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October 2005 

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Combination Therapies: 
Benefits and Challenges in Drug, Device,  and Biologicals Development

Richard Fisler and Olivia Scaros, PharmD 

New Page 1
Table 1.1. Number of NDAs for Combination Products (Years 2001-2005)

Table 1.2. Examples of Top-Selling Drugs in 2003 with Patent Expiration Years and 2003 US Sales (Billions of Dollars)

Table 3.1. Studies of Losartan and Hydrochlorothiazide Examining Effects on Blood Pressure

Table 3.2. NSAID-Associated Gastric Ulcer Risk-Reduction Rates

Table 3.3. Gastric Ulcer Risk-Reduction Rates in Patients Whose NSAID was Naproxen Only or Naproxen and Aspirin Only

Table 5.1.
Examples of Prices of Combination Products Compared to the Individual Components Added Together

Table 6.1. Examples of Fixed-Dose Combination Products From Various Therapeutic Areas

Table 6.2. Classification and Management of Blood Pressure for Adults

Table 6.3. Oral Antihypertensive Medication Combinations

Table 6.4. Antiretroviral Agents Approved for the Treatment of HIV Infection

Table 6.5. Price Comparison of Arthrotec 75 in Comparison to the Individual Components

Table 6.6.
Combination Antibiotics According to Class

Table 6.7. Ratio of Male and Female Medical, Law, Dental, and Business Students From
1960-2000

Table 6.8. Low-Dose Oral Contraceptives Currently Available in the United States

Table 6.9.
Licensed Vaccines in Combination

Table 6.10. Drug-Eluting Coronary Stents Currently Available

Table 6.11.
Drug-Eluting Coronary Stents in Clinical Trials

Table 6.12. Currently Available Helicobacter pylori Detection Tests

Table 6.13. Wound-Care Combination Products Currently Available

Table 6.14.
Monoclonal Antibodies (Monotherapy) Currently Available

Table 8.1. Value Proposition and Opportunities of Different Types of Combination Products

Figure 1.1. Patent Issues Throughout the Product Lifecycle Stages

Figure 1.2. Development Process Regarding Timelines and Regulatory Procedures

Figure 2.1. Combinations of Previously Marketed Drugs: Recommended General Procedure

Figure 2.2. Combinations of Previously Marketed Drugs with NMEs: Recommended General Procedure

Figure 2.3. Combinations of NMEs with NMEs: Recommended General Procedure

Figure 3.1.
Hypothetical Factorial Study Design for Combination Antihypertensives

Figure 3.2. Hypothetical Factorial Study Design for Combination Cholesterol-Lowering Drugs

Figure 4.1. Comparison of Number of Submissions to FDA Versus Cost of Pharmaceutical Research

Figure 4.2. Pfizer’s Revenue From Lipitor Sales, 1999-2005

Figure 5.1. Increased Development Efforts Required When Combining Two Already-Released Drugs in a Fixed-Dose Combination Product

Figure 5.2. Increased Development Efforts Required When Combining a NBE and a Released Drug in a Fixed-Dose Combination

Figure 6.1. The Stent Procedure

Figure 6.2.
Principles of PDT After Application of Metvix

Figure 6.3. LidoSite Patch and Dose Controller Combining a Transdermal Delivery System and Topical Anesthesia

Figure 7.1. CombinatoRx’s Approach to Drug Discovery in Comparison to Traditional Methods

Figure 7.2. CombinatoRx Compounds in Clinical Trials by Phase and Disease Area

 


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