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May 9, 2013
An Anticoagulant Antidote
Here's a drug-discovery problem that you don't often have to think about. The anticoagulant field is a huge one, with Plavix, warfarin, and plenty of others jostling for a share of a huge market (both for patients to take themselves, and for hospital use). The Factor Xa inhibitors are a recent entry into this area, with Bayer's Xarelto (rivaroxaban) as the key example so far.
But there's a problem with any Xa inhibitor: there's no antidote for them. Blood clotting therapies have a narrow window to work in - anything effective enough to be beneficial will be effective enough to be trouble under other circumstances. Anticoagulants need a corresponding way to cancel out their effects, in case of overdose or other trouble. (Vitamin K is the answer for warfarin). We don't often have to consider this issue, but it's a big one in this case.
Portola Therapeutics has developed a Factor Xa mimic that binds the inhibitors, and thus titrates their effects. They have their own Xa inhibitor coming along (bextrixaban), but if this protein makes it through, they'll have done the whole field a favor as well as themselves.
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