We talk to Eric Hughes about his role as Novartis’ global development unit head of Immunology, Hepatology and Dermatology

What is your background and current role?

I joined Novartis in 2015 as the head of the development unit for immunology, hepatology and dermatology. It’s our job to oversee the clinical development and regulatory approvals of a number of innovative treatments, both in development and already in market. I’ve also just recently been appointed head of drug development for the company in China.

Before joining Novartis, I worked for other pharmaceutical companies on projects ranging from Phase I to Phase III development. I’m a licensed physician with specialty training in infectious diseases – with a doctoral degree in immunology from Yale.

What does your day-to-day work involve?

Immunological diseases are in the middle of a vivid scientific debate and I’m happy to be part of this exciting innovation journey. Since my responsibilities cover a wide variety of disease areas, an average day for me can be incredibly varied. I could be discussing psoriasis with dermatologists or working with a kidney transplant team in the morning, speaking to an osteoarthritis team in the afternoon and then travelling to China in the evening – with strategy briefings on non-radiographic axial spondyloarthritis and nonalcoholic steatohepatitis (NASH) as my in-flight reading!

Why the interest in immuno-dermatology?

It’s difficult to overestimate the impact skin diseases have on a patient’s quality of life and the enormous burden of disease this represents for society. Take psoriasis, for example. This painful and distressing autoimmune disease affects the lives of over 125 million people worldwide and brings with it a significant emotional and physical daily toll. And that’s just one disease – there are many other immunologically driven skin diseases such as atopic dermatitis, hidradenitis suppurativa, alopecia areata and vitiligo. These represent an enormous unmet medical need. So, our focus on patient need and our passion to better understand the immune system and advance immuno-dermatology – these are what get me out of bed in the morning.

Do you feel Novartis is making a meaningful difference to the treatment of psoriatic disease?

I’m proud to say that with the development of anti-IL-17A therapy, Novartis in many ways revolutionised psoriatic disease therapy and really raised the treatment expectations of physicians and patients. We now know that IL-17A is the cornerstone cytokine involved in the inflammatory process and development of psoriatic disease, which includes psoriasis, psoriatic arthritis and ankylosing spondylitis. We know also that IL-17A is produced by both IL-23 dependent and IL-23 independent pathways, by various cells from both the innate and adaptive immune system. But mostly importantly for patients, by directly inhibiting all sources of IL-17A we’ve been able to achieve rapid, long-lasting efficacy and safety in the treatment of moderate to severe psoriasis, psoriatic arthritis, and importantly, the more persistent manifestations of psoriasis – in the scalp, palms, soles and nails.

What do you see as the key advances in the field?

Defining the essential role of IL-17A in the disease pathogenesis of psoriatic disease was a major advance in the field. We’re further investigating why IL-17A has this immense relevance and how patients could optimally benefit, and this is why we’ve conducted over 100 well-controlled studies that include over 10,000 patients.

What are the key challenges?

I think Novartis has the vision to enhance every aspect of drug development using digital technology. In development, this includes how we collect clinical data, how we monitor and run studies, as well as how we analyse our data. This is no easy task. Fully understanding the disease will require a significant investment in our ability to pool data seamlessly and facilitate new analytic methods. It starts with a change in mindset, but we’ve made great progress already and our collaborations with outside partners are beginning to bear fruit.

What else is on the horizon for Novartis in immuno-dermatology?

We’ve an extensive and exciting immuno-dermatology portfolio. Novartis was a pioneer in chronic spontaneous urticaria with omalizumab, and we just initiated a new Phase III programme with ligelizumab in this area of continued unmet need. We also have an intense focus in atopic dermatitis, having recently acquired ZPL-389 and in-licensed MOR-106. ZPL-389 is a once-daily oral H4 receptor antagonist and MOR106 is a monoclonal antibody directed against IL-17C. Both are in Phase IIb and have the potential to be first-in-class compounds.

If you could highlight a single thing that would make the biggest impact on fulfilling unmet need in this area, what would it be?

While our impact begins with the discovery and development of highly effective and safe therapies, disease awareness by both patients and health care practitioners is essential for patients to receive the treatments they need. Often, only a small proportion of patients have been properly diagnosed. And even then when patients are identified their understanding of what can be achieved with therapy is poorly understood. To give you an example, over 50% of psoriasis patients who have achieved clear or almost clear skin did not previously believe it to be a realistic or attainable goal!

Do you have any examples where Novartis is ‘going beyond the pill’ to help patients improve management of these conditions?

At the end of last year we launched Alia – a ChatBot for patients and healthcare providers. Users can ask Alia at any time a wide range of questions on treatment topics they care about, including symptoms, care and lifestyle.

For people living with psoriasis and psoriatic arthritis and their care providers, Alia provides AI-powered advice and support wherever and whenever they need it.

Generally speaking, do you feel medical professionals are adequately educated on psoriatic conditions and how to treat them?

Psoriasis is a relatively common skin disease that can be easily diagnosed, but awareness and use of effective treatment has not kept pace with the rapid scientific progress in the past few years. For example, the key role of IL-17A to control the disease has not been fully understood. At the same time, patients expect physicians to expand their expertise to cover the full spectrum of psoriatic disease manifestations, including psoriatic arthritis and the more persistent manifestations. I must admit, my own medical training only touched on this in passing and I missed the diagnosis of psoriatic arthritis in a number of my patients. I’m sure I could do better now!

What keeps you awake at night?

What concerns me most is making sure we develop and deliver life-changing treatments as quickly as possible and in a way that meets the needs of patients – and I’m a strong believer that this can only be achieved by working closely with patient advocacy groups, health authorities and healthcare practitioners.

What are your passions outside of work?

My work brought my family and me to Basel, Switzerland, and the move opened our eyes to the beauty of European Alps and surrounding countryside. So we take every opportunity to hike as much as possible in our adopted country!

What do you consider your greatest achievement to date?

My scientific training, experience in patient care and then clinical research have all given me a huge sense of purpose and happiness over the past 20 years. But really I’m most proud of my contribution in helping drive innovation that has improved the lives of patients all around the world. When I look back and see how far we’ve come, I’m excited about the possibilities. The future is bright!