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TB Drug Development

TB Drug Development. Gerald J. Siuta, Ph.D. Business Development May 8, 2007. Tuberculosis. One-third of the world’s population is infected with Mycobacterium tuberculosis 2 billion people 8-9 million develop active disease annually 2 million deaths occur each year

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TB Drug Development

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  1. TB Drug Development Gerald J. Siuta, Ph.D. Business Development May 8, 2007

  2. Tuberculosis • One-third of the world’s population is infected with Mycobacterium tuberculosis • 2 billion people • 8-9 million develop active disease annually • 2 million deaths occur each year • 1 person dies every 15 seconds • 400,000 cases of MDR-TB each year • Leading cause of death in HIV-positive people • 12 Million people are TB/HIV co-infected

  3. Current TB Drug Therapy • Active TB • Standard therapy – 4 drugs (isoniazid, rifampin, pyrazinamide & ethambutol) for 2 months, followed by isoniazid and rifampin for 4 months • Latent TB • Standard therapy – isoniazid for 9 months • Multi-Drug Resistant TB (MDR-TB) • Prolonged therapy, few available drugs, poorly tolerated and difficult to administer • TB/HIV Co-Infection • Drug interactions with antiretroviral agents - simultaneous therapy difficult

  4. The Need for New TB Drugs • Complex 6-9 months treatment with a 4 drug combination regimen • No new anti-TB drug in over 30 years • TB/HIV co-infections fueling each other • MDR-TB is on the rise • Unattractive market for private sector • No capitalization of public sector research

  5. History of the TB Alliance • Cape Town Declaration – Feb 2000 • Hosts: Rockefeller Foundation & MRC S. Africa • Over 120 organizations (health, science, philanthropy and private industry) • Results • Support goals of Stop TB Initiative • Create Scientific Blueprint • Develop Pharmacoeconomic Analysis Build a global alliance for TB drug development

  6. The TB Alliance • International Public-Private Partnership • Non-profit organization • Based in New York City, Brussels and Cape Town • Entrepreneurial, virtual R&D approach • Out-source R&D to public or private partners • Pro-active fundraising

  7. Public-Private Partnership An organization that pursues a social mission by employing the best practices of the private sector and drawing upon resources from the public and private realms

  8. TB Alliance Mission To ensure equitable access to a faster tuberculosis cure that will advance global health and prosperity

  9. Profile of New TB Drug • Shorten the duration of TB treatment or otherwise simplify its completion • Be effective against multi-drug resistant tuberculosis (MDR-TB) • Improve the treatment of latent TB • Be compatible with HIV treatment

  10. Goals and Objectives • Develop an entirely new therapeutic regimen that will shorten or simplify the treatment of tuberculosis • Coordinate and catalyze TB drug development activities worldwide • Ensure Affordability, Adoption and Access (AAA Strategy)

  11. AAA Strategy • Affordability • Appropriate pricing in developing countries • Adoption • Ensure that new drugs are incorporated into existing treatment programs • Access • Procurement and distribution to those patients who need them most

  12. Financial Support • Bill and Melinda Gates Foundation • Rockefeller Foundation • Netherlands Ministry for Development Cooperation • United States Agency for International Development (USAID) • Governments of Great Britain and Ireland

  13. Types of Deals/Agreements • Licensing • Sponsored Projects • Outsourcing/Contracts • Co-Development • Co-Investments • Partnerships • Others

  14. TB Alliance Portfolio Discovery Preclinical Clinical Compounds, Analogs and Derivatives Nitroimidazole Analogs (University of Auckland, Novartis ITD, NIAID) Moxifloxacin (Bayer HealthCare AG) Quinolones (KRICT/Yonsei University) Nitroimidazole PA-824 (Chiron/Novartis) Multi-Functional Molecules (Cumbre) Bacterial Topoisomerase Inhibitors (GlaxoSmithKline) InhA Inhibitors (GlaxoSmithKline) Pleuromutilins (GlaxoSmithKline) Focused Screening – Two Projects (GlaxoSmithKline) Riminophenazines (Institute of Materia Medica) Active TB Alliance program Malate Synthase Inhibitors (GlaxoSmithKline/Texas A&M) TB Alliance in discussion Proteasome Inhibitors (Cornell University) New Targets (University of Pennsylvania)

  15. Chiron • Novel anti-TB compound (PA-824) • Discovered by Pathogenesis, Inc. • Exclusive worldwide license • Defined scientific milestones • Grant-back option • Manufacturing rights • No royalties in high endemic countries

