Seeing the whole patient is at the heart of transformative healthcare

[Human Pharma](/content/annualreport/2024/storyhub/#human-pharma "Human Pharma"/index.html)

Medications have traditionally targeted cardiovascular, renal, and metabolic diseases in isolation. Boehringer Ingelheim's long-time work on more integrative approaches, combining innovative drug therapy with comprehensive and patient-centered transformative healthcare, has led to improved health outcomes and better quality of life for patients.

1bn

people are affected by CRM (cardio-renal-metabolic) diseases

20m

deaths annually are associated with CRM diseases

This makes them the leading cause of death worldwide. CRM diseases are interconnected - they interact, often occur together, and exacerbate each other. Good to know: Effective treatment of one CRM disease can have a positive impact on the others.

The human body is a complex, interconnected machine. At all times, it has an array of systems running in symbiosis to keep our biological inner workings ticking over. So, when one of these systems goes awry, it often has knock-on effects on the rest of the health setup. However, medicine has often treated a system dysfunction as a solitary error. If patients have a heart condition, they take beta blockers; if patients suffer from diabetes, they're prescribed insulin.

But increasingly, scientists are beginning to realize that this isn't always the best therapy. Taking a more holistic, comprehensive approach for transformative healthcare, they are developing solutions that perform better, improving individual lives and public health in general.

The approach of Boehringer researchers is patient-centric. “If you consider the other conditions, then you can also treat the disease.”

Patient-centric not disease-centric

This is something that medical researchers at Boehringer Ingelheim have long understood and implemented to great effect. Their integrative approach is about being “patient-centric, instead of disease-centric,” says Dr. Ramy Younes, global evidence lead of Boehringer's cardiovascular, renal, and metabolic (CRM) diseases division. “Sometimes we focus on a disease, and we forget that behind the disease there is a patient with other health conditions,” he explains, “and maybe if you consider the other conditions, then you can also treat this disease.”

The CRM group of conditions, which affects organs such as the heart, kidneys, and liver, and includes diabetes, heart disease, and kidney disease, affects more than one billion people across the world. While there is a wide array of medicines available, there is still a large unmet healthcare need for these individuals.

More often than not, these diseases are related to one another, as they are linked through the body's metabolic cycle. Understanding those links is crucial when developing therapeutics, and a fragmented care response can hinder these patients from getting the help and transformative healthcare they need.

CRM diseases

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Cardiovascular diseases

Diseases involving the heart or blood vessels, including high blood pressure, coronary artery diseases, cardiomyopathy, and arrhythmia.

Liver diseases

Affect the liver's ability to filter blood and include Metabolic Dysfunction-Associated Steatohepatitis (MASH) and liver fibrosis.

Obesity

Excess body fat can lead to cardiovascular diseases, type 2 diabetes, as well as certain types of cancer and osteoarthritis.

Chronic kidney disease (CKD)

A gradual loss of kidney function or an abnormal kidney structure can result in kidney failure and other serious health issues.

Type 2 diabetes

Long-term health complications from high blood sugar include heart disease, stroke, diabetic retinopathy, and kidney failure.

One drug with antidiabetic potential, cardiovascular protection, treating patients with heart failure and CKD is the drug that can lay the foundation for other drugs that should be developed and built upon this concept.

Dr. Ramy Younes, global evidence lead of Boehringer's cardiovascular, renal, and metabolic (CRM) diseases division

One drug to lay the foundation

An example of this thinking at work at Boehringer is the drug JARDIANCE®. Developed initially as a medicine to help improve glucose control in type 2 diabetics, it has since demonstrated significant health benefits in the treatment of heart failure and chronic kidney disease (CKD). “One drug with antidiabetic potential, cardiovascular protection, treating patients with heart failure and CKD is the drug that can lay the foundation for other drugs that should be developed and built upon this concept,” says Younes.

The idea of capitalizing on the drug's active ingredient, empagliflozin, was put forward by Boehringer's Dr. Michael Mark in the late 1990s. Mark had been poring over the medical literature and happened upon phlorizin, a compound which comes from the root bark of the apple tree. Phlorizin had long been known to be able to regulate glucose levels in both urine and blood, although the exact mechanism of action by which it did this was a mystery.

