Vet Times The website for the veterinary profession https://www.vettimes.co.uk Pain management: making the most of the latest options Author : James Westgate Categories : Business, Business planning Date : October 22, 2015 Three companies working in different fields of pain management spoke to VBJ to explain how they are seeking to improve clinical outcomes and boost practice revenues. Nexvet Mark Heffernan, chief executive, Nexvet. NEXVET is a global clinical-stage biopharmaceutical company focused on developing and commercialising novel biologic therapies for the companion animal sector. Mark Heffernan, Nexvet s chief executive, explains how advances in the field of monoclonal antibodies being pioneered by the firm could transform pain management for certain conditions. Could you explain some of the recent advances your company has made with monoclonal antibodies to relieve pain in dogs and cats? Our most recently announced clinical results were positive top-line results from a study of 32 client- 1 / 7
owned cats with degenerative joint disease (DJD). This was a randomised, double-blinded, placebocontrolled proof-of-concept (POC) efficacy study of NV-02, our monoclonal antibody (mab) therapy in development for the control of pain associated with DJD, including osteoarthritis, in cats. NV-02 and its canine version, NV-01, are anti-nerve growth factor (NGF) mabs, a class of therapies which aim to block pain signalling by inhibiting NGF, a protein involved in neural pain signalling. Monoclonal antibodies, or mabs, are a class of protein-based drugs that can be designed to target a wide range of biological targets in the body. There are a number of therapeutic attributes of mabs which make them appealing for pain management indications, when compared to current standards of care such as NSAIDs. Are these products on the market, if not when do you anticipate they will be widely available? All of Nexvet s product candidates are in development. NV-01 and NV-02 our anti-ngf mabs are in advanced clinical development. NV-01 is now undergoing two large multi-centre field studies: one a pivotal field efficacy and safety study enrolling at least 250 dogs; the other, a field safety and efficacy study enrolling at least 150 dogs and assessing various doses and dosing regimens of NV-01. Data from both these studies is expected by the end of 2015. Do you think being able to offer these kinds of treatments will offer financial benefits to practices and in what way? There is already unmet medical need in chronic pain management for cats and dogs, because many clinical cases do not have their pain adequately treated with currently approved standards of care. As more dogs and cats reach their senior years, and dog and cat ownership increases generally, we anticipate the medical demand for innovation in chronic pain management to increase substantially. The target product profile of NV-01 and NV-02 includes a dosing schedule that recommends administration between every four to six weeks. As injectable products, only veterinary professionals would be able to administer them. This encourages regular, repeated visits by patients. As older dogs or cats are more likely to present. 2 / 7
Vets interested in learning more about mabs or fusion proteins (both classes of biologic drugs) should visit www.nexvet.com VBS Direct Stephen Barabas, managing director, VBS Direct. VBS Direct was formed in 2010 and specialises in bringing new technologies and products to the veterinary market. Its managing director Stephen Barabas spoke to us about two products in the VBS range; the K-Laser and platelet-rich plasma therapy or V-PET. Could you explain how V-PET and laser therapy can be used in the management of pain in companion animals? When a tissue is damaged platelets degranulate releasing thousands of proteins that start the healing process. These growth factors speed up the healing process returning the damaged tissues to as close a return to the tissues prior to the initial damage. By creating new tissue over damaged surfaces, that is fibrocartilage over cartilage deficits, or collagen fibrils in ligaments and tendons this reduces the catabolic process and the inflammatory 3 / 7
cytokines allowing less pain in joints or soft tissue injuries and encouraging anabolic healing of the tissues. K-Laser, a Class IV therapeutic laser, is a biostimulator so has an indirect effect on general tissue metabolism speeding up the healing and having a similar effect to growth factors in the locality they are shone via red and infra-red beams created by diodes. Specific wavelengths of red and infra-red light increase oxygenation (via changing the shape of haemoglobin), production of ATP (via cytochrome C increased activity) and improve perfusion of tissue by opening capillary beds by creating alterations in temperature gradients (increasing metabolites for healing, but especially taking away inflammatory cytokines). Inflammatory cytokines increase the pain sensation, thus a reduction in their levels will increase the range of movement and general activity. Directly they