Hospital-Treated Gram-Negative Infections | Current Treatment: Physician Insights | US | 2017

Due to rising antimicrobial resistance (AMR) rates, powerful antibiotics historically reserved for later lines of therapy are becoming standard-of-care treatment for gram-negative infections (GNIs), particularly those acquired in healthcare facilities (e.g., hospitals, nursing homes, long-term care facilities). Rising AMR rates have created an urgent need for new therapies with activity against multidrug-resistant gram-negative pathogens. As a result, commercial opportunities remain, particularly in the hospital setting, for emerging brands demonstrating clinical efficacy in patients with resistant infections, and especially those associated with high rates of mortality. Our Current Treatment content provides deep insights drawn from a survey of 101 hospital-based infectious diseases specialists regarding how GNI inpatients are being treated in the United States today and what factors are behind treatment decisions.

• Patients with urinary tract infections comprise a notable proportion of the hospital-treated gram-negative infections (GNI) market. What percentage of inpatients have GNIs confirmed to be due to key pathogens (e.g., Escherichia coli, Klebsiella spp., Pseudomonas spp., Acinetobacter spp.)? How has the distribution of GNI inpatients by infection site changed over the last three years?
• Generically available antibiotics are commonly used as empiric treatment, and they continue to dominate the hospital-treated GNI market. The majority of inpatients are effectively treated empirically, making it difficult for novel, branded products to gain uptake in early lines of therapy. What are the most prescribed first-, second-, and third-line therapies for urinary tract infections (UTIs), nosocomial pneumonia (NP), and complicated intra-abdominal infections (cIAIs)? What are the most common therapies that GNI inpatients are administered before being initiated on branded products like Zerbaxa or Avycaz?
• The treatment of drug-resistant GNIs represents a segment of the GNI market that is characterized by relatively high unmet need. Antibiotic products that target drug-resistant GNPs, such as carbapenem-resistant Enterobacteriaceae or Acinetobacter spp., will gain patient share as physicians encounter an increasing number of these rare, yet deadly infections. Whatpercentage of inpatients have confirmed infections due to key drug-resistant gram-negative bacterial strains (e.g., multi-drug resistant, carbapenem-resistant, ESBL-producing, aminoglycoside-resistant, fluoroquinolone-resistant), and how have these proportions changed over the last two years?How have treatment failure rates associated with various antibiotics in key indications changed over the last three years? What proportion of surveyed ID specialists report increasing their use of carbapenems in the past 12 months and why?
• Safer agents are needed to treat drug-resistant GNIs, yet strong safety and tolerability performance is not an important driver of prescribing for Merck & Co.’s Zerbaxa or Allergan’s Avycaz, the newest products to enter the market that are used to treat such infections. What are the most important clinical and non-clinical factors that drive prescribing of antibiotic products? How does an agent’s activity against key gram-negative pathogens impact prescribing? How important is the drug’s cost to prescribers?

Scope:

• Markets covered: United States
• Methodology: Survey of 101 hospital-based infectious disease specialists, 50% of whom sit on their hospital’s pharmacy and therapeutics committee, completed in January 2017.
• Indication coverage:UTIs, NP—including hospital-acquired bacterial pneumonia, ventilator-associated bacterial pneumonia, and healthcare-associated pneumonia—cIAIs, complicated skin and skin structure infections, and bloodstream infections, with in-depth analysis on the current treatment landscape for UTIs, NP, and cIAIs.
• Key Drugs covered: Piperacillin/tazobactam, imipenem/cilastatin, meropenem, doripenem (Doribax), ertapenem (Invanz), fluoroquinolones (e.g., levofloxacin, ciprofloxacin, moxifloxacin, ofloxacin), ceftaroline (Teflaro), ceftriaxone, ceftazidime, ceftolozane/tazobactam (Zerbaxa), ceftazidime/avibactam (Avycaz), cefepime, tigecycline (Tygacil), minocycline IV (Minocin), colistin, polymyxin B, aminoglycosides (e.g., amikacin, gentamicin, tobramycin)
• Key companies mentioned: Allergan, Merck & Co., Pfizer, Shionogi, The Medicines Company