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Hospital-Treated Gram-Negative Infections | Landscape & Forecast | Disease Landscape & Forecast

Hospital-Treated Gram-Negative Infections | Landscape & Forecast | Disease Landscape & Forecast

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Rising rates of antimicrobial resistance have created an urgent need for antibiotics with activity against drug-resistant gram-negative pathogens (GNPs). Antibiotics such as carbapenems, which have historically been reserved for later lines of therapy, are being used earlier in treatment, placing additional pressure on the already limited gram-negative infection (GNI) armamentarium. Despite the launch of antibiotics such as Avycaz/Zavicefta, Zerbaxa, and Vabomere, unmet needs remain for additional effective treatment options. There are commercial opportunities for emerging therapies with efficacy in patients with drug-resistant infections, especially those associated with high rates of mortality. However, the market is heavily genericized, and cost-containment measures may limit commercial success.

Questions Answered:

  • What are the drivers and constraints in the HT-GNI market, and how will the market evolve over the forecast period? How will rising antibiotic resistance rates and entry of new generics shape the market?
  • How large are the different GNI indications? What are the resistance rates to different classes of antibiotics across several pathogen species?
  • How will emerging therapies such as Merck’s imipenem/cilastatin/relebactam, Achaogen’s plazomicin, Tetraphase’s eravacycline, or Shionogi’s cefiderocol address current unmet needs? What emerging therapies do ID specialists consider the most promising?
  • What attributes will emerging therapies need to improve on to compete with currently marketed products?

GNIs account for a large portion of hospital-treated infections (HTIs), which represent a high-value segment of the antibacterial market given the severity of these infections. In the past, developers have focused heavily on anti-gram-positive therapies, such as those against methicillin-resistant Staphylococcus aureus (MRSA), which has allowed the number of antibiotics for GNIs in the late-stage pipeline to dwindle. Therefore, the GNI market provides wide market opportunity for developers that can tackle segments of unmet need. In particular, rising multidrug resistance in key GNPs (e.g., Pseudomonas aeruginosa, Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae) leaves physicians with limited therapeutic options. With fewer alternatives, high-volume use of several current agents creates selective pressure for the further development of drug resistance to therapy. Thus, opportunity exists for developers that can provide therapies to not only overcome drug resistance to current treatments but that are safe and tolerable and can stave off the emergence of antibiotic resistance by using novel mechanisms of action.

