Sanofi-Aventis Asia Pacific R&D Head Frank Jiang On Opportunities In China And India: An Interview With PharmAsia News (Part 2 of 2)

Sanofi-Aventis VP and Head, Asia Pacific R&D Frank Jiang talked to PharmAsia News along the sidelines of the recent DIA China conference in Beijing. Jiang shared his vision of how the company is revamping its R&D strategies in Asia to bring more therapies to patients in India and China.

Having recently forged its first partnership in India with Glenmark, Sanofi is gearing up for more acquisitions and partnerships in India and larger Asia to meet the new challenges of the constantly evolving R&D landscape in Asia. Jiang said that in 20 years, roughly 50 percent of the pharma business will come out of emerging markets .

[Editor's note: In part one of this interview, Jiang discussed Sanofi's strategy for driving research in Asia Pacific (Also see "Sanofi-Aventis Asia Pacific R&D Head Frank Jiang On Opportunities In China And India: An Interview With PharmAsia News (Part 1 of 2)" - Scrip, 18 Aug, 2010.).]

PharmAsia News: Collaborations are the name of the game these days, but is it unsettling for Big Pharma to have to rely so much on external collaborations?

Jiang: Yes, we are modifying our R&D organizations toward being more externally oriented and this is in recognition that most of science occurs outside Sanofi-Aventis' walls. We are working with the top institutions in the region and are building up assets and capabilities through strategic investment in people and sciences. It is critical to find the right partners.

I think that the organization reorganization or modification has to be patient centered and patient insurance oriented as well. So, if you have a very good drug, not only do you treat that disease, but the level of the efficacy has to meet the minimum of payers' requirements.

PharmAsia News: This is a very new conversation - the influence of payers - that wasn't heard as much in discussions even five years ago. How does it change your R&D strategy?

Jiang: One is from a regulatory perspective. They want to see a clinically meaningful improvement. That's one aspect, but even if regulatory thinks it's clinically meaningful, the payers may not think the same way.

I'll give you one example. For hypertension, for instance, let's say you have blood pressure of 160 over 90. That's hypertension, by definition, and you tell the regulators that you have this wonderful drug that can consistently lower that blood pressure down to 158 overnight. FDA will tell you, "Numerically very interesting, but clinically meaningless. A decrease of two millimeters has nothing to do with clinical outcome. We're not going to approve you."

Okay, you come back, you modify your drug. You know what? Now I have a drug that actually can decrease it from 160 to 154. Now it's six millimeters. Let's just assume that FDA says, "Yes, this is meaningful, and you can tell me that there is a meaningful decrease from 160 to 154." And that could translate in five years to saving one patient for every 1,000 patients. And you know what? Insurance companies say, "From 160 to 154, five years you save one life, I'm not going to pay for it."

So this game is totally changed. And also you see that in cardiovascular today, where there is no longer a medical need. For hypertension, let's say you start with a very mild medication. You double the dose and you mix with another one. It's still one pill. So each time you modify, it gives you at least two, maybe two years on average. And then when one pill is not enough, you go to more, maybe mix it with another pill. And now we have 10 different pills. So there is no unmet medical need. Cholesterol? Fine. Start with 5 mg, and then go up to 10, 20, 30, 50.

Diabetes? I'll give you more insulin. This is very different from cancer.

Now, cancer is an unmet medical need. If it's lung cancer, we have some medication, but you can't say with that medication that you can cure that disease. So I think that the landscape today is very, very different. So in order to be innovative, that's why companies have to do more external innovation - they have no other choice. The science happens 99 percent of the time outside of your own company's walls.

PharmAsia News: So I wanted to also talk briefly about the therapeutic focus. Pain is a new area for Sanofi?

Jiang: Pain is an important unmet need. There are several therapeutic units of our company that are working on innovation for pain from different angles. For instance, diabetic pain may have some similarity and dissimilarity with that of aging-related pain. I see synergy and collaboration between the two.

PharmAsia News: According to a recent study, China is now number one in diabetes, surpassing India, I believe [ (Also see "China At Ground Zero In Explosion of New Diabetes Cases; International Federation Now Projects 500 Million Diabetics Worldwide By 2030" - Scrip, 14 Apr, 2010.)]?

Jiang: Diabetes has become a major public health problem in China. Based on a recent publication from NEJM, there are 92.4 million adults with diabetes and 148.2 million adults with pre-diabetes.

We work very closely with our diabetes division to look for overall health care solutions for our patients. Education, exercise and diet are the first step. Effective therapeutics is next. It is also very important to have the right monitoring of blood sugar. Finally, accurate delivery of drugs such as insulin requires a reliable and handy device.

PharmAsia News: Do you have a strategy for making these treatments affordable for patients in emerging markets?

Jiang: Yes, "affordable medicine" is an important strategy for our AP R&D. We are talking to several partners now including health authorities to find ways forward.

PharmAsia News: So, as we talk about diabetes and innovation, are you looking for diagnostic device companies to acquire?

Jiang: Yes. We have AgaMatrix for blood glucose monitors and we are looking at different companies to make these deliverables to patients easier and more cost-effective and more effective. So whether it is insulin devices, diagnostics, monitoring or education, it's a total package, basically.

- Tamra Sami ([email protected])