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What’s the Most Worthwhile New Drug Since 1990?

A query from a reader prompts me to ask this question, in preparation for a rather long post in the new future. What do you think is the most worthwhile new pharmaceutical brought to market since 1990? That’s an arbitrary cutoff, but twenty years is a reasonable sample size. And I’ll let everyone define “worthwhile” as they see fit – improvement over existing drugs, opening new therapeutic areas, cost-effectiveness, what have you. Just be sure to make your case, briefly, when you nominate a candidate. Let’s see, first off, if it’s a topic that can be agreed on at all.

61 comments on “What’s the Most Worthwhile New Drug Since 1990?”

  1. Old Timer says:

    Didn’t put much thought into this, but how about artemisinin and its derivatives? “Brought to market” is a bit of a misnomer in this case. But these compounds are cheap, highly effective and save an amazing number of lives each year.

  2. thomas says:

    Simvastatin just makes it into the twenty-year block. Even if we are getting progressively less clear on why it works, it and relatives reduces CHD enough to be visible in population statistic. I’m picking simvastatin rather than any of the other statins because it was the first to demonstrate mortality reductions.
    I like artemisinin and derivatives, too.

  3. daen says:

    AZT, I would suggest.

  4. anchor says:

    I am not including “me too” that has came out (like Lipitor after Zocor and they both saved lot of lives), but I will have to settle on “Gleevac”, that has raised hopes for many cancer patients that “cancer can be won”. Now that it went generic, the price are also down.

  5. lester freamon says:

    I would use a metric of most healthy (or somewhat healthy) years added as a result of the drug getting approved–so yes, the first one deserves most of the credit for the later, more improved versions.
    I think you have to go with saquinavir by that reasoning–so many 20 year olds with HIV would be dead in 3 years without it, but are likely to live to their 70’s now (HAART would be nothing without a protease inhibitor).
    My other candidates:
    2) Zyvox (linezolid)–basically everyone that gets this would die otherwise, and it works pretty damned well.
    3) Fluconazole–the first oral antifungal, allowing prophylactic therapy in immunocompromised patients.
    Obviously I have a bit of a therapeutic area bias here.

  6. Erock says:

    As a pharmacist, I’m going to have to go with Viagra on this one. It’s the first effective oral treatment for ED. This is a symptom that affects a significant portion of the population and was previously only treatable by Caverject (ouch) or Muse (double-ouch). This was a huge breakthrough and a real blockbuster for Pfizer.

  7. Yggdrasil says:

    I would agree with daen that antiretroviral drugs would probably top my list. A quick wikipedia search reveals that AZT was FDA approved in 1987 (just outside the window), so I would add 3TC (approved 1995), nevirapine (approved 1996) or tenofovir (approved 2001). It’s remarkable how quickly we’ve been able to take AIDS from a very problematic and deadly disease to a condition that can be managed fairly well with set of relatively cheap drugs.
    The only other class of drugs that might challenge the antiretrovirals would be statins.

  8. HelicalZz says:

    Worthwhile is a kicker isn’t it? So many ways to interpret.
    In terms of creating revenue for the industry and consequently jobs for those in it, you can not beat Lipitor. We can lament job losses, but without Lipitor and the statins, they would never have existed. But I suppose we ‘should’ focus on the patients right?
    I’d give Erythropoietin a shout out for further driving the biotech industry, but it was approved in 1989 (fails the cut). Plenty of Mab’s make the cut, but the first of those dates to the 80s as well.
    Herceptin as the poster child of personalized medicine is a worthy candidate.
    I guess I would second imatinib (Glivec, Gleevec, whatever) as opening up oncology to drugs which we didn’t cringe to develop (like the carpet bombs of the past) and improved the likelihood of efficacy in this prior black hole of drug development.
    Zz

  9. darwin says:

    Thalidomide. Brilliant re-work and rise from the catacomb of Rx ill-repute…or…one of the myriad joint supplements simply for innovative marketing of ground-up dogshark.

  10. Mark V Wilson says:

    I think it’s Avastin – the target, angiogenesis, is groundbreaking and its effectiveness is substantial in many cancers and in age-related macular degeneration.

  11. Dave says:

    Humalog (or Lispro) combined with Lantus (glargine)
    I’m a type I diabetic and the combination of these two have made my life enormously better

  12. Phil says:

    @6
    I give your troll a 5/10.
    If you’re serious, I give it 1/10.

