AbbVie's global head of immunology discovery research says the ability to profile patients at the molecular level has the potential to dramatically change treatment for people living with chronic conditions.
Dr Lisa Olson spoke with PharmaDispatch during her current visit to Australia. She trained as an in vivo pharmacologist, has worked in immunological discovery for over two decades, and joined AbbVie around 13 years ago.
Dr Olson has led the company's global immunology discovery effort for the past decade and currently manages an organisation of around 240 people.
"In terms of the biggest advance over the past ten years, it has been the ability to actually profile patients - to ask questions about a disease that we used to have to model in rodents," said Dr Olson.
"We can now identify cell types causing inflammation and ask some very sophisticated questions about why. We are beginning to answer these questions, and that is providing a window into the future of treatment. We are learning more about a disease so we can build better therapies against it."
Dr Olson said patients living with chronic conditions like rheumatoid arthritis have historically been "defined by their symptoms".
"We can now ask questions about that disease and are learning that there are probably four-to-five different sub-diseases of rheumatoid arthritis. They look the same clinically because that is how we define the disease, but they are different molecularly and what I hope is that this leads to more selective treatment.
"When it comes to treatment, it may be a small molecule or large molecule to block cell interactions. Most pharmaceutical companies are excellent in medicinal chemistry but that is not the issue - it is understanding what to make the treatment against.
"My hope for the future is that samples of a patient's blood and genetics are used to diagnose. That diagnosis creates a signature that will enable the treating physician to identify the most appropriate treatment potentially based on a company's 'bag' of therapies.
"The patient can be treated with the therapeutic most likely to work based on the diagnosis. There are two key advantages to this. The first is that the patient can be treated with the right drug faster. At the moment, there can be a lot of trying, and it can take a year to get it right because when a patient has Crohn's disease they simply have Crohn's disease. The second is a much greater clinical response.
"This is not the way we are treating now so the change is going to be massive and a seismic shift for the entire health system."
Dr Olson said while it may lead to higher upfront costs for the system it will also result in better patient outcomes with faster and higher responses to more targeted treatment.
She said the industry may need to become comfortable bringing new therapeutics to market that only treat patient sub-sets. "The market may be defined by the molecular definition of the disease rather than the clinical definition."
She said the experiences in the development and use of oncology medicines shows the transition is more than possible.
"Tumours are being typed and that is part of the treatment algorithm. Maybe it is easier in oncology but that was not the case 20 years ago. Oncology has evolved to include the diagnosis of tumour type to inform the treatment.
"It is harder to define those genetic mutations in chronic disease and we will probably have an approach built more around 'buckets' based on patient subsets."
In terms of the future, Dr Olson said she hopes more patients are being diagnosed molecularly and responding to targeted treatment.
"I really dream about a disease like Lupus. There are multiple Lupus' and a high unmet patient need. If we can identify patient sub-types we can really move the needle on treatment with a higher response rate and that would be so incredibly motivating and satisfying for me."