An Endless Cycle of Suffering
Autoimmune diseases can wreak havoc on a person’s life. Despite their best efforts to lead a healthy lifestyle, for patients with an autoimmune disease, it’s common for standard treatments to become ineffective over time, leading to relapse with no consistent relief in sight. When this happens, the unceasing cycle of symptoms, diagnosis and treatment can often feel like an unwinnable battle.
There are more than 24 million people in the United States who are living with one or more autoimmune conditions like inflammatory bowel disease (IBD), atopic dermatitis and rheumatoid arthritis. Due to the complexities of these diseases, it may take months or even years for patients to receive a proper diagnosis. And even then, many lack effective and potentially curative solutions to their conditions — leaving a significant, negative impact on their physical and mental health, quality of life and longevity.
Further complicating matters is the method of treatment. Traditional treatments for many autoimmune, inflammatory, and immunological conditions are medications, such as steroids, that aim to alleviate symptoms through strong suppression of the immune system to decrease inflammation. But these medications only provide symptomatic relief – often while exposing patients to difficult side effects, even as their disease advances.
“Patients with autoimmune diseases are often suffering in silence,” says Cathy Begley-Frawley, Vice President, Commercial Strategy and Innovation at Pfizer. “If you consider a patient with inflammatory bowel disease, they may need access to a bathroom multiple times a day. How can they commute to work, or meet other responsibilities in their lives? Given the nature and unpredictability of this disease, everyday activities which most people take for granted are incredibly challenging for patients with IBD. Making the world more aware of these diseases is fundamental to helping them not only get treatment but get a treatment that works for them.”
The Immune System Connection
The origin of inflammatory and immunological conditions lies in the immune system. Each step of the immune system response is susceptible to dysregulation or uncontrollable inflammation. But while autoimmune diseases — especially in dermatology, gastroenterology, rheumatology, respiratory, allergy and fibrosis — have complex disease networks, they share similar immuno-inflammatory pathways and disease etiologies, or drivers of disease, which can be organized into functional immunological axes.
“We think there is great potential to help patients if we think of the immune system and the way inflammatory diseases progress as more of a system as opposed to a collection of individual disorders,” says Michael Vincent, the Senior Vice President and Chief Scientific Officer of Pfizer’s Inflammation & Immunology Research.
Today, Pfizer is using this new systems-based approach to identify new potential targets for improved and more personalized therapies for autoimmune disease patients. This shift from focusing on specific autoimmune diseases to scientific axes aims to help address multiple aspects of a patient’s healthcare journey, finding common pathways that are disrupted in pathologically related autoimmune diseases, ultimately leading to more effective treatment plans for patients.
“A common thread in many inflammatory diseases is that despite having therapies that are known to be effective, they are not curative. Once a patient stops taking their medicine for a week or maybe a month - as soon as the drug is washed out of their system - the underlying inflammatory process that has been held at bay will proceed to flare up. Then the patient will either go back on the same drug or potentially try a different drug,” says Vincent. “One element of remittive therapies is the potential to not have to take a daily medicine. Perhaps in the future we'll be talking about cures for autoimmune diseases, or possibly only treating during flare-ups. If we can extend the period between those flare-ups, maybe someone only needs to be on a medicine once every few years with better results.”
“One element of remittive therapies is the potential to not have to take a daily medicine. Perhaps in the future we'll be talking about cures for autoimmune diseases, or possibly only treating during flare-ups. If we can extend the period between those flare-ups, maybe someone only needs to be on a medicine once every few years with better results.”
Michael Vincent — Senior Vice President and Chief Scientific Officer of Pfizer’s Inflammation & Immunology Research Unit
Potentially Addressing Multiple Diseases with One Molecule
Pfizer’s new approach involves examining potential medicines that could impact multiple diseases simultaneously. For patients living with several autoimmune conditions, this may mean treating more than one disease with the same therapy.
“There are many co-morbidities in the inflammation and immunology space. For example, many patients with asthma also have atopic dermatitis,” adds Begley-Frawley. “If you have a molecule that’s approved for both, this is just one example where there’s potential for multiple benefits from this approach.”
According to Michael Vincent, the key to changing the trajectory of the study and treatment of inflammatory and immunological diseases is through bioinformatics - or the use of computational techniques to analyze biological data - and systems immunology. Systems immunology involves research that examines the interaction between cellular and molecular networks within the immune system.
“Bioinformatics, along with focused use of artificial intelligence, increases our understanding of the interconnectivity of diseases through shared inflammatory pathways,” Vincent says. “Systems immunology applies this understanding to select and target multiple diseases with a single molecule.”
A Potential Game Changer
Knowing that improving outcomes for patients struggling with autoimmune disease is a huge undertaking, Pfizer is not tackling the issue alone. Pfizer’s team is collaborating with CytoReason, AI technology company, to leverage their data integration platform to assist their scientists in finding the best potential therapeutic approaches for treating these conditions. Vincent recognizes the importance of this research and how it can be utilized to decipher which proteins or cells should be a primary target for treatment plans for autoimmune disease patients.
“We’re pursuing next-generation, solutions to autoimmune, inflammatory and immunological conditions so patients may better manage their conditions” says Vincent.
Like Pfizer’s new research approach, these next-generation multispecific antibodies, including bispecifics and trispecifics (manmade antibodies), offer the potential for more complete regulation of common immunoinflammatory pathways by simultaneous modulation of multiple targets. In theory, this may maximize the value of a single molecule to target multiple diseases while treating individual patients more effectively.
“We’re pursuing next-generation, solutions to autoimmune, inflammatory and immunological conditions so patients may better manage their conditions.”
Michael Vincent — Senior Vice President and Chief Scientific Officer of Pfizer’s Inflammation & Immunology Research Unit
Looking Toward the Future
“Through additional research we may one day see more exciting innovation in this disease area. The variety of ways in which the body tries to control immune response creates potential avenues to ultimately try to get patients to a point in their disease management where they have no symptoms at all - or perhaps they don't even have an underlying inflammatory process that we can detect - and won't return if we stop their anti-inflammatory medication,” says Vincent. “We think it's a very exciting time in the treatment of anti-inflammatory diseases, both due to the variety of innovative approaches we've taken to better understand the immune system, as well as our understanding of the body's processes for maintaining a state of tolerance in which the immune system is only attacking infectious agents, and not attacking its own tissues.”
This is only the beginning for patients with autoimmune diseases.
“Our aspiration is to help the patient’s body almost develop a curative approach over time, so they won’t need these interventions for the rest of their life,” says Begley-Frawley. “If we can crack that in the future, it would be so amazing for many people across the globe.”
