

The com­pa­ny al­so hasn’t giv­en up on selon­sert­ib, which is be­ing test­ed in a triple com­bo with cilofex­or and fir­so­co­stat.

Im­age: Er­ic Ris­berg AP

For years, the idea of protein degradation — utilizing the cell’s natural garbage disposal system to mark problematic proteins for destruction — remained an elegant but technically difficult concept. But now established as a promising clinical strategy, with major biopharma players such as Bayer, Gilead and Vertex trying to grab a foothold via partnership deals, a San Diego startup is looking to exploit it and push its limits.

Medical animation has in recent years become an increasingly important tool for conveying niche information to a varied audience, particularly to those audiences without expertise in the specialist area. Science programmes today, for example, have moved from the piece-to-camera of the university professor explaining how a complex disease mechanism works, to actually showing the viewer first-hand what it might look like to shrink ourselves down to the size of an ant’s foot, and travel inside the human body to witness these processes in action. Effectively communicating a complex disease pathophysiology, or the novel mechanism of action of a new drug, can be complex. This is especially difficult when the audience domain knowledge is limited or non-existent. Medical animation can help with this communication challenge in several ways.
Improved accessibility to visualisation
Visualisation is a core component of our ability to understand a concept. Ask 10 people to visualise an apple, and each will come up with a slightly different image, some apples smaller than others, some more round, some with bites taken. Acceptable, you say, we can move on to the next part of the story. Now ask 10 people to visualise how HIV’s capsid protein gets arranged into the hexamers and pentamers that form the viral capsid that holds HIV’s genetic material. This request may pose a challenge even to someone with some virology knowledge, and it is that inability to effectively visualise what is going on that holds us back from fully understanding the rest of the story. So how does medical animation help us to overcome this visualisation challenge?

After gaining credit as the architect of Gilead’s $12 billion Kite buyout as well as the recent $5 billion partnership with Galapagos, chief strategy officer Andrew Dickinson is being promoted to the prestigious CFO post at the big biotech. And new CEO Daniel O’Day says the latest move completes his makeover of the top team.
Dickinson will remain in charge of strategy in his new post.
A 3-year veteran at Gilead, Dickinson joined the bellwether biotech after a lengthy stint at Lazard Frères & Co, where he was global co-head of healthcare investing. Before that, ironically enough, he had been at Myogen, which was bought out by Gilead in 2006. Now he’ll be primarily responsible for building confidence in the numbers at a company that has a strong foundation in HIV, a disappearing franchise in hep C and a CAR-T subsidiary in Kite that has a long way to go in establishing a new business.