Table of contents

  • Disease Landscape & Forecast
    • Key Updates
      • December 2018
      • September 2018
      • August 2018
      • June 2018
      • September 2017
      • June 2017
    • Market Outlook
      • Key Findings
        • Key Findings
        • Market Overview
      • Market Drivers and Constraints
        • What Factors Are Driving the Market for Hospital-Treated Gram-Negative Infections?
        • What Factors Are Constraining the Market for Hospital-Treated Gram-Negative Infections?
      • Drug-Class-Specific Trends
        • Cephalosporins
        • Beta-Lactam/Beta-Lactamase Inhibitor Combinations
        • Carbapenems
        • Aminoglycosides
        • Tetracyclines
        • Quinolones
        • Outer Membrane Protein Targeting Antibiotics
        • Phosphomycins
    • Forecast
    • Etiology and Pathophysiology
      • Etiology and Pathophysiology
        • Key Findings
        • Expert Insight
        • Disease Overview
      • Nosocomial Pneumonia
        • Etiology
        • Pathophysiology
      • Skin and Skin Structure and Surgical-Site Infections
        • Etiology
        • Pathophysiology
      • Urinary Tract Infections
        • Etiology
        • Pathophysiology
      • Intra-Abdominal Infections
        • Etiology
        • Pathophysiology
      • Bloodstream Infections
        • Etiology
        • Pathophysiology
      • Common Gram-Negative Pathogens in Hospital-Treated Infections
        • Enterobacteriaceae
        • Pseudomonads
        • Acinetobacter
      • Key Drug-Resistant Pathogens
        • Quinolone-Resistant Pseudomonas Aeruginosa
        • Third-Generation Cephalosporin-Resistant Klebsiella Pneumoniae
    • Epidemiology
      • Key Findings
        • Key Findings
      • Epidemiology Populations
        • Diagnosed Events of Hospital-Treated UTIs Due to Gram-Negative Pathogens
        • Diagnosed Events of Hospital-Treated BSIs Due to Gram-Negative Pathogens
        • Diagnosed Events of Hospital-Treated NPs Due to Gram-Negative Pathogens
        • Diagnosed Events of Hospital-Treated cIAIs Due to Gram-Negative Pathogens
        • Diagnosed Events of Hospital-Treated SSIs and cSSSIs Due to Gram-Negative Pathogens
        • Diagnosed and Drug-Treated Populations
        • Gram-Negative Pathogens
        • Antimicrobial Resistance to ESCs
        • Antimicrobial Resistance to CPs
        • Antimicrobial Resistance to FQs
    • Current Treatment
      • Key Findings
      • Treatment Goals
        • Key Physician Insights on Clinical End Points
      • Key Current Therapies
        • Overview
        • Cephalosporins
        • Beta-Lactam/Beta-Lactamase Inhibitor Combinations
        • Carbapenems
        • Aminoglycosides
        • Tetracyclines
        • Quinolones
      • Medical Practice
        • Overview
        • Treatment Guidelines
        • Drug Selection
        • Region-Specific Treatment Practices
    • Unmet Need Overview
      • Key Findings
      • Attainment of Unmet Needs
        • Current Attainment of Unmet Needs in Hospital-Treated Gram-Negative Infections
        • Future Attainment of Unmet Needs in Hospital-Treated Gram-Negative Infections
        • Unmet Need and Opportunities in Gram-Negative Infections Due to ESBL-Producing Pathogens
        • Unmet Need and Opportunities in Hospital-Acquired and Ventilator-Associated Bacterial Pneumonia Due to Carbapenem-Resistant Organisms
    • Emerging Therapies
      • Key Emerging Therapies
        • Notable Developments Among Key Emerging Therapies for Hospital-Treated Gram-Negative Infections
        • Beta-Lactam/Beta-Lactamase Inhibitor Combinations
        • Carbapenems/Penems
        • Cephalosporins
        • Aminoglycosides
        • Tetracyclines
        • Quinolones
        • Fosfomycin
        • Murepavadin
      • Early-Phase Pipeline Analysis
        • Notable Developments in the Early-Phase Pipeline for Hospital-Treated Gram-Negative Infections
      • Nontraditional Therapies
        • Emerging Nontraditional Antimicrobial Therapies
    • Access and Reimbursement Overview
      • Region-Specific Reimbursement Practices
        • United States
        • Europe
        • Japan
      • Looking for More?
    • Methodology
      • Bottom-Up Forecasting Overview
        • Patient Populations
        • Drug-Specific Assumptions
      • Bottom-Up Forecast Assumptions
        • General Sources of Data
        • General Statements About Pricing
        • Dosing, Days of Therapy, and Compliance
        • Generic Erosion
        • Out-Year Forecasting
        • Emerging Therapy Prices
      • Primary Market Research
        • Experts Interviewed
    • Appendix
      • Bibliography

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  • Pub Date: December 2018
  • Author(s): Nuno Tiago Giao Antunes, PhD; Fjoralba Kristo, MD, MPH
  • Nuno T. Antunes, ,  is senior business insights analyst on the Infectious, Niche, and Rare Diseases team at Decision Resources Group, specializing in antibacterial agents. Previously, he was a Latin America Market Access senior analyst in the Global Market Access Insights Team, where he developed expertise in market access, pricing and reimbursement, health technology assessment, and health policy. Nuno holds a in animal health from the Universidad de las Palmas de Gran Canaria, Spain, and a degree from the Universidade de Trás-os-Montes e Alto Douro, Portugal. Prior to joining DRG, he conducted research in antimicrobial resistance and antimicrobial development, and worked in the medical devices industry as a scientist.

  • Fjoralba Kristo has expertise in forecasting infectious diseases and chronic diseases in both the mature and global markets. She has extensive academic experience with quantitative and qualitative research methods. Prior to joining Decision Resources Group, she completed a postdoctoral fellowship at University of Kentucky, Division of Cardiovascular Medicine, and more recently worked as Research Scientist at Massachusetts General Hospital, where she investigated mechanisms of inflammation in cardiovascular diseases. Fjoralba holds an MPH degree from Boston University School of Public Health, concentrating in Epidemiology and Biostatistics, and a medical degree from University of Medicine, Bucharest, Romania.

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