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TB Alliance-Bayer Partnership. Background Information. Tuberculosis – a Global Epidemic. 2 billion people are infected with M. tb 12 million persons are TB/HIV co-infected 8-9 million new active TB cases/year 2 million people die/year ~400,000 cases of Multi-Drug Resistant-TB/ year
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TB Alliance-Bayer Partnership Background Information
Tuberculosis – a Global Epidemic • 2 billion people are infected with M. tb • 12 million persons are TB/HIV co-infected • 8-9 million new active TB cases/year • 2 million people die/year • ~400,000 cases of Multi-Drug Resistant-TB/ year • Biggest killer of women of childbearing age
The TB Alliance Mission To develop world-class, affordable medicines for the poor and cure a disease that kills someone every 15 seconds.
TB Alliance Priorities Based on impact and feasibility • Active Disease • MDR-TB • TB/HIV Co-Infection • Latent TB Infection
Reaching Patients: AAA Strategy • Affordability • Appropriate pricing for developing countries • Leverage/access IP rights • Adoption • Orally available, easy to use, compatible with ARVs • Leveraging WHO treatment protocol for TB • Access • Procurement & distribution • Funding via Global Fund to Fight AIDS, TB, Malaria or IFFFm
Historic Opportunity to Develop New Therapeutic Options for TB 1950 1970 1980 2010 1960 1974 BMRC Trials add RIF & PZA 1963 Rifampin (RIF) discovered 1970 BMRC Trials add RIF • 1952 • 1st regimen: • Streptomycin • PAS • Isoniazid 2005 Trials substitute Moxifloxacin into regimen 1954 Pyrazainimide (PZA) discovered – but liver toxicity Standard Therapy 2 months: rifampin, isoniazid, pyrazinamide, ethambutol + 4 months: rifampin, isoniazid Standard Regimen by 1960s based on 1952 drugs Rx target: 3-4 months Rx shortened to 6 months Rx shortened to 9 months Rx lasts from 12-24 months
Bayer: A Strong Tradition in Anti-Infectives NEOTEBEN (Isoniazid) 1952: Long-term therapy of tuberculosis (based on Dr. Domagk’s work) MOXIFLOXACIN 1999: Fluoroquinolone for treatment of respiratory tract infections – 7 FDA-approved indications ZEPHIROL 1935: External disinfectant that treat wound infections PRONTOSIL 1935: Sulphonamide therapy that drastically reduced death caused by infectious diseases; research led by Nobel Prize winner and Bayer scientist, Professor Dr. Gehard Domagk CONTOBEN (Thiacetazone) 1950: Treatment of tuberculosis CIPROFLOXACIN 1987: Fluoroquinolone for treatment of urinary tract infections – 14 FDA-approved indications
2005 Complicated skin and skin structure infections 2004 Community acquired pneumonia due to multi-drug resistant Streptococcus pneumoniae 2003 Community acquired pneumonia due to Penicillin-Resistant Streptococcus pneumoniae 2001 Uncomplicated skin and skin structure infections Acute bacterial sinusitis (ABS), acute bacterial exacerbations of chronic bronchitis (ABECB), community-acquired pneumonia (CAP) 1999 Moxifloxacin Timeline (US)
Moxifloxacin Basics • Description • Discovered and manufactured by Bayer • Antibiotic in the fluoroquinolone class • Approved in 1999 in Germany and by U.S. FDA • Currently approved in 104 countries (oral and/or IV formulation) • Safety • More than 42 million patient uses worldwide for all indications • Generally well-tolerated • Most common, mild side effects include nausea, diarrhea, and dizziness • Current Indications • Acute bacterial sinusitis (ABS) • Acute bacterial exacerbations of chronic bronchitis (ABECB) • Community acquired pneumonia (CAP) • Uncomplicated and complicated skin and skin structure infections (uSSSI, cSSSI)
Moxifloxacin for TB Scientific Rationale • Investigators at Johns Hopkins University found that substitution of moxifloxacin for isoniazid in a mouse model decreased treatment time by two months • Moxifloxacin has demonstrated activity against mycobacterium tuberculosis in both in vitro and in vivo published studies • Moxifloxacin has an excellent oral bioavailability & long biological half-life (T1/2) • Moxifloxacin has a low potential for drug-drug interaction because it is not metabolized by the cytochrome P-450 enzyme system • Moxifloxacin has a demonstrated safety record: 42 million patient uses for all indications worldwide
In an animal study*, moxifloxacin regimen shortened treatment duration by 2 months 10 Legend 9 Untreated 8 7 2 months rifampin, isoniazid and pyrazinimide followed by 4 months rifampin and isoniazid 6 5 Log CFU in entire lung 4 2 months rifampin, moxifloxacin and pyrazinimide followed by 4 months rifampin and moxifloxacin 3 2 1 0 0 1 2 3 4 5 6 Duration of treatment (months) *In vivo data does not predict clinical response.
TB Alliance-Bayer Relationship • Goals • Coordinate clinical trials to support registration of moxi-based regimen for TB at affordable price • Common GCP/GMP-based clinical trial standards • Unified safety data base • Clinical data-sharing • Affordability • For patients most “in need” • By-products for drug development • Chart regulatory path • Evaluate/validate potential surrogate markers • Build clinical trial capacity
TB Alliance-Bayer Partnership Background Information