We talk to Janssen’s global therapeutic area head for pulmonary hypertension, Neil Davie, about his role at the firm and the current challenges for patients with the condition

What is your background and current role?

I started my career with a firm focus on pulmonary diseases through my PhD in Pulmonary Pharmacology, and from there my interest has continued to grow. I’ve led projects across multiple therapeutic areas, including pulmonary, neurology, immunology and haematology. But my passion has always been rare diseases – it’s an area with high levels of unmet need which I feel we must address.

Before joining Johnson & Johnson I held a number of positions in academia and industry, including Assistant Professor of Pediatric Cardiology at the Children’s Hospital in Denver, Medical Director roles at Encysive Pharmaceuticals & Pfizer, and Development roles at Bayer and UCB. Throughout the years I’ve seen and been a part of exceptionally exciting work that has led to new treatments and better outcomes for patients. I have always been surrounded by incredibly talented and motivated teams.

Continuing my journey in the rare disease field, last year I joined Johnson & Johnson, where I lead research and development (R&D) for the pulmonary hypertension (PH) therapeutic area (TA), one of Janssen’s six TAs. The TA team is focused on optimising treatments for patients with PH and closing the diagnosis gap.

What does your day-to-day work involve?

Ultimately, I am responsible for R&D for our Janssen PH portfolio. Our goal is to bring treatments to patients earlier and, fundamentally, improve patient outcomes.

Day-to-day, I work with external partners, researchers and key thought leaders on emerging science, innovative technologies and clinical practice. I count myself exceptionally lucky to be working with brilliant, passionate and dedicated people every day. Although, I look forward to when my current schedule of back-to-back virtual Zoom calls returns to include a few more face-to-face meetings!

Why the interest in pulmonary hypertension?

I completed my PhD in this area, and it has long remained interesting to me, particularly as it is still an area of high unmet need. During the time of my PhD, I had the honour of working alongside the formidable Dame Professor Julia Polak, who not only worked on PH but sadly later was diagnosed with it – she was an inspiration to me and many others, and her sheer determination for us to find a cure keeps encouraging and driving me to this day.

Unfortunately, we are not quite there yet. Pulmonary arterial hypertension (PAH), one type of PH, is a rare, progressive disease, which is often fatal. Although there are no cures (yet!) the science is advancing and we won’t stop until we get there. Our vision is for patients to be able to live a normal life.

What are the key challenges in the UK for improving outcomes for patients with pulmonary hypertension?There are a number of challenges we face in the UK and globally, with one of the most pressing being significant delays to diagnosis – which can take an average of two years from the onset of symptoms to a correct diagnosis. One reason for this is that PH is often misdiagnosed with other more common conditions, including asthma and COPD, with similar respiratory symptoms, such as breathlessness.

After a PAH diagnosis, life expectancy is short – currently one in three patients die within five years of diagnosis. This is why we are striving for an earlier diagnosis for patients, so that they can get optimal and timely therapy to improve their outcomes and quality of life. However, since the onset of COVID-19, shortening the time to diagnosis has become increasingly challenging as people are naturally worried about visiting their doctor in clinical settings. To overcome this, clinicians in the UK have modified the extensive diagnosis criteria, to ensure people who have PAH receive appropriate drug therapy quickly.

PAH patients are also facing other major challenges throughout this time as a population deemed high risk by the NHS, not just through the management of their condition but also the difficulties they face upon leaving home. Furthermore, the need to wear masks can make breathing even more difficult than it already is and significantly impact their quality of life.

As noted, these are issues that are a concern globally. In the UK specifically, we have several key PH centres that are working with us to address the challenges patients face.

Is there potential for a closer working relationship with healthcare services?

Yes – in today’s pandemic times, we have to think differently about providing patients with the safest approach to manage their condition. For example, the use of telemedicine, which can bring the clinic to the patient and deliver care and medicines directly to patients’ homes.

Since March, outpatient consultations have switched to virtual sessions, and technology has been more readily used to protect patients. For PAH patients, many have to complete a six-minute walk test to assess their exercise capacity – these tests are now being completed on exercise apps, which can send information directly back to the clinicians without the patient needing to visit.

As we learn to navigate this ‘new normal’ and support PAH patients throughout, we need to continue working closely with healthcare services to ensure neither patient safety nor their condition’s needs are compromised.

What do you think lies in the future for this therapeutic area?

The next frontier will focus on the development of disease-modifying medicines, directly influencing the pathophysiology of the disease, which can be used alongside existing therapies.

We also want to explore the opportunities and potential of non- invasive diagnostics, to help meet our goal of closing the diagnosis gap. We are currently working with teams both within and outside of Johnson & Johnson to harness advanced data science along with artificial intelligence to help identify potential PH patients earlier. Other diagnostic tools being explored include biomarker identification specific to PH, and non-invasive imaging as a potential future tool to detect PH in patients. In fact, it may be that in the future it can help in monitoring disease progression and even escalate treatment at the right time. The future of diagnostic tools and potential disease- modifying drugs is exciting; it will help us to transform PH into a long- term, manageable condition, so that patients can live a normal life.

What are your passions outside of work?

I love to stay active! Whether it is through playing rugby (Veterans team!), skiing, running (or fast walking, perhaps!) or gardening. Since the pandemic I have managed to hone the skill of mowing fine stripes down my lawn!

My family has always been my first passion though, even if it means acting as a ‘taxi driver’ for my 15-year-old daughter most weekends! I always aim to strike a healthy life balance, allowing me to spend time with my family and keep myself healthy.

What keeps you awake at night?

My wife tells me that nothing will keep me awake at night! But I would cite the pandemic – how it is going to play out, when we will get a vaccine and when our research and trials can proceed unimpeded by the threat of COVID-19.

If you could invite anyone (alive or dead) over for dinner, who would it be and why?If my wife is joining me, can we invite two people over for dinner? I think it would make my wife very happy if George Clooney received an invitation – for obvious reasons! From my side, my guest would be, without doubt, Nelson Mandela. As one of the few statesmen and political figures to have achieved universal respect around the world and across the political spectrum, he’s a change agent extraordinaire. What a dinner party that would be!