Striving to revolutionize mental health research

The numbers are shocking. Nearly one billion people worldwide live with a chronic and complex mental health condition. Approximately half of the population will experience a mental illness in their lifetime. Research in the central nervous system (CNS) is incredibly complex and major improvements have been limited. In fact, development of new medicines in this area is complicated by many factors including the stigma surrounding mental health and governmental under-funding.

Our commitment to evolving mental health to enable people to thrive

On today’s World Mental Health Day, we want you to know that we are committed to addressing this global crisis. We are striving to better understand the diseases and the link between neurobiology by moving from diagnosis based on symptoms to a deeper level of understanding.

“For decades, people with a mental illness were diagnosed and treated based purely on their symptoms rather than the biological cause of the symptoms,” says Dr. Hugh Marston, Head of CNS Diseases Research at Boehringer Ingelheim. “This traditional approach makes it very difficult to develop new therapeutic options, and we are committed to challenge and transform this approach. By taking a strategic and intentional precision psychiatry approach, our hope is to design treatments that have the potential to address the maladapted brain biology associated with specific symptoms.”

Knowledge before treatment

Knowledge comes before treatment – this has been the fundamental principle driving progress in nearly every medical field in recent decades; as researchers learn more and more about the biological mechanisms underpinning a disease, new and increasingly precise treatments can be ultimately developed. This principle has also led to the scientific community better differentiating between the different forms of disease. This we can now include in the journey towards precision psychiatry.

We are now applying those insights and the rapidly advancing understanding of the various mental health conditions as to how we conduct research. Moving from a symptom diagnostic framework to an approach focusing on the biology driving the symptoms of mental health disorders – “precision psychiatry” - means we hope to develop treatments that focus on the brain circuits associated with specific symptoms. “This will allow us to improve symptom control by offering people living with mental health conditions the right treatment targeting their biology and hence offer more predictable outcomes,” says Hugh.

A rich pipeline in all phases of development

Our innovative pipeline of owned and partnered assets represents potential opportunities to address unmet needs in the mental health treatment landscape.

One example is iclepertin, an investigational asset and a GlyT1 inhibitor that is proposed to target the brain biology linked with the cognitive symptoms associated with schizophrenia. These symptoms are a particularly burdensome unmet need as it affects 80% of those with schizophrenia. The cognitive impairments associated with schizophrenia include trouble with problem solving, paying attention and memory, leading to significant reductions in the ability to independently complete activities of daily living -a burden for those living with the disease, their families, and caregivers.

The TRPC 4/5 inhibitor BI 1358894, currently in phase II, is another example of the groundbreaking work being done by Boehringer Ingelheim’s CNS researchers. BI 1358894 is an investigational transient receptor potential canonical ion channel 4/5 (TRPC4/5) inhibitor being developed to treat the overwhelming uncontrolled emotions experienced by people living with conditions such as post-traumatic stress disorder (PTSD) and major depressive disorder (MDD).

Going beyond a pill

This approach to precision psychiatry means we also go beyond the idea that mental health treatment is just a pill. We are driven to provide more holistic support through early detection of disease, ongoing psychological and social interventions, and prescription digital therapeutics (PDT) for people living with chronic and complex mental health conditions.

Together with expert partners, we are investigating the applications of PDTs, as we recognize the potential for these to address gaps in care, reach a broad population, and introduce real-time care management to those who need it the most. PDTs are software-based treatments that are evaluated for safety and efficacy in clinical trials. Once cleared by health authorities, PDTs can expand accessibility to evidence-based treatments for people with mental health conditions and can work in concert with remote education, assessment and telehealth visits to further enable a holistic approach to care.

“Treatments which offer more effective symptom control are urgently needed”, says Dr Vikas Sharma, Head of Medicine CNS, Retinopathies & Emerging Areas (TA CREA). “For people living with a chronic and complex mental health condition, this could mean living a life with fewer challenges and greater wellbeing.”

The meaning of ‘precision’ in the context of psychiatry

Precision psychiatry is an exciting and promising frontier and Boehringer Ingelheim’s goal is to challenge traditional classifications, uncover connections between specific brain circuit dysfunctions and the emotions and behaviors experienced by a person with a mental health condition. For example, rather than developing a medicine for schizophrenia as a whole (i.e. a syndrome-based treatment), we want to develop solutions, pharmacological or otherwise, that can alter the specific biological processes that lead to the manifestation of symptoms and behaviors. Not everyone living with a given condition experiences the same set of symptoms, and even within an individual, symptoms can alter day by day.

“Precision psychiatry needs to become a reality as the potential benefit for people living with complex mental health conditions can’t be overstated,” says Vikas. “Through our unique approach, we may have the chance to bring new treatment options that are truly innovative and alleviate the burden on people living with mental health conditions, their loved ones, and society.“

* These compounds are investigational agents and they have not been approved for use by any regulatory authority. The efficacy and safety of these investigational compounds have not been established.