More on the looming shortage of new antibiotics

 From Medpage Today:

Superbugs Are Getting Stronger— Our defenses are getting weaker  by David Thomas, MS, and Emily Wheeler 

"There are only 64 antibacterial therapeutics currently in clinical development. That's compared to 1,300 treatments in development for various cancers. Over one-third of antibacterial drug candidates target just two bacteria: Clostridioides difficile and Mycobacterium tuberculosis. That leaves only 44 drugs to target all other pathogenic bacteria.

"In other words, the antibacterial pipeline is grievously small. And it's shrinking compared to previous decades. In the last 35 years, just one antibacterial with a novel way to target bacteria has been approved. Comparatively, 18 new antibacterials with novel targets were approved by the FDA between 1940 and 1990.

"Meanwhile, superbugs continue to grow stronger. New research estimates they claimed 1.27 million lives in 2019 -- more than twice the estimated number of annual deaths just 5 years prior.

...

"Every time we use an antimicrobial, the target microbes have a chance to survive and become resistant. So, clinicians prescribe them only when needed. But this sound medical practice makes for poor economic incentives for private companies in a market system.

"Take the experience of the biotech firm Achaogen, which secured FDA approval in 2018 for its novel antibiotic plazomicin (Zemdri), after 15 years of development. The medication treats infections caused by one of the most challenging superbugs, carbapenem-resistant Enterobacteriaceae.

"While important for the overall armamentarium, such novel antimicrobials are used particularly sparingly to prevent dangerous pathogens from developing resistance to our strongest medications. As a result, clinicians hold novel antibiotics like plazomicin in reserve, using them judiciously to preserve effectiveness. That means companies like Achaogen don't sell large quantities of the drugs they develop -- or earn back the capital they invested in the research and development process.

"Achaogen filed for bankruptcy in 2019. In the 3 years since, several other small biotech companies that successfully cleared the clinical pipeline with FDA-approved antibacterials have seen a similar fate.

"The market conditions for antimicrobials are so discouraging that most large biopharmaceutical companies have pulled out of the sector entirely. Small companies discovered over 80% of the antibacterial therapeutics currently in clinical trials.

"These dynamics are causing investors to vacate the antimicrobial sector, too. Venture capital funding for biotech firms focusing on antibacterial research declined over the last decade, while other areas such as oncology rose 700%.

... 

"One solution is the bipartisan, bicameral Pioneering Antimicrobial Subscriptions To End Upsurging Resistance (PASTEUR) Act, which would change the current dose-based payment model for certain antimicrobials. Under PASTEUR, the government would offer developers of the most critically needed antimicrobials between $750 million and $3 billion up front in exchange for access to their medications once they hit the market.

...

"Another bill under consideration is the Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms (DISARM) Act. The legislation would increase Medicare reimbursements for certain antimicrobials"

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I don't know how I should feel about the fact that proposed legislation is named with clever acronyms (and I'm not sure that DISARM sends the right message...)