Darrell E. White, MD, is the founder of Skyvision Centers in Ohio. His blog for Ocular Surgery News will focus on issues related to dry eye disease.

BLOG: Alcon, er, Novartis takes out Shire

For those of you keeping score at home, make this one a win for White the prognosticator. In my annual September column on anti-inflammatory meds in dry eye disease, my penultimate prediction went like this: “Of course, the easiest way to resolve that would be for Allergan to buy Shire/Takeda’s eye care business unit if Takeda leaves the space. That would be pretty slick, although it would be way better theater if Alcon picked off Xiidra and the Shire/Takeda pipeline. Back to the future with Allergan and Alcon at each other’s throats like in the good old days!”

Booyah!

Anyway, for those of you who have been hiding under a rock (or you retina folks), late in the day on May 8 Takeda and Novartis announced a sale of the assets in what was formerly known as the Shire eye care business unit. The sale price was $3.4 billion in cash with as much as $1.9 billion in so-called milestone payments (ie, Takeda gets a cut of future sales of Xiidra). If you do the math, this is nearly 10 times 2018 sales of Xiidra (~$388 million), a pretty penny in our fraught pharma universe. This means that what we used to know as Alcon on the pharma side now includes Xiidra as well as the rest of the Shire anterior and posterior segment pipeline.

So what does all of this mean for DED patients and the doctors who treat them? Alcon hasn’t had a breakthrough medication since Durezol. I mean, its most recent “big thing” was Pazeo, the third iteration of a topical antihistamine first introduced as Patanol in 1959. Not a whole lot of innovation in that shop. Will Novartis put money into R&D for eye care? Xiidra is a highly effective treatment for a disease that wreaks havoc with the daily activities of millions of individuals. Our biggest challenge when it comes to prescribing Xiidra continues to be our toxic insurance environment. Will Novartis be better at negotiating formulary positions for Xiidra, especially with regard to Medicare? Will it continue the efforts made by Shire to reduce the administrative burden placed on prescribing physicians and staff?

Big, important questions, those.

While I’m asking questions, anybody know who their Novartis sales rep is? As I just wrote last month, I know pretty much every single rep that visits SkyVision. Heck, I even know how many kids the contact lens rep from Alcon has at home, and I haven’t fit a contact lens in almost 30 years. Novartis/Alcon makes Travatan, Durezol, Vigamox and all of those Patanol/Pazeo drops, but I wouldn’t know our Novartis rep if I tripped over them on the way to the loo. Early reports say that Novartis will transfer 400 people in the Shire/Takeda eye care unit over with the deal. If anyone at Novartis is listening, I’d go heavy on the salesforce among that 400.

DED is unique in many ways. Symptoms bring patients to the office, and regardless of what signs we see, it is symptom relief that brings them back. Doctors who treat DED know this. Both Allergan and Shire broke away from the hidebound fealty to academic advisers when they brought Restasis and Xiidra to the market. Their success is due in many ways to this “bottom-up” collaboration with doctors who spend the majority of their time treating patients. Alcon has had less engagement; it has not sought insight from frontline doctors, at least on the pharma side of things. What kind of company will Novartis be?

In the end, the most fascinating battle may not be between Allergan and the vestiges of Alcon, but the internal battle between Alcon and Shire for the soul of the new Novartis.

Disclosure: White reports he is a consultant to Allergan, Shire, Sun, Kala, Ocular Science, Rendia, TearLab, Eyevance and Omeros; is a speaker for Shire, Allergan, Omeros and Sun; and has an ownership interest in Ocular Science and Eyevance.