Not to be disrespectful, but I'm not sure the 'First in Best...

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    Not to be disrespectful, but I'm not sure the 'First in Best Dressed' is always the golden rule.

    As I have mentioned, I've no experience in Oncology either. Only in the Cardio-metabolic space with BP.

    An interesting example is the introduction of DPP4-i medication for Tx of T2DM.

    For a very long time, SU's were the only available, worthwhile 2nd line medication available after a Biguanide. However. They had limited efficacy due to the nature of the disease and the potential for a significant AE was high (hypoglycaemia).

    Sitagliptin was introduced by MSD and became a blockbuster. It replaced the SU not with superior efficacy, but with a better safety profile. It's efficacy, especially early on in Tx, was poorer. Sitagliptin made MSD $5.3b USD in 2020.

    After Sitagliptin (2006) came a bucketload of DPP4-i:

    Vildagliptin (Novartis) (2007)
    Saxagliptin (AZ) (2009)
    Linagliptin (Lily) (2011)
    Alogliptin (Takeda) (2013)

    All of these drugs were 'me-too'. They offered poorer efficacy than the drug they were superseding (SU), and a marginally better safety profile. They cost a bucket load more however. Each DPP4-i was virtually indecipherable to one another. Yet all received approval.

    Maybe oncology is a different game altogether. I don't know. But I feel with the safety profile or lines of IP offer, it still stands us in good stead for future approval.





 
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