TY - JOUR
T1 - Analysis of the Clinical Pipeline of Treatments for Drug-Resistant Bacterial Infections
T2 - Despite Progress, More Action Is Needed
AU - Butler, Mark S.
AU - Gigante, Valeria
AU - Sati, Hatim
AU - Paulin, Sarah
AU - Al-Sulaiman, Laila
AU - Rex, John H.
AU - Fernandes, Prabhavathi
AU - Arias, Cesar A.
AU - Paul, Mical
AU - Thwaites, Guy E.
AU - Czaplewski, Lloyd
AU - Alm, Richard A.
AU - Lienhardt, Christian
AU - Spigelman, Melvin
AU - Silver, Lynn L.
AU - Ohmagari, Norio
AU - Kozlov, Roman
AU - Harbarth, Stephan
AU - Beyer, Peter
N1 - Funding Information:
criteria (see “Scope and inclusion/exclusion criteria”) that are noteworthy. The first is the aztreonam (monobactam-type β-lactam) and avibactam (BLI) combination (ATM-AVI), which was not included, as both components are previously approved drugs. ATM-AVI is being studied by Pfizer in a phase 3 trial (NCT03580044) to treat serious infection due to metallo-β-lactamase (MBL)-producing Gram-negative bacteria (50, 51) with support from the Biomedical Advanced Research and Development Authority (BARDA), Innovative Medicines Initiative (IMI), and AbbVie, through their 2020 acquisition of Allergan. The second is the carbapenem prodrug tebipenem pivoxil (52, 53), which was first approved for pediatric use in Japan in 2009 but has not been used elsewhere. Spero Therapeutics recently completed a phase 3 trial (NCT03788967) for tebipenem pivoxil (SPR994) as an oral treatment for Gram-negative cUTI and acute pyelonephritis infections. Clinically, the oral administration of tebipenem pivoxil could provide an alternative to i.v. administered carbapenems.
Funding Information:
Funding for the WHO report was kindly provided by the Governments of Austria and Germany (Ministry of Education and Science). We acknowledge Fran?ois Franceschi (GARDP, Switzerland), Jennie Hood (Global AMR R&D Hub, Germany), and Mike Sharland (Chair of the WHO Antibiotic Working Group of the EML/EMLc, and St George's University London, UK), who were observers at the November 2020 WHO antibacterial pipeline meeting, as well as Haileyesus Getahun (WHO, Antimicrobial Resistance Division), for supporting this work. This contribution has been prepared strictly in a personal capacity and reflects the view of the authors. The views expressed must not be attributed to the WHO, its Secretariat, or its Member States.
Funding Information:
The WHO has published an economic model that demonstrates these financial challenges (20). To address this issue, several “push” and “pull” development incentives are being proposed and implemented in several countries (21–25). Push-funding policies aim to reduce early development costs of developers by providing funding (e.g., grant support, contract funding, tax incentives, and private/public partnerships), while pull-funding policies aim to optimize the late stage of drug development and create viable market demand for sponsors (e.g., market entry rewards, extended exclusivity period, tradable market voucher, and higher reimbursement) (26). For example, the United Kingdom’s antibiotic subscription pilot is the first ever fully delinked antibiotic pull incentive (27, 28). In the United States, the PASTEUR Act is a bipartisan bill that, if passed into law, would similarly create a delinked reward model for novel and clinically needed new antimicrobials (29, 30).
Publisher Copyright:
Copyright © 2022 Butler et al.
PY - 2022/3/15
Y1 - 2022/3/15
N2 - There is an urgent global need for new strategies and drugs to control and treat multidrug-resistant bacterial infections. In 2017, the World Health Organization (WHO) released a list of 12 antibiotic-resistant priority pathogens and began to critically analyze the antibacterial clinical pipeline. This review analyzes "traditional"and "nontraditional"antibacterial agents and modulators in clinical development current on 30 June 2021 with activity against the WHO priority pathogens mycobacteria and Clostridioides difficile. Since 2017, 12 new antibacterial drugs have been approved globally, but only vaborbactam belongs to a new antibacterial class. Also innovative is the cephalosporin derivative cefiderocol, which incorporates an iron-chelating siderophore that facilitates Gram-negative bacteria cell entry. Overall, there were 76 antibacterial agents in clinical development (45 traditional and 31 nontraditional), with 28 in phase 1, 32 in phase 2, 12 in phase 3, and 4 under regulatory evaluation. Forty-one out of 76 (54%) targeted WHO priority pathogens, 16 (21%) were against mycobacteria, 15 (20%) were against C. difficile, and 4 (5%) were nontraditional agents with broad-spectrum effects. Nineteen of the 76 antibacterial agents have new pharmacophores, and 4 of these have new modes of actions not previously exploited by marketed antibacterial drugs. Despite there being 76 antibacterial clinical candidates, this analysis indicated that there were still relatively few clinically differentiated antibacterial agents in late-stage clinical development, especially against critical-priority pathogens. We believe that future antibacterial research and development (R&D) should focus on the development of innovative and clinically differentiated candidates that have clear and feasible progression pathways to the market.
AB - There is an urgent global need for new strategies and drugs to control and treat multidrug-resistant bacterial infections. In 2017, the World Health Organization (WHO) released a list of 12 antibiotic-resistant priority pathogens and began to critically analyze the antibacterial clinical pipeline. This review analyzes "traditional"and "nontraditional"antibacterial agents and modulators in clinical development current on 30 June 2021 with activity against the WHO priority pathogens mycobacteria and Clostridioides difficile. Since 2017, 12 new antibacterial drugs have been approved globally, but only vaborbactam belongs to a new antibacterial class. Also innovative is the cephalosporin derivative cefiderocol, which incorporates an iron-chelating siderophore that facilitates Gram-negative bacteria cell entry. Overall, there were 76 antibacterial agents in clinical development (45 traditional and 31 nontraditional), with 28 in phase 1, 32 in phase 2, 12 in phase 3, and 4 under regulatory evaluation. Forty-one out of 76 (54%) targeted WHO priority pathogens, 16 (21%) were against mycobacteria, 15 (20%) were against C. difficile, and 4 (5%) were nontraditional agents with broad-spectrum effects. Nineteen of the 76 antibacterial agents have new pharmacophores, and 4 of these have new modes of actions not previously exploited by marketed antibacterial drugs. Despite there being 76 antibacterial clinical candidates, this analysis indicated that there were still relatively few clinically differentiated antibacterial agents in late-stage clinical development, especially against critical-priority pathogens. We believe that future antibacterial research and development (R&D) should focus on the development of innovative and clinically differentiated candidates that have clear and feasible progression pathways to the market.
KW - Clostridioides difficile
KW - WHO priority pathogens
KW - antibacterial pipeline
KW - antibiotic
KW - clinical trials
KW - mycobacteria
KW - nontraditional
KW - traditional
KW - tuberculosis
KW - Gram-Negative Bacteria
KW - Humans
KW - Anti-Bacterial Agents/pharmacology
KW - Bacterial Infections/drug therapy
KW - Drug Resistance, Multiple, Bacterial
KW - Gram-Negative Bacterial Infections/drug therapy
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U2 - 10.1128/aac.01991-21
DO - 10.1128/aac.01991-21
M3 - Review article
C2 - 35007139
AN - SCOPUS:85126082428
SN - 0066-4804
VL - 66
SP - e0199121
JO - Antimicrobial Agents and Chemotherapy
JF - Antimicrobial Agents and Chemotherapy
IS - 3
M1 - e01991-21
ER -