Innovating in inflammation and immunology

For World Inflammatory Bowel Disease day we spoke to Pfizer’s Matt Shaulis, president of international developed markets for inflammation and immunology, to hear how the company hopes to harness innovation to address the many unmet needs in these disease areas.

What would you say are the biggest challenges in the area at the moment?

One of the biggest challenges in the area of immune-mediated and inflammatory diseases is the lack of understanding of the true burden of these diseases, which has meant that these patients have historically been underserved.

While significant advances have been made in the treatment of rheumatic diseases, such as rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS), many patients still experience the daily burdens of living with these diseases.

Whether a patient is unable to reach remission with his or her current treatment or is settling for ‘good enough’, uncontrolled disease can lead to irreversible joint damage and may also impact overall wellbeing and daily functioning.

For this reason, different treatment options – in addition to timely diagnosis and access to advanced therapies – are needed.

As for gastroenterology, chronic inflammatory diseases of the digestive tract can be painful, inconvenient and embarrassing, dramatically affecting how patients live their lives. Many patients have not been able to achieve optimal symptom control with current therapies and lead a life profoundly impacted by ongoing symptoms.

“Wearable technologies commonly seen in the fitness field can be employed to measure itching and sleep disturbance in atopic dermatitis”

There is also a critical unmet need for diseases such as nonalcoholic steatohepatitis (NASH), a leading cause of liver transplant, for which there are no approved drug therapies.

In dermatology, despite significant recent advances in inflammatory skin diseases, there are still many – such as atopic dermatitis (AD), alopecia areata (AA) and vitiligo – where new treatments are needed to make a meaningful impact in patients’ lives.

Are there any particular issues in diagnosis and detection you’re hoping to address?

The treatment landscape for immune-mediated diseases has evolved significantly, from broad immunosuppression with steroids to targeted immune modulation through selective agents. However, improved treatment options will only really make a difference to patients’ lives if they go hand in hand with an increase in awareness among physicians and other healthcare providers.

We need to work with the medical community to enable a deeper understanding of immunological disease management, triggers, and the importance of treatment adherence. The resulting improvement in patient wellbeing can soften the impact on healthcare systems.

What does ‘innovation’ mean to you when it comes to inflammation and immunology?

Innovation comes in many forms for the inflammation and immunology (I&I) team. Innovation in research and development is crucial and we are relentlessly pursuing new breakthroughs such as next generation kinase inhibitors, novel biologics and topicals.

But we also strive to innovate in how we run clinical trials both in terms of the technology we use – for example employing wearable technologies commonly seen in the fitness field to measure itching and sleep disturbance – through to the means to undertake testing in patients’ homes to obtain true real world evidence.

Finally, we partner with a variety of organisations who are driving innovation in helping patients make informed lifestyle choices, manage treatment adherence and facilitate doctor/patient relationships.

What kind of beyond-the-pill measures are important for patients in these disease areas?

There are improvements that could be proposed at all levels of the healthcare ecosystem to help address immunological and inflammatory diseases, but a critical step is for stakeholders to collaborate and drive meaningful change at the policy level.

This begins with establishing guidelines to ensure standardised treatment paradigms. Further assistance can be provided to patients through holistic patient and family support programmes that integrate disease management with good overall health and wellness practices.

One organisation we are partnering with in this regard is Sidekick Health, which offers technology-based solutions for patients suffering from the two main IBD conditions ulcerative colitis (UC) and Crohn’s disease (CD), and also for patients with rheumatoid arthritis (RA), atopic dermatitis (AD) and psoriatic arthritis (PsA).

The platform provides these patients with a rich user experience, where they earn rewards for managing their nutrition, exercise, sleep, stress and medication adherence. They also receive condition-specific education, and a connection to a community of health professionals and patients on a similar health journey.

Finally, expanded general awareness of AD can break the stigma associated with its flare-ups. When patients’ concerns are met with understanding and support, it can lessen their embarrassment and anxiety. This in turn may make them more likely to seek the help they need to manage their condition successfully.

What’s your overall view on how digital technology fits into I&I research, treatment and care?

There is a lot of interesting work being done in I&I research utilising technologies from the broader health arena. For example, our own Pfizer Innovation Research (PfIRe) lab is looking at solutions such as using wearable devices to help scientists monitor treatment for atopic dermatitis.

The lab equips patients with a device that can monitor sleep disruption caused by scratching. The team assesses that sleep disruption both with treatment and without treatment to determine how effective a particular therapy is for that particular endpoint. This is particularly critical in assessing scratching and sleep disruption in younger patients who would have trouble recalling or indeed articulating these symptoms themselves.

Do you think eczema and other inflammatory skin diseases are overlooked compared to other conditions?

Chronic inflammatory skin diseases can have a devastating impact on a person’s mental and emotional wellbeing, although they are often overlooked as being simply cosmetic. This leads to a vast discrepancy in how patients are managed around the globe. Furthermore, the physical and social pressure that this disease creates goes hand in hand with a financial burden as patients pay for various products and treatments in search of symptom relief.

One recent study found that the average AD patient spends an additional €927 per year on health care expenses. Add to this the potential cost of doctors’ visits and treatments for co-morbidities, and the economic impact of absenteeism and time off work, and we start to get a true picture of the cost this condition imposes on health care systems at large.

We are now seeing an increased focus on developing treatments for chronic inflammatory skin diseases, but there is still a long way to go.

How do you see I&I evolving in the future?

The JAK pathways are believed to play an important role in inflammatory processes as they are involved in signalling for over 50 cytokines and growth factors, many of which drive immune-mediated diseases. JAK inhibition may offer patients with these conditions a potential new advanced treatment option.

We’re taking a different R&D approach to that of other companies involved in JAK research – instead of studying a single molecule for all its potential uses, where it may not be optimal for some, we purposefully match Pfizer’s candidates with unique selectivity profiles to the conditions where, if approved, we believe they have the greatest potential to address unmet need.

Ultimately, we are working toward supporting fast, accurate diagnoses, providing effective treatment options and enabling appropriate patient choices which lead to freedom from the burden of immune-mediated and inflammatory diseases.

About the interviewee

Matt Shaulis currently serves as the president of Pfizer inflammation and immunology for international developed markets. He has approximately 20 years of experience in the pharmaceutical industry across several functions including: in-line and global strategic marketing, sales management, strategic customers group, licensing and acquisitions, finance, and compound and indication launches across multiple disease states. He joined Pfizer from Teva Pharmaceuticals, where he was vice president, global CNS, multiple sclerosis.