  16. PA-824 • Novel nitroimidazole • Potent activity against both active and slow growing M.tb. • Possesses both bactericidal and sterilizing activity • Phase I clinical trials began June 3, 2005 • Preclinical development completed in 3 years

  17. University of Auckland • Synthesis of PA-824 analogs • Joint program with: • Novartis Institute of Tropical Diseases (Singapore) • National Institute of Allergy and Infectious Diseases • Aims to discover new nitroimidazopyrans that may have improved profiles over PA-824

  18. GlaxoSmithKline • Joint drug discovery program at GSK’s Diseases of the Developing World facility in Tres Cantos, Spain • Four individual projects: • Bacterial topoisomerase inhibitors • InhA inhibitors • Pleuromutilins • Focused screening (two projects)

  19. Korea Research Institute of Chemical Technology (KRICT) • Daejeon, South Korea • Three year research funding • Quinolones, pyridones & quinolizines • Chemical synthesis at KRICT • In vitro and in vivo biological testing at Yonsei University College of Medicine in Seoul, South Korea • Clinical compound selection in progress

  20. Cumbre Pharmaceuticals • Joint program on the design, synthesis and optimization of two different classes of multi-functional antibiotics • The TB Alliance will have exclusive rights to these compounds for the treatment of tuberculosis and other neglected diseases • Cumbre will retain the rights to pursue the compounds for use in other infectious diseases

  21. Institute of Materia Medica • Member of the Chinese Academy of Medical Sciences that is one of the primary institutions for drug research in China • Joint research partnership for the design, synthesis and evaluation of a class of compounds known as riminophenazines • Originally discovered to be active against TB in the 1950s • Has not been used due to side effect profile • The collaboration will utilize IMM's expertise and integrated capabilities in chemistry, pharmacology and manufacture

  22. The TB Alliance-Bayer Moxifloxacin Deal

  23. Moxifloxacin • Fluoroquinolone antibiotic • Orally active • Once-a-day dosage • Approved in 104 countries for the treatment of bacterial respiratory and skin infections

  24. Moxifloxacin for TB • Novel mechanism of action: kills M.tb. by inhibition of DNA gyrase • In vivo studies showed moxifloxacin reduced treatment time by two months when substituted for isoniazid • Safe to use with antiretroviral agents since it is not metabolized by the cytochrome P-450 enzyme system

  25. October 18, 2005 TB Alliance and Bayer HealthCare announced a partnership to coordinate a global clinical trial program to study the potential of moxifloxacin to shorten the standard six-month treatment of TB

  26. The Partnership • Clinically assess the efficacy and safety of moxifloxacin as a front-line agent for the treatment of TB • If clinical trials are successful, register moxifloxacin for a TB indication • Committed to making the product affordable and accessible to patients in the developing world

  27. Moxifloxacin Clinical Trials • Phase II program will evaluate whether substitution of moxifloxacin for one of the standard TB drugs (isoniazid or ethambutol) eliminates TB infection faster than current standard therapy • Trials to be run in Brazil, Canada, South Africa, Spain, Tanzania, Uganda, the United States and Zambia • Nearly 2,500 TB patients are being enrolled

  28. Bayer Commitments • Donate moxifloxacin for each clinical trial site • Cover costs of regulatory filings • Provide moxifloxacin at an affordable price for patients with TB in the developing world

  29. TB Alliance Commitments • Coordinate and help cover the costs of the clinical trials • Ensure coordination of information and results towards the goal of registration • Leverage substantial support from: • U.S. Centers for Disease Control and Prevention (CDC) • Orphan Products Development Center of the U.S. Food & Drug Administration • European and Developing Countries Clinical Trials Partnership (EDCTP)

  30. Special Recognition

  31. Licensing Executives Society On September 13, 2006, the Licensing Executives Society Industry/University and Government Laboratory Transactions Industry Sector presented the TB Alliance and Bayer its Deals of Distinction Award which recognizes worthy transactions involving licensing and transfer of intellectual property and promote creative and innovative solutions to business issues

  32. Scrip – World Pharmaceutical News The TB Alliance-Bayer deal was also one of six finalists for the Scrip 2006 Best Partnership Alliance Award which recognizes the importance of partnerships involving pharmaceutical and/or biotech companies, focusing on deals that require strong strategic input from both partners, are mutually beneficial to both parties, hold promise to address an unmet medical need and demonstrate strategic potential as well as an innovative business model

  33. Global Alliance for TB Drug Development www.tballiance.org

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