In our latest Q&A series Anushka Patel, Chair of George Medicines and CEO and Director of The George Institute for Global Health, shares her perspective on the progress within George Medicines’ GMRx2 hypertension program, what it means for the Institute and the potential impact it could bring to the organization’s mission to improve global health.
- You were the principal investigator on the Institute’s TRIUMPH study, back in 2016/17, investigating a low dose 3 in 1 combination pill for lowering blood pressure – a study that fueled George Medicines’ GMRx2 development program. Tell us about your involvement in that research and its findings.
Many of us at The George Institute had been involved in fixed dose combination therapy research for many years, even before the TRIUMPH study. That research was primarily focused on the somewhat ‘traditional’ atherosclerotic vascular disease polypill, which includes blood pressure lowering therapy as well as cholesterol lowering therapy and aspirin. But we decided, given the scale of the problem, that there was a strong rationale for this approach to be applied to hypertension. We hypothesized that existing, commonly available drugs, if used in an entirely different paradigm, could actually have a big impact. Based on extensive prior evidence, we expected to see the results that we did in TRIUMPH. We just needed to demonstrate this, and we did. The trial showed us that not only was this an effective strategy, but one that could be very well tolerated by patients.
- How did that study influence global thinking around the combination therapy approach for cardiovascular disease treatment?
It really set things running and it was certainly a pivotal moment for The George Institute, because here we had something that could potentially be scaled and have a significant impact on hypertension-related disease burden globally.
I’d love to say it was a pivotal moment for the global community. But as a researcher, I know that evidence accumulation is always incremental. There’s never one single study that will entirely change the paradigm. But TRIUMPH was the first time that we’d demonstrated that you can achieve very high rates of blood pressure control with one simple step, and in a way that was well tolerated. It was the evidence that we required, but such evidence is never enough to change decades-old paradigms of treatment. So, we saw it as an important step, but recognized there was much more to be done, even beyond commercialization of the triple therapy as a product. It’s also thinking about how you can help to influence behavior and systems change.
- What are your hopes for the impact that George Medicines’ GMRx2 program can have on hypertension management around the world? (GMRx2 was recently approved by the US FDA as the first, and only, triple combination for the initial treatment of hypertension)
Given that hypertension is the single most important cause of premature death and disability worldwide – one of the leading causes of health inequity worldwide – for me, even modest improvements can have a massive impact on addressing premature death, disability and health inequity.
The largest gaps in hypertension treatment and control occur in low- and middle-income countries, where most people don’t get adequate treatment. So here we have an opportunity for a simple intervention, like this single pill triple combination, to make a significant difference for those who can least afford or otherwise access the traditional treatment paradigm and who most need effective treatment approaches.
The focus of our Institute is global health and health inequity wherever it exists. Global health is not just about addressing the needs of populations in low- and middle-income countries. There’s plenty of health inequity in Australia as there is in the UK, the US and so on. When I was a practicing cardiologist, here in Australia, I saw many patients who had challenges accessing the care they needed with either undiagnosed or inadequately managed hypertension. That reflected the old treatment paradigm which we know doesn’t get most patients to target. So, the need to better control hypertension is there. It’s everywhere.
- What does it mean for you personally to see the GMRx2 development program reach this point?
The George Institute is a leading health and medical research institute. We’re proud of our very strong track record based on traditional research metrics. We publish in the top journals all the time, we’re very successful in obtaining funding and doing high quality research, but that’s never enough for us. For us, it’s about impact. We are constantly thinking about how we can go beyond the publications, beyond clinical guideline changes, to deliver real impact.
The work of George Medicines, and making GMRx2 available in commercial markets, speaks directly to that. As I said earlier, our focus is on health inequity wherever it exists, and we really do want to address markets globally, private and public. That includes where the need is greatest, so facilitating access to this single pill triple combination in lower income countries is a critical next step for us at The Institute.
- What excites you about the future of cardiovascular care and innovation in the field?
When I was training as a cardiologist, there was a lot of excitement about the new drugs becoming available that could make a difference preventing and treating common cardiovascular conditions. And then there was a lull for around 15 years. The so-called blockbuster era of cardiovascular medicines was said to be over. Now, there has been a recent resurgence of that, partly pushed through by drugs such as GLP-1 receptor agonists and the SGLT-2 inhibitors, which, while they were developed initially for diabetes, clearly have a strong beneficial effect on cardiovascular and kidney disease outcomes in broader populations. And there are even many novel treatments and technologies emerging that are being used for conditions such as resistant hypertension (high blood pressure that does not respond well to aggressive medical treatment), including entirely new chemical entities. So, there is excitement around that.
But what I am excited about is the growing recognition that the safe, inexpensive existing treatments that we have, which are highly effective if used appropriately, could prevent so much of the global cardiovascular disease burden. And a growing recognition that we need innovative solutions like GMRx2. GMRx2 comprises existing medicines but in a novel, single pill combination and in low doses. Such new approaches, of getting effective medicines to the patients who need them, now that excites me more than anything.