  13. David Formerly Known as a Chemist says:

    Saquinavir, the first HIV protease inhibitor. This was a breakthrough product, and the HIV protease inhibitor class subsequently transformed HIV infection from a death sentence into a manageable disease.

  14. RAGuy says:

    The TNFalpha inhibitors as a group have been huge to RA patients – this includes enbrel, humira, etc – they are biologics so need to be injected. The combined sales of these drugs is massive and not just because they cost a lot (though they do) but they work very well and lots of folks take them. A runner up would be the bisphosphonates. They are now generic (e.g. alendronate) but before they came along, not much was available by way of inexpensive, relatively trouble free ways to prevent fractures.

  15. hypnos says:

    As #4: Imatinib. A revolution for patients with CML and the first kinase inhibitor on the market (?). One could thus claim that it opened a new world of therapies for cancer.

  16. Cytirps says:

    If one counts the US marketing date, azithromycin (Zithromax 1991) should be one of the top contenders. It’s a remarkable antibiotic with wide impacts, acid stable, long half-life allowing qd dosing and high Vd for effectiveness. One would not go back to those old qid antibiotics.

  17. Cytirps says:

    If one counts the US marketing date, azithromycin (Zithromax 1991) should be one of the top contenders. It’s a remarkable antibiotic with wide impacts, acid stable, long half-life allowing qd dosing and high Vd for effectiveness. One would not go back to those old qid antibiotics.

  18. barry says:

    The HIV protease inhibitors are a big deal, but we already knew that small-molecule protease inhibitors were viable drugs.
    Gleevec/imatinib:
    1-saved a bunch of lives
    2-opened the human kinome as drug targets (we had been telling the biologists for a decade that all the ATP-binding sites were too similar)
    3-demonstrated that a cancer therapeutic needs to be validated against a focused clinical population (you can get the expanded indications after you’re on the market)

  19. CMCguy says:

    Its hard to call out any one drug but as a class, or more so combination therapy, the HIV drugs first came to mind as significantly positive impact on patients.
    Next although does generates cognitive discontinuity in what I would classify as worthwhile I did think of Viagra as a major consideration which has created plenty of financial worth while causing acceleration in strive for lifestyle drugs and only seeking Blockbusters.
    Generics are not seemingly with in the scope of the conversation since are inherently not “new” yet again come to mind in conflicting assessment of past 30 years as greatly impacting the Pharma Industry.

  20. Ronathan richardson says:

    I’ll throw in Lovenox, as it brings a lot of dying people back to life in situations where Warfarin never worked.
    As an aside, it’s quite amazing how many of these were approved between 1991 and 2000, and how few were in the second half of that 20-year window (and I don’t think it’s just that they haven’t had time to achieve greatness yet).

  21. CR says:

    Based on the TV commercials during football and golf – you have to go with Viagra/Cialis. And yes, I did determine this using the scientific method.

  22. Joe T. says:

    As a non-pharma guy, I’m going to throw the HPV vaccine (do vaccines count as pharmaceuticals?) into the mix, because of its extremely wide potential benefits (any woman anywhere could be affected by HPV-induced cervical cancer) and relatively low cost.

  23. GreedyCynicalSelfInterested says:

    Viagra, by a longshot.
    Viagra has been saving sex lives since it first came out and is god’s gift to middle-aged and elderly men. It’s great to feel young again!

  24. Jan says:

    Oseltamivir and Zanamivir? For quite obvious reasons.

  25. Annette says:

    Derek, have you seen this column in today’s C&E News?
    http://pubs.acs.org/cen/science/89/8905sci1.html
    More of what you’ve written about before–too many PhDs, not enough jobs.

  26. TwoYaks says:

    I think Viagra is a reasonable answer – tons of human identity is tied up in sexuality. Viagra markedly improved quality of life for tons of people. Not my pick, but definitely a defensible one.
    I’d pick Lipitor, myself

  27. cynical1 says:

    I have to go with rituximab (MabThera or Rituxan). Its use in B-cell lymphomas and leukemias, RA, ITP, multiple sclerosis, SLE, and other autoimmune diseases and also transplant make it one of the most important drugs to have ever been discovered. Just look at how many second generation CD-20 antibodies are currently in development. I know about the PML risk but it’s still a life saver, literally, for many patients.
    BTW – with regard to the Viagra votes above – it’s hard to get a woody if you’re dead. Just saying.

