an average of two extra weeks in the hospital, says White, during which time they undergo long-term antibiotic therapy, and all of the equipment inserted into the body has to be removed and replaced. White says that can add up to a whopping roughly $75,000 bill per patient. In addition, an average of between 26.5 and 35.1 percent of the people with those infections don’t survive for more than a year. That number spikes to over 50 percent after three years, Tyrx says.
“Mortality rates increase at a much more rapid rate for patients with cardiac device infections compared those who don’t,” White says.
There are about 500,000 implantation procedures per year in the U.S., he says, and roughly 1.5 million annually worldwide. Though infections occur in some 2 and 4 percent of that group, Tyrx’s believes doctors will use the product on patients they deem at “high risk” of infection. About 75 percent of patients getting a pacemaker or defibrillator have at least one significant risk factor—such as a history of infection, diabetes, or heart failure—and 60 percent of them have two.
Tyrx’s goal is to see its device used in that roughly 60 to 75 percent range of patients, though it foresees more widespread use of its next-generation version of the Aigis system.
The first version of Aigis went on the market after winning FDA clearance in 2008. The device is a small orange mesh sock that covers a pacemaker before it is surgically implanted. The device contains two antibiotics—rifampin and minocycline—that are released into the body over the span of a week to 10 days to fight off pathogens that can be introduced to the body during surgery.
Typically, patients are either given antibiotics about 24 hours before the procedure, or during the surgery via a saline solution. When they are discharged, those patients are often given a post-operative antibiotic for about a 24-hour period, says White.
“With all of those steps taken, the infection rate out there is still between 2 and 4 percent,” he says. “This technology is aimed at significantly lowering that 2 to 4 percent by 70 to 100 percent.”
White says Tyrx has sold more than 40,000 Aigis systems since it first hit the market. The product is priced at $800, giving Tyrx north of $30 million in total revenue to date.
The newest version of Aigis dissolves completely, whereas the original system is only partially resorbed and leaves a substrate that remains with the pacemaker over the long-term. That substrate can be problematic later on when a doctor needs to perform an additional procedure on a patient with a pacemaker—say, to change the battery—making surgery take more time to get rid of the remnants.
By dissolving, the new system eliminates the risk of any long-term infection that could occur by remaining in the body, according to White.
“We heard many doctors over the years saying ‘if you make the first generation technology completely resorbable, we’ll use it on the majority of our patients,’” he says. “And that is what we anticipate based on early demand.”
Long-term, Tyrx plans to apply its drug-device combination to other implantable devices, such as orthopedic devices for hips and knees, or hernia repair.
“This technology is applicable anywhere where you have significant clinical and economic consequences associated with these infections,” White says.
Tyrx is weighing the idea of either an IPO or a sale of the company but is not quite ready to pursue either despite interest from potential buyers.
“As we move into next year and have a few quarters of revenue growth under our belt we’ll explore that and see which of those two scenarios is the best,” White says. “There’s a lot of appetite out there, and candidly, we’d like to enjoy some growth for awhile.”
