Travere Therapeutics Advocates for Patients and Health Equity While Finding Treatments for Rare Diseases

Eric Dube is no stranger to overcoming adversity. When he was 18 years old in the early ‘90s, he came out as a gay man—at a time when the HIV epidemic was at its height. By his 30th birthday, he was diagnosed with a rare form of cancer and there were no proven treatments available if it advanced. Luckily, Eric’s condition was identified early on, and he has since survived cancer once again. Today he is president and CEO of Travere Therapeutics, a San Diego-based company devoted to finding treatments for rare diseases, and a dedicated advocate for patients and health equity. Earlier this year, Travere received accelerated approval from the FDA for FILSPARI (sparsentan), a once-daily oral tablet that reduces proteinuria in adults with primary IgA nephropathy (IgAN), which damages the kidneys if left untreated.

Eric says that being diagnosed with a rare disease can be a lonely journey and isolating for both patients and their families, and that providing patients with support is central to Travere’s mission in addition to drug development and discovery. He says he openly shares his personal story because it’s an example of what drives the 450-plus employees. “I want to ensure that even one family doesn’t have to hear those words of ‘there’s not an effective therapy for your rare condition,’” Eric says. He is also co-founder of OUTBio San Diego, the largest group for LGBTQ biotech professionals in the area, and was named one of the “OUTstanding 100 LGBT+ Executives” by the Financial Times in 2022. In celebration of Pride Month, we spoke to Eric about how he got into the industry, the challenges of leading a biotech company, how his experience as a rare cancer survivor drives him, and what life science companies can do to be truly inclusive organizations.

When did you get your start in this field, and how did you make the transition into biotechnology from behavioral health?

When I was trying to figure out in school what I wanted to do, I had a couple of things converge as life-defining moments. I came out in 1991, when I was 18. I was in the Bay Area, and that was at a time when the death rate from HIV/AIDS was highest–there were no effective therapies. I saw the opportunity to help others in what I thought would be ‘medicine.’ I gravitated to the behavioral health aspect and a glimmer of hope: a community advocating for themselves and trying to find a way to rather than just focus on risk, focus on the aspects of resilience. And I really wanted to be a part of that.

When I was getting my Ph.D., there were breakthroughs within HIV treatments as well as breakthroughs within mental health. That was the opportunity for me to transition from academia into the pharmaceutical industry because I was excited about seeing new hope on the horizon.

After nearly 20 years at GlaxoSmithKline, you joined Travere in 2019. Did you ever imagine that you would one day be the CEO of a biotech company?

I never imagined myself as a CEO for several reasons. One, there were not many CEOs that are like me–I didn’t know any out LGBT CEOs, but I have since then met many. Oftentimes in my career, I didn’t feel that representation [at large companies] so it was hard to imagine what that would look like. But as I started to build confidence and an amazing set of experiences, I knew that I had the opportunity to take a courageous step and say, ‘I trust that I can be a great leader.’

Another aspect is I don’t have the traditional science background: I’m not an M.D., I’m not a Ph.D. in chemistry or genetics. But I stopped apologizing for that and realized there is a unique perspective I can bring to this industry and to this role by thinking about the individual, the family dynamic and the community as a core part of how we deliver innovation, rather than starting with what is the disease and what is the mechanistic target for a disease.

What role does your personal experience play in leading a life science company that is focused on finding treatments for rare diseases?

I feel very fortunate to be working in an industry like we do. I think there’s no more noble calling than being part of the healthcare ecosystem to help individuals who may oftentimes feel hopeless. That’s what resonated with me in reflecting on my experience, where—at least at the time, and I still believe now—there is not an effective therapy for the type of cancer that I had.

There are so many people that join this industry in biotechnology for that purpose and for that reason: they’ve been touched personally by a disease. This is not an easy industry to be in. It is fraught with uncertainty and setbacks and clinical failures. And yet, it is an industry of persistence and passion and bringing hope to others–that’s really what drives me over the years that I’ve been in this industry.

Travere has four approved therapies: FILSPARI, Thiola, Cholbam, and Chenodal, which treat rare kidney, liver, and gallstone diseases, respectively. Why the focus on rare diseases which affect these organs? And what new therapies are in the works?

Historically, kidney and liver disease within the rare space have been some of the lowest areas of clinical trial activity. Partly because there hasn’t been as much of the scientific breakthrough, but also the regulatory pathways have not been as clear. But we’re now starting to see that change over the last three to five years. I’m really proud that Travere has been a pioneer in helping to set that pathway for both of these therapeutic areas because they have been underserved.