  28. cancer_man says:

    With respect to HEART turning an HIV death sentence into a manageable disease, while great that 40,000 died in 1994 at the peak, over 10,000 still die of AIDS in the US every year.

  29. Isn’t it either imatinib or simvastatin? Maybe atorvastatin, if “worth” is taken in the same sense as “worth” magazine.
    cynical1’s Viagra rebuttal should win an Internet.
    Hard to pick a single AIDS drug; ARV would certainly qualify, though.

  30. cancer_man says:

    …(while great that 40,000 no longer die as they did during the peak in 1994)

  31. Orthogon says:

    I also think it has to be an HIV drug, though I’m not sure which one should be chosen. Since AZT is out of the window, I think I’d pick Atripla–just one pill/day, dramatically decreases mutations, and it’s the product of Gilead and BMS–the last point alone is novel enough that it should be considered.

  32. Henok says:

    Imatinib.

  33. barry says:

    I don’t believe the Pharma community has taken the lessons of azithromycin to heart. It was rejected for development at least once because it’s inconvenient to monitor (distributed to the tissues, very little circulates in the plasma). It has been worth billions over the years, but many people continue to turn up their noses at any potential drug that can’t be mindlessly monitored in plasma.

  34. cliffintokyo says:

    Modern HIV drugs and Imatinib, for completely different but probably equally valid reasons, as already described.

  35. chris says:

    Whilst you often see rankings of drugs in terms of sales revenue I’d actually interested to see rankings based on the number of patients treated, is the data available?

  36. CR says:

    @Cynical1 who said…
    “BTW – with regard to the Viagra votes above – it’s hard to get a woody if you’re dead. Just saying.”
    Since a drug has yet to be invented that allows you to live forever – maybe it’s better to go through life with a woody…

  37. Chemjobber says:

    Gotta go with the assoerAIDS, if only because of the amount of the collective consciousness of the US was spent from circa 1984 to circa 1999 or so. I grew up believing the “you will know someone who has AIDS/HIV+ or will” that they were pushing back then.

  38. Derek H says:

    Latest from the Guardian newspaper in the UK – Pfizer to close the Sandwich research site – 2,400 jobs to go

  39. HappyDog says:

    Rituxan.
    I have to say I’m biased though, since my wife was on it to treat her lymphoma!

  40. Petros says:

    So much for the Viagra suggestions above
    Sandwich, source of sildenafil, amlodipine and multiple other NCEs for Pfizer bites the dust.

  41. drug_hunter says:

    TNF blockers like Embrel?

  42. Virgil says:

    If we’re talking non-US, I would suggest rimonobant. Yeah it has some nasty side effects (suicide) which are red-button issues for the FDA, but oh-boy does it work for weight loss in morbidly obese individuals.
    It’ll be interesting to see 20 years from now, what the reaction is to the inaction of the FDA in allowing any anti-obesity drugs through the firewall. Say all you want about lifestyle changes, but in a capitalist democracy where junk food manufacturers have free reign to say what they want and put what they want into the food, there is a desperate need for anti-obesity drugs.

  43. HelicalZz says:

    I struggle to fit this into the ‘worthwhile’ bin, but if we are merely looking for impact on the industry – Vioxx.
    Zz

  44. Suzanne says:

    I think all the TNF voters pay too much to attention to DTC ads.

  45. bmartinmd says:

    Is a vaccine a pharmaceutical? If so, then it’s hands-down Gardasil, the first marketed vaccine to reduce the risk of a cancer. If not, then I’m on the imatinib wagon.

  46. epistemology says:

    Statins will change the average longevity in this country. All the others are niche products.

  47. Jay says:

    I am a bit surprised how people are forgetting atorvastatin, the drug which makes truckload of money for pfizer; and was such an huge improvement over simvastatin too…..

