Modern Blockbusters

Abstract

Five modern antiepileptic drugs have reached the fabled blockbuster status (more than $1 billion sales per year), albeit for treatment of not only epilepsy but for other disorders of the central nervous system too. These drugs generated huge profits, and the chapter asks, how were they discovered and are they worth their money? The history of the five blockbusters—levetiracetam, lamotrigine, topiramate, gabapentin, and pregabalin—provides an interesting study of chance, science, wrong ideas, and finance, and most importantly luck. The discovery of the antiepileptic effects of some of these compounds was stumbled upon by simple good fortune, and others barely escaped an early demise during an unpromising early development. Despite the commercial success, no study has shown any of these drugs to be any more effective than older drugs, yet they made billions. This chapter examines how industry could do this and what the drivers are for success.