Who can help me survive a heart attack?

Acute coronary syndromes – or ACS – is a term used to describe sudden chest pain and other symptoms caused by an insufficient blood supply to the heart. They are the most common manifestation of coronary heart disease (CHD) with over      2.5 million occurrences in the developed world each year. Despite the availability of current treatment options, data suggests that up to 15% of patients die within one year of their cardiovascular event.

Brilinta / Brilique (ticagrelor tablets) is an oral antiplatelet treatment we have developed for ACS. The clinical development for Brilinta / Brilique included the PLATO study, one of the largest clinical trials we have ever undertaken, involving 18,624 patients in 43 countries. PLATO was designed to reflect current clinical management of ACS patients and to establish whether Brilinta / Brilique could improve cardiovascular outcomes beyond those afforded by clopidogrel (Plavix™/Iscover™). The overall PLATO results demonstrated the superiority of ticagrelor in reducing heart attacks and cardiovascular death in patients with ACS. The data has provided the basis for regulatory filings worldwide.

For more than half a century, AstraZeneca has been at the forefront of R&D in cardiovascular diseases. Brilinta / Brilique was discovered at our laboratories in the UK and represents another example of our commitment to developing and delivering innovative medicines that make a meaningful difference to patient health.

What will help me take my medicine?

Research tells us that many patients prescribed drugs do not take their medicine as they should – whether the right amount, at the right time or in the right way. The position is worst for inhaled medicines, which include some of our asthma medicines. Research also tells us that we can use packaging – which is usually our only way of communicating directly with patients – to improve adherence to a medicine’s instructions.

The opportunity for AstraZeneca to use packaging design to influence behaviour is being pursued through a range of initiatives. These include customising packaging to address patient needs better and making the pack part of the treatment. At the same time we are simplifying processes where possible and aim to improve the efficiency with which we use packaging materials by 20% by 2015.

One example of our work is the packaging for our children’s asthma inhalers in Spain, which now features an image of a kite – associated with fresh air and physical activity – to help children feel more positive about taking their medicine.

Better packaging can help make our medicines more effective. That helps us and our patients, and improves treatment outcomes.

How can I help manage my asthma?

Approximately 300 million people worldwide suffer from asthma. It is one of the most common chronic diseases and its prevalence is increasing every year, especially among children. It is estimated that by 2025 there will be an additional 100 million sufferers.

Although asthma cannot be cured, it can be treated effectively. Research shows that with the right treatment nearly all asthma patients can achieve and maintain good asthma control, enabling them to live full and active lives.

Our Symbicort medicine provides important improvement in the health of many patients with asthma. Symbicort pMDI (pressurised metered-dose inhaler) is approved in the US for the treatment of asthma in patients 12 years of age and older.

Outside the US, our Symbicort Turbuhaler maintenance and reliever therapy (SMART) combines both regular maintenance and as-needed reliever therapies. It is the only asthma treatment regime to do so and allows patients to control daily symptoms and reduce the severity and number of asthma attacks using a single inhaler. It gives asthma patients what they want in daily symptom control and also gives them what they need in the longer term – improved asthma management.

What is being done to make sure my medicines are genuine?

The WHO estimates that between 1% and 30% (rising to 50% on the internet) of medicines sold worldwide are counterfeit. Every year, thousands of patients are seriously harmed or killed as a result of taking these products rather than the real thing. Counterfeiting is particularly prevalent in the developing world and with medicines bought online.

To combat the problem we have a comprehensive product security strategy which includes:

• partnering with others to strengthen enforcement and raise awareness
• securing products through pack features and enhanced integrity of the supply chain
• combating illegal operations through proactive investigation of suspicious activity and reported incidents.

In 2010, a life-threatening counterfeiting operation was thwarted following an investigation in Colombia. Twenty four members of a criminal gang were arrested in May on charges relating to making and selling a counterfeit of our antibiotic, Meronem. Suspicions first came to light in 2007 when we received reports from employees about suspect Meronem bearing the same batch number. A painstaking investigation was carried out, including the use of undercover techniques to gather evidence. By early 2010, we were able to hand over enough evidence for the Colombian police to conduct a series of raids.

Who is protecting me from new infections?

