
The First Deuterated Drug Arrives - adenadel
http://blogs.sciencemag.org/pipeline/archives/2017/04/04/the-first-deuterated-drug-arrives
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advisedwang
I expect we will see a slew of out-of-patent drugs re-created with deuterium
atoms for marginal clinical benefit and then sold under patent again.

~~~
adenadel
That might happen, but nothing would stop people from using the much cheaper
generic of the original drug.

~~~
colinbartlett
Nothing except their doctor recommending the more expensive name brand drug,
which happens all the time. I'm sure there are many reasons why this happens
including drug companies having cosy relationships with doctors and also
consumer advertising causing patients to request specific drugs.

Take Nexium.[1] I'm no expert, but I understand Nexium to be esomeprazole, the
s-isomer of omeprazole which is to say it's a mirror image chemically. Yet
it's the second most prescribed drug in America.

1\. [http://scienceblogs.com/denialism/2012/01/09/why-no-one-
shou...](http://scienceblogs.com/denialism/2012/01/09/why-no-one-should-take-
nexium/)

~~~
ksenzee
There can be a real benefit to isomer drugs. They get prescribed way more than
they need to, no question, but that doesn't make them entirely useless.

For example, desvenlafaxine (Pristiq) is the R-isomer of venlafaxine
(Effexor). You'd think it would be a useless me-too drug, but in fact it's
metabolized differently, which affects people with CYP450 mutations.
Ultrarapid metabolizers will end up with way too little Effexor in their
system, whereas Pristiq will work fine for them. Other way around with poor
metabolizers: they don't metabolize Effexor well enough, so they'll get worse
side effects. (See
[http://psychopharmacologyinstitute.com/antidepressants/snris...](http://psychopharmacologyinstitute.com/antidepressants/snris/venlafaxine-
desvenlafaxine-differences-similarities/) and specifically
[http://psychopharmacologyinstitute.com/wp-
content/uploads/12...](http://psychopharmacologyinstitute.com/wp-
content/uploads/12-Metabolizer-types.png.))

Ideally we'd all know our CYP450 profile, or our doctors would, so they could
prescribe older and cheaper drugs when they work well enough, and save the new
expensive stuff for patients who need it. Maybe someday medicine will come
around to using the tools it already has at hand. Sigh.

~~~
maxerickson
That it is sometimes important makes the (apparent) sham use of the
distinction all the much worse.

------
reasonattlm
An interesting topic to look into is the effect of deuterium on longevity in
various species. It appears to induce a form of hormesis at low levels
(perhaps) or improve resistance of certain important cell structures to
oxidative damage (perhaps). [1]

The company Retrotope [2] is trying to do something with what is known of this
biochemistry.

Deuterated drugs after the fashion of the one in this article are probably not
going to be delivering enough deuterium to trigger this sort of effect,
however.

[1]:
[http://onlinelibrary.wiley.com/doi/10.1002/bies.201600040/fu...](http://onlinelibrary.wiley.com/doi/10.1002/bies.201600040/full)

[2]: [https://www.retrotope.com/](https://www.retrotope.com/)

------
refurb
What's interesting is that Concert Pharmaceuticals (Derek mentions this in his
post) has been working on this technology for the past two decades. I'm kind
of surprised they weren't the first to market.

Drug R&D is hard!

~~~
chroem-
Everything is hard with software being a notable exception.

~~~
GenerocUsername
I don't know who you think you are. Coming on here and saying things like
this. How dare you.

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caycep
as the article probably said..this is adding deuterium to an old drug that has
been around for a while. The pharma for the old stuff is Lundborg, supposedly
one of the "non-profit" pharmas focused on orphan drugs. Pricing is high,
mostly due to supply constraints, so they say, but the foundation attached to
the company gives patients some sort of financial advice.

Basically, the drug induces a form of parkinsonism (hypokineticism) to combat
conditions that cause hyperkineticism.

------
Pulcinella
I'm interested in seeing how the patent issues turn out around reiterated
drugs in the future.

I predict that they will be and remain patentable. I'm no lawyer, but
deuteration does not seem obvious. Yes the idea that you can swap out hydrogen
for deuterium is obvious, but the idea that deuteration will have a meaningful
effect on a specific drug is not. For some drugs it may do nothing while in
others it will.

------
legulere
When the drug finally gets metabolized, are there any effects of a higher
presence of deuterium in the body to be expected?

------
woofyman
$60,000 usd a year list price.

~~~
adenadel
To play the devil's advocate, there are 30,000 people in the US with
Huntington's [0]. If all of them paid full price for the drug that comes out
to 1.8B. Bringing a drug to market costs 2.5B [1]. In order to encourage drug
development for rare diseases, there needs to be some financial reward. Often
more than half of a drug's patent is gone by the time that the drug is
approved.

0\.
[http://www.medicalnewstoday.com/articles/159552.php](http://www.medicalnewstoday.com/articles/159552.php)

1\. [https://www.scientificamerican.com/article/cost-to-
develop-n...](https://www.scientificamerican.com/article/cost-to-develop-new-
pharmaceutical-drug-now-exceeds-2-5b/)

~~~
jcoffland
Drug developers have a strong incentive to overstate what they spent
developing a drug. Since they are the source of these numbers, I suspect they
are inflated. If you were to take all of the drugs a company developed during
some time period and add up their reported development costs the total would
likely far exceed the companies total expenditure.

~~~
JBReefer
That's a strong claim that you could probably support with data with little
effort, but as it stands, it's conjecture.

I do agree with your analysis, but it's a weak argument to incentive.

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pizza
VMAT2 target has me considering some.. interesting.. hypothetical
deuteronomical creations.

~~~
throwanem
I like the pun, but Hamer's work isn't well supported. I won't even ask what
you had in mind.

~~~
pizza
Hah, I hadn't even noticed that pun. I was thinking of the drug target. And
maybe if Walter White would, in another universe, be cooking "heavy meth"

~~~
droopyEyelids
Heavy versions of most performance enhancers have been "available" for
decades, for obvious reasons.

