GlaxoSmithKline Leads Group Combatting Antimicrobial Resistance

Reliance on just a select few pharmaceutical companies to carry the fight against the growing public health threat that is antimicrobial resistance could be what is holding back real progress. 

The Access to Medicine Foundation takes a look at efforts made by 30 pharma companies to limit drug resistance in its 2020 Antimicrobial Resistance Benchmark report from Tuesday. The assessed companies made some progress since 2018, but most need to step it up, fast. The reliance on those with the most significant progress fuels the rising threat, the report suggests. 

Progress in curbing overuse and misuse of antimicrobials to slow the rate at which AMR is spreading worldwide is assessed using the 2018 AMR Benchmark report for comparison. It takes into account the need for new antibiotics to safeguard effective treatment options, as well. 

The 2020 results "indicate that a core group of pharmaceutical companies are making progress in tackling the spread of antimicrobial resistance, but "change is not happening at the scale needed to radically impact the threat from drug resistance," the report reads. "With pharmaceutical companies leaving the anti-infectives market due to poor financial rewards, the supply of life-saving medicines is now increasingly reliant on just a handful of companies,” it adds. 

A leading cause of hospital-related deaths, which have been increasing in recent years in concert with the rise of AMR, is Clostridioides difficile. With 250,00 cases of life-threatening diarrhea and colitis in hospitalized patients in 2017 across the US only, the worldwide spike incidence of C. diff cases has been linked to an increase in resistance to fluoroquinolones.

The report “is the first and only independent measure” of how pharma companies across the world that are “involved in developing and supplying antibacterial and antifungal medicines and vaccines are taking action to limit AMR,” according to the Amersterdam-based nonprofit. 

The assessment is based on areas ripe with opportunities and responsibility to limit AMR, which include research and development, managing manufacturing waste, as well as striking a balance between access and stewardship. The companies include eight large R&D-based companies, nine generic medicine manufacturers, and 13 small and medium-sized enterprises.

GlaxoSmithKline tops the list with the most progress, leading the group in all research areas. It is followed by Pfizer and Johnson & Johnson. Shionogi moved up in front of Novartis and Otsuka in 2020. 

Overselling of antibiotics is aligned with driving resistance. But only 10 out of the 30 companies have taken steps to address the overselling of antibiotics by decoupling bonuses from sales volume, up from just five companies taking such actions in the 2018 evaluation. Not actively promoting antibacterial and antifungal medicines or fully decoupling sales agents' bonuses from volumes is seen as a best practice that currently six companies are following, the report finds.

The report stresses that decoupling bonuses to sales agents from sales volumes is "particularly important" because many of the assessed companies "report pursuing a low-price/high-volume business model." Cipla is one of three companies to decouple its bonuses from volumes fully.

There is progress in areas other than just appropriate access and stewardship. More companies have plans to expand the small clinical pipeline of antibiotics for high priority infections, with eight out of 32 (25%) key candidate antibiotics versus just two out of 28 (7%) as of 2018. But the foundation also notes that “such advance planning is so far benefitting only a few diseases.”

Only 51 drug candidates are in advanced development to treat bacterial. Only 10 out of the 138 R&D projects that are targetting the bacteria and fungi posing the most significant threats are for novel candidates, with 40 having dropped out of the pipeline and 49 have been added since 2018. 

Another area that has seen a slight improvement relates to publicly sharing AMR surveillance results, a now common practice for most companies, but only Pfizer shares raw data too. 

Several (13), 12 of which AMR Industry Alliance members, also demonstrated having an environmental strategy to minimize the impact of manufacturing processes promote resistance.

The road ahead is not behind, despite the update to 2018 results showing signs of progress. It is in the best interest of the companies involved to be more engaged in the fight against AMR. 

Novartis AG and Sanofi, two major players, have shifted their focus away from antibiotic research toward other R&D areas like cancer since the last report in 2018. Achaogen Inc. and Melinta Therapeutics, which are smaller drug developers, have filed for bankruptcy since then.

The foundation explains that “tackling the problem demands the concerted effort of multiple stakeholders, and the role for pharmaceutical companies is clear: to develop new medicines to replace ones that no longer  work, make them available and accessible to those who need them, and find new ways to ensure antibiotics are produced and promoted responsibly.” 

The 2020 AMR Benchmark report follows on the heels of a similar one the AMR Industry Alliance released earlier this month, stressing the need for investment in R&D projects.