Seventy years ago, the discovery of antibiotics revolutionised the treatment of bacterial infections and saved millions of lives. But the growing problem of bacterial resistance threatens to put global health at serious risk. Finding new antibiotics that will be effective against bacterial resistance is not impossible, but it is challenging. It is also an area that has not been a primary focus for the pharmaceutical industry in recent years. AstraZeneca is one of a few key players that has continued to invest in antibiotic research and in 2010 we made a regulatory submission in the EU for a new antibiotic, Zinforo, that will provide new treatment options for Gram-positive infections such as those due to MRSA.

Another clear example of the challenge is provided by tuberculosis. TB claims 5,000 lives every day and multi-drug resistant TB affects half a million people annually. To accelerate development of new treatments, a collaboration led by the Bill and Melinda Gates Foundation, the TB Alliance, and the Critical Path Institute has brought AstraZeneca, including our dedicated TB facility in Bangalore, India, together with other pharmaceutical companies, government agencies, donors, advocates, academics and NGOs.

No single organisation can win the bacterial battle. We need a vibrant pipeline of new classes of antibiotics. Working together creatively in partnership with others we believe we can make a greater contribution to that goal.

Who is improving my healthcare?

TB is the leading cause of death in people living with HIV. Together, the two diseases are a deadly combination. In Uganda, there is the added burden of malaria, which causes more illness and death than any other single disease. The diseases are linked but Ugandans with TB/HIV, malaria and other conditions have to attend separate health services for treatment.

Our partnership with the African Medical and Research Foundation (AMREF) is focused on developing a model for the integrated management of TB, HIV/AIDS and malaria that provides a framework for effective and efficient healthcare at local and national levels.

Working in collaboration with the Ugandan government in the districts of Luwero and Kiboga in central Uganda, the partnership has focused on increasing laboratory diagnostic capacity and improving community-based healthcare management. Progress to date includes the completion and handover to local district management teams of four new laboratories and the establishment of 328 village health teams with over 1,300 people trained in health promotion in their local communities. In addition, a study of drug logistics management revealed significant knowledge gaps and out of stock supply problems. Subsequently, 108 health workers have been trained in drug logistics management to help prevent shortages.

What is being done to improve health in China?

AstraZeneca is one of the country’s fastest growing multinational pharmaceutical companies. At present, most of our business comes from big hospitals in 200 of the largest cities that have a population of more than one million. We are investing to improve our sales capabilities in these and in a further 100 large cities.

At the same time, nearly 900 million people live outside big cities and the Chinese government is investing $125 billion between 2009 and 2011 to support healthcare reform by expanding basic healthcare insurance and upgrading community and rural hospitals. We have plans to build a sustainable business in this broader market.

We are also supporting the Chinese Ministry of Health in improving patient health with an innovative programme to increase the capacity of community healthcare services by strengthening the training of general practitioners. In collaboration with the China Medical Association, which will be providing the training, AstraZeneca is sponsoring a three-year programme. It will help train some 30,000 community general practitioners so that they can better treat some common chronic diseases.

How do I find a cancer treatment that’s right for me?

In a world where there is increasing pressure on healthcare budgets, we can be more effective if we can identify the patients likely to benefit most from particular medicines. We have experience of this personalised healthcare approach with our lung cancer therapy Iressa.

At one stage Iressa had its submissions withdrawn because its benefits failed to reach statistical significance in the overall population. However, it worked well on some patients and subsequent analysis of data from clinical studies showed that it was superior to conventional chemotherapy in 1st line treatment of lung cancer patients who had a mutation of the EGFR gene.

Identifying the right treatment for the right patient at the right time and to embed it as part of routine clinical practice was the major challenge for Iressa. We worked with a variety of healthcare professionals (HCPs) to improve education and best practice in EGFR testing. Workshops involving pathologists, oncologists and respiratory physicians were run around the world. These were complemented by digital activities, including websites, e-learning, and even iPhone applications, to promote best practice and facilitate routine diagnostic testing.

As the first personalised medicine in lung cancer, Iressa is pioneering, not just for the benefits it offers patients, but for the way in which it has brought together different groups of HCPs and changed the way patients are tested and treated as part of routine clinical practice.