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delivery mode, and a different antibiotic, so that patients would be able to take alternating treatment cycles with TOBI and something else. The idea was to transform aztreonam, an intravenous antibiotic, into an inhalable form. When combined with a new nebulizer from Germany, the new drug could be given in a more convenient two-minute inhalation, two or three times a day, through a handheld device, Montgomery said. And by delivering it directly to the lungs, where the bacteria were hiding out, the hope was to deliver 1,000 times greater concentrations. “This way, you could deliver a neutron bomb to the lungs,” Montgomery said.
The drug has shown in a pair of clinical trials that it can help patients breathe better, and the company was also required to gather questionnaire data that showed it improved patients’ quality of life. The product has now been approved in Europe, Canada, and Australia, but Montgomery wasn’t making any predictions that he’s going to get clearance in the U.S. next month.
Even so, King, the Merriman Curhan analyst, isn’t expecting much commercial success. He’s forecasting $31 million in sales from aztreonam lysine in 2015.
Montgomery didn’t offer any sales forecasts in his talk, but he’s clearly suggesting it has bigger potential than that. He said aztreonma has generated some “dramatic responses” in a mid-stage clinical trial of patients with bronchiectasis, a disease in which part of the bronchial tree in the lung expands too much and blocks airways. The results were compelling enough that Gilead plans to start a pivotal study for that use in 2010, and Montgomery noted it could be a bigger commercial opportunity than cystic fibrosis, because it affects more patients.
Montgomery was pretty vague about some of the other projects in the pipeline. Three or four research programs are progressing for chronic obstructive pulmonary disease—a leading killer in the U.S. that’s commonly found in smokers, and which has no effective treatments. That’s a big, long-term, risky challenge that few companies other than Gilead have the money and expertise to take a swing at. But he definitely wanted to leave the audience of Seattle business leaders with the impression that Gilead is here to stay for the long run.
“I think I have another 10 years left,” said Montgomery, who’s 56.