  48. JT says:

    imatinib.
    CML became a condition to be managed, no longer a death sentence.
    HIV drugs are a distant second. reason = the fact that a cocktail of these is required, the cmpds themselves have terrible PK properties, etc…
    the end result, which is important of course, is that they work. HIV = manageable disease

  49. Flem says:

    Jay you believe double the potency is a huge improvement? why not crestor then? i give pfizer credit for expanding use of statins by doubling down on $ spend to promo statins (without outcome evidence intially)

  50. LGF says:

    Vaniqa, ending the scourge of UWFH (that’s unwanted facial hair. Eflornithine the ornithine decarboxylase suicide inhbitor and perhaps only effective treatment for the African sleeping sickness parasite – is now worth manufacturing.
    See. JH. Friedman MEDICINE AND HEALTH, RHODE ISLAND
    2001 Jul;84(7):222-3.”Thank God for rich women with mustaches”.

  51. LGF says:

    Vaniqa, ending the scourge of UWFH (that’s unwanted facial hair. Eflornithine the ornithine decarboxylase suicide inhbitor and perhaps only effective treatment for the African sleeping sickness parasite – is now worth manufacturing.
    See. JH. Friedman MEDICINE AND HEALTH, RHODE ISLAND
    2001 Jul;84(7):222-3.”Thank God for rich women with mustaches”.

  52. Anonymous says:

    Enzyme replacement therapies have also made a dramatic difference in the lives of many patients (mostly young children) and their caregivers making what were essentially death sentences largely manageable.

  53. Needle Finder says:

    My vote is for Gleevec, as it is the first kinase inhibitor that targeted cancer, gave hope to patients and paved the path for other kinase drugs.

  54. JW says:

    And the people behind these drugs, where are they today? A. Working at Denny’s

  55. Myma says:

    I vote gleevec, and a second place to HPV vaccine.

  56. Paul Offit says:

    Rotateq/Rotarix could top the list for worldwide lives saved (if we count vaccines, which we should if we’re counting antibodies)

  57. peej says:

    Plaviz certainly deserves a mention. Clopidogrel allowed the widespread use of coronary stenting, clearly extending the life of millions of patients with MI. On the downside, it has kept Dick Cheney alive throughout the decade.

  58. Charley's Angle says:

    This is a great demonstration of the highly contentious nature of agreeing the value of a drug. For some quality of life (‘wood on tap’) is more important than treating a fatal condition which affects a younger (and hence longer lives ahead of them) portion of society. Perhaps the question should really be, what are the criteria which we as a society should place on the value of a treatment (innovation, economic benefit, life-quality impact, etc.). If we could agree this, then perhaps the pharma industry would be better able to control the narrative of the role it should play in society and with it agree more favourable terms from reimbursement committees, and, dare I say it, those who could influence the period of exclusivity (which has remained constant, despite rising regulatory contraints, pricing pressure, development lifetimes, etc.).
    Viagra’s impact has been a remarkable and an eye opening discovery, but it has also played into the the hands of those who seek to discredit the industry. My money is currently on Gleevec, not only for the obvious reasons already mentioned, but it blew open the door on the potential of and the need for understanding multi-target drugs. With good data mining, this has the potential to address the wider productivity issue.

  59. Druceratops says:

    @45 bmartinmd – Not to say that they were not an important advance, but I disagree that Gardasil/Cervarix were the first marketed vaccines to reduce the risk of cancer. That distinction would lie pretty clearly with HBV immunization and reduction in hepatocellular carcinoma. Ironically, I also just saw this paper today implicating childhood HBV, polio, and Hib immunization in a reduction in ALL http://www.jpeds.com/article/S0022-3476(10)01048-6/abstract
    As for the most worthwhile vaccine product of the last 20 years, at the risk of disagreeing with the supporters of the HPV vaccine and the esteemed Dr. Offit, my vote would lie with Prevnar.

  60. andrew pharmd says:

    Agree with @20;
    Lovenox has saved numerous lives, decreased length of stay in hospitals, and has basically no heparin-induced thrombocytopenia.
    Could pradaxa be the best of 2010?

  61. Antipodean Lurker says:

    I’d like to point out that Prescrire, the French independent pharmaceutical review organisation, rates pharmaceutical innovations each year and they have a list for 1981-2011 of “Golden Pills”.
    I think a compare and contrast would be interesting, their list is quite different to the list suggested by contributors above (I personally identify much more with the products listed above than the Prescrire list, but I think the conversation would be worth having). Maybe even a separate article. I don’t think the Prescrire list gets revised (except when they mark things as “second look”), so their error correction process may be problematic.

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