Many major pharmaceutical companies who were big players in the field have discontinued their Urology programs either because they have been absorbed by another company or it was no longer ranked as one of the company’s highest priority therapeutic areas for preclinical research efforts (e.g. R.W. Johnson Pharmaceutical Research Institute of J&J, Abbott, Wyeth, Pharmacia, GSK, Roche, and more recently it seems that the same may be true for Pfizer). It appears that the “me-too” antimuscarinic efforts for OAB are no longer viewed as profitable, monoaminergic re-uptake inhibitors have black box warnings for suicide, and compound specific side effects have been the bane of neurokinin receptor antagonists and beta 3 adrenergic receptor agonists (at least in the past).
Given the huge market potential and still largely unmet need (patient compliance with antimuscarinics is purportedly low due to dry mouth and dizziness), this shifting away from Urology as a therapeutic R+D focus presents an “open niche” opportunity. So, where will the new therapeutics come from and to which targets will they be directed? What about the specialty niche markets, still largely unexplored and/or underserved, like interstitial cystitis and neurogenic bladder (spinal cord injury and MS)? What about the ever increasing diabetic and aging portions of the population?
Are there compounds out there that have failed their primary therapeutic targets, but were nonetheless safe, which might be developed for treatment of urologic dysfunctions as a repositioning strategy? What will be the role of medical devices – will they fill in where the pharmacology has left off or failed? Finally, what about combination approaches, both utilizing more than one drug (or drugs with multiple mechanisms of action), or drug and device combinations. Maybe this is the way to get around side effect issues, etc., which may block the development of attractive targets for what may be considered “lifestyle” health problems.