For rare liver disease, we have two medicines that are currently available and we’re studying one of those for another condition. We have another medicine, pegtibatanase, which is in Phase 2 right now. It’s an enzyme replacement therapy for a rare metabolic disorder. It’s a genetic disorder where patients are often not diagnosed until early adulthood, and have to be on a very restrictive diet of essentially no protein other than medical protein. We’re looking to hopefully change that because there is a high unmet need for that condition.

How does the company support rare disease patients and underserved communities?

Within rare disease, oftentimes you need to advocate for yourself and you need to become as educated about your condition, or your child’s condition, as the medical professional. An expert or a specialist may only see a handful of people with a rare disease in their entire career. We do see, whether it’s through telehealth, educational initiatives, or our advocacy work, it very much is about connecting and empowering rare families. That was the impetus for us to be a founding member with the Black Women’s Health Imperative of the Rare Disease Diversity Coalition, formed to address the barriers to diagnosis and clinical trials that so many rare disease patients of color face.

It’s not enough to have a great clinical trial and a drug approved if the patients that you’re looking to serve cannot reach it. It may be because they’re in a rural community, don’t have the insurance, or the ability to advocate for themselves. The industry has to help to tackle these barriers.

You mentioned that biotechnology can be a difficult industry to be in. Can you share a recent setback that the company experienced, and how you overcame it? What is your biggest challenge right now?

We certainly have had a lot of great success in our pipeline and in our commercial portfolio. But we recently did announce trial results for a rare kidney condition, FSGS, [focal segmental glomerulosclerosis] where we had very promising data in Phase 2. Our Phase 3 was a very unique trial design, and at the interim analysis saw very promising results. But at the end of the trial, we did not achieve the primary endpoint with statistical significance. It was disappointing, because we are so hopeful and have been fighting for years side-by-side with the FSGS community. However, one of the defining aspects of our culture at Travere is to be courageous and to continue to push forward on this path.

While we did not achieve our endpoint, statistically, we believe that this is a landmark trial. It’s the only Phase 3 ever completed for this disease. There’s a lot of rich information that we have to understand: How do we make sure that we understand whether there’s a regulatory pathway for this condition, with sparsentan based on the study results? How can we help best serve this community? We’re in the process of figuring that out now, and that’s certainly one of the business challenges that we face.

What piece of advice would you offer to a young person who wants to start a career in this industry?

Have a deep sense of your purpose. Why do you do this? Why are you choosing this work? I think if you have a deep sense of purpose, and oftentimes it’s in service of others, that’s going to guide you along the way. You need to have a hunger for knowledge and constantly be a student, whether it’s a student of science and medicine, of our environment, or a student of people as you learn how to interact with others. Curiosity and that eagerness to learn is fundamental to the work that we do in innovation and in human health.

This June, we’re celebrating Pride Month. In that spirit, what is one thing that a life science company should be doing to be truly inclusive?

It’s about visibility and a sincere desire to be inclusive as an organization. For me, just having that visibility would have made a world of difference because for the first half of my career in large pharma, I foolishly thought I was the only one out of tens of thousands of employees. That happened because there was never a discussion. Today, that’s changing. Whether it’s through Pride Month or any other opportunity, just being able to give that visibility to patients that you serve and people in your organization who are coming out. There’s such a power to seeing someone like yourself in an organization.

What does Pride Month mean to you, and why is it important that we all celebrate it?

I think my view of Pride has changed over the 30-plus years (my goodness!) that I’ve been out. Initially, it was about a sense of freedom and personal expression because for so long I didn’t feel like I could express who I truly was. This year as I reflect on what Pride means for me, I think about all of the men and women who are no longer with us because they were lost to HIV and AIDS. Think back to 1992–that’s the first year that FDA said, ‘we will grant access to innovation through accelerated approval [for HIV/AIDS treatments]’ Now, there are news stories that accelerated approval is under attack—it is incredibly disappointing.

All of the men and women who sacrificed and fought for this incredible pathway saying, ‘I will take the risk myself in having something that may not be fully proven, but if the science is there, I will do it because I know what’s best for my health.’ Those are the same pleas I hear from parents of children with rare disease. We have access to so many new therapies in rare disease because of those early days of advocates in HIV. So for me, Pride is about recognizing and standing on the shoulders of those that came before us and realizing that we couldn’t do what we could today without them. And that makes me incredibly proud to now serve others because of their efforts.