are able to reduce pain sensation along afferent pain fibres by altering the electrolyte flow across trans-membrane proteins in nerve fibres accumulated K-Laser sessions over the pain receptors and nerve fibres will reduce pain perception, resulting in greater range of movement. Is this kind of therapy easy for vets to get their heads round and what kind of training is needed/required for these treatments to be effective in practice? For both V-PET and K-Laser, the initial demonstration is from one to two hours to half a day, followed up by another whole day for installation and training staff. If you have anatomy and biological understanding, both products PRP and laser therapy are easy to grasp conceptually. How much of an investment is required to introduce these kinds of therapies? V-PET costs under 200 per unit, and with mark-up and surgical time, usually costs the owner between 450 to 650. Laser therapy is also relatively inexpensive based on return on investment most clinics purchase it as a tax allowance or under a lease/hire agreement. Laser therapy costs to the practice range from 14K to 22K and work out at about 6 to 15 per working day. Could you outline some of the financial benefits of offering these therapies? 4 / 7
K-Laser is very profitable as it is nurse time with only vet involvement at the first and last session for assessment of improvements. Potentially, if used in combination with V-PET, vets could charge 600 to 800 for the service and six sessions. I know of referral hospitals charging a lot more, but these have prevented animals undergoing hip/elbow replacements and cruciate surgery, so the savings for insurance companies/pet owners and welfare for the pet is significantly improved. Vets need to realise the potential of regenerative medicine is huge and will undoubtedly be a big growth area in the coming decade. Lintbells Andrew Connolly, product manager, Lintbells. Lintbells provides a wide portfolio that includes supplementary products that can be used as part of multi modal treatment protocols for the management of pain in cats and dogs. The company s product manager Andrew Connolly explains how offering these products can help bond clients and drive footfall. How far do you feel this market has developed over the past 20 years when it comes to delivering proven supplementary products for the market? 5 / 7
The supplement market has developed greatly over the past 20 years. Our understanding and knowledge of conditions is improving all the time with the emergence of new science. This has allowed us to produce solutions to more conditions than ever before with better efficacy, and this is something that is only going to increase with time. What products does Lintbells have to assist with the management of pain in companion animals? Our unique green-lipped mussel extract provides a specific combination of Omega 3 fatty acids (ETA, EPA and DHA), which aids the animals own natural anti-inflammatory process. It is, therefore, an important ingredient in a number of our products from Yumove for joints to Yurelieve for feline urinary health. How important is it that these products are now undergoing rigorous, independent clinical trials and what value does that add to the clinician in practice when recommending these products to clients? The groundbreaking clinical study conducted by the RVC allowed a specific joint supplement to be included as part of a multi-modal treatment protocol for mobility, formed on evidence based medicine. This gives both clinicians and clients the confidence to use a specific joint supplement. In what way can veterinary practices use the availability of these proven vet-only products to enhance animal welfare, clinical outcomes and improve profits? YUMOVE Advance, our veterinary practice exclusive joint supplement, encourages pet owners to discuss the care of their senior pets with their vet. This gives the practice the opportunity to engage with the pet owner to ensure the pet is receiving the correct care in relation to any health condition. When a product has the ability to enhance the relationship between a client and their pet, they are, of course, likely to continue purchasing. This is great for practice profits. Owners with positive experiences of products generate phenomenal word of mouth, which increases brand awareness and supplement usage overall. How important is the vet-only element of your product range? 6 / 7
Powered by TCPDF (www.tcpdf.org) Pet owners place a great deal of trust in their vet to recommend the best products for their pet. With so many products available on the market, vets are in a good position to assist owners in selecting the most suitable product. The quality of veterinary supplements are not always reflected by price. Stocking the most expensive product on the market does not always grow practice revenue. Supplements that can deliver a genuine benefit to the animal, at an affordable price, will ensure client compliance. This, in turn, grows supplement usage overall and it is that which has the greatest impact on practice revenues. 7 / 7