It was determined that phlorizin - and its synthetic analog empagliflozin, the active ingredient in JARDIANCE® - achieved this effect by inhibiting the sodium-glucose co-transporter-2 inhibitors (SGLT-2). These proteins play a crucial role in maintaining glucose balance in the blood. Blocking these proteins can allow the kidneys to get rid of excess blood glucose in the urine.

In modern pharmaceutical research, we constantly ask ourselves which patients and which diseases need improved therapies. What applications are possible?

Dr. Michael Mark, former head of cardiometabolic diseases research at Boehringer

Running with an integrative approach

Mark and his team were among the first to develop this ingredient into an effective medicine. “In modern pharmaceutical research, we constantly ask ourselves which patients and which diseases need improved therapies. What medical applications are possible?” Mark says. “And then we search for therapeutic solutions in full knowledge of the disease and with understanding of the fundamental biological mechanism, as well as with expertise in how to arrive at the suitable molecules.”

Mark then went on to expand his research to focus more generally on lipid metabolism. “We have never looked at diabetes and glucose metabolism in isolation but always as interconnected with the body's entire metabolic events,” Mark says. Boehringer has taken this integrative approach and run with it for many years since, building on and researching the interactions between different diseases in [pursuit of transformative healthcare](/content/human-health/metabolic-diseases/cardio-renal-metabolic-research "Discover transformative healthcare in cardio-renal-metabolic research"/index.html). “We draw on this experience to uncover the links between diseases and find more effective ways to treat them,” says Dr. Søren Tullin, global head of cardiometabolic diseases research at Boehringer.

Acting early for cardiovascular health

Another fruit of this approach to transformative healthcare is [Boehringer's drug survodutide](/content/human-health/metabolic-diseases/survodutide-us-fda-breakthrough-therapy-phase-3-trials-mash "Learn more about transformative healthcare and innovative treatments like survodutide"/index.html). A GLP-1 agonist, it is currently being studied in people who are overweight or living with obesity. However, recent clinical data suggested it could be an effective medicine to treat a condition called metabolic dysfunction-associated steatohepatitis, or MASH - a serious liver disease characterized by the inflammation of the liver due to a buildup of excess fat cells. MASH is also associated with other conditions such as diabetes, hypertension, and heart disease, and is a prime example of an interconnected CRM disease.

Worldwide, more than 115 million people live with MASH, for which there are limited treatment options. MASH is predicted to be the leading cause of liver transplantation by 2030, placing significant financial strain on healthcare systems.

Boehringer's Phase II trial of survodutide found that up to 83% of adults treated with the medicine achieved a statistically significant improvement in MASH compared with those on placebo. “Targeting the liver is very important because there is a big connection between liver and obesity,” says Younes. “Treating MASH has an impact on obesity and treating obesity has an impact on MASH.”

The success of GLP-1 agonists in treating metabolic conditions opens up therapeutic options that we couldn't even dream of.

Dr. Alessandra Lafranconi, global medical affairs lead for survodutide at Boehringer

The success of GLP-1 agonists in treating metabolic conditions opens up transformative healthcare options that “we couldn't even dream of,” says Dr. Alessandra Lafranconi, global medical affairs lead for survodutide at Boehringer. “With cardiovascular death accounting for two-thirds of deaths worldwide, we now have the opportunity to act earlier in the chain that is going to lead there. That's a tremendous opportunity for transformative healthcare,” Lafranconi adds.

With survodutide in Phase III trials, it's hoped that it will continue to show promise for an even wider range of medical conditions within the CRM family. Survodutide could lead to clinically meaningful benefits across the cardiovascular, renal, and metabolic spectrum - interconnected diseases that affect over one billion lives worldwide and are responsible for up to 20 million deaths annually.

Boehringer Ingelheim's commitment:

The holistic approach that Boehringer has taken towards disease has led to groundbreaking solutions, such as JARDIANCE® and survodutide, that redefine what is possible in modern medicine. This integrated vision for transformative healthcare not only holds promise for better health outcomes, but also sets a new standard for medical innovation, reminding us that treating the whole patient - not just the disease - is the key to truly transformative healthcare for millions of people.