Doing our part: Innovating to fight Neglected Tropical Diseases April 2017 Designed by ACW, London www.acw.uk.com Contents BIOPHARMACEUTICAL INDUSTRY CONTRIBUTIONS TO THE GLOBAL FIGHT AGAINST NTDs 4 8 Staying the Course: A Global Commitment to Fight NTDs - The scope of the NTD epidemic - The London Declaration 16 18 Scaling Up Access to Existing Treatments Strengthening Health Systems Boosting Innovation - Discovery - Pipeline - Funding R&D PIPELINE FOR NTDs 20 22 24 26 28 30 American trypanosomiasis (Chagas disease) Chikungunya Dengue (dengue hemorrhagic fever) Human African trypanosomiasis (sleeping sickness) Leishmaniasis Lymphatic filariasis 32 34 36 38 40 42 Mycetoma (river blindness) Onchocerciasis (river blindness) Rabies Schistosomiasis Trachoma Abbreviations STAYING THE COURSE: A GLOBAL COMMITMENT TO FIGHT NTDs We are witnessing one of the greatest public health achievements of the century. This year marks the 5th anniversary of the World Health Organization’s (WHO) Neglected Tropical Diseases (NTD) Roadmap1, establishing targets and milestones for the control and elimination of ten of the most prevalent NTDs by 2020. Inspired by the WHO NTD Roadmap, a group of 20 partners from governments, intergovernmental organizations, NGOs, foundations and R&D biopharmaceutical companies came together to pledge support to the WHO by signing the London Declaration2. Today, the London Declaration’s endorsers have grown to include over 200 organizations3. “Today, we have joined together to increase the impact of our investments and build on the tremendous progress made to date. This innovative approach must serve as a model for solving other global development challenges and will help millions of people build self-sufficiency and overcome the need for aid.” Bill Gates, co-chair of the Bill & Melinda Gates Foundation, at the signing of the London Declaration in 2012 Now at the halfway mark of the WHO NTD Roadmap’s timeline, this publication outlines how the R&D biopharmaceutical industry is contributing to this global agenda, with active research projects to uncover new or improved treatments and vaccines. It also provides context of how these R&D efforts are part of an integrated approach to combatting NTDs, including an unprecedented medicines donation program of 14 billion treatments over ten years and support for local capacity building. THE SCOPE OF THE NTD EPIDEMIC Although most NTDs are preventable and treatable, they sadly continue to be a heavy burden on the most vulnerable, disadvantaged people in the world. One person in seven suffers from one or more NTDs – comparable to the entire population of Europe – with the vast majority of cases in low- and middleincome countries (LMICs). NTDs are caused by a range of different parasites, bacteria and viruses, which primarily thrive in subtropical climates. They can be painful, blinding and disfiguring; each year they lead to the poor-health, disability and death of hundreds of thousands of people. As they are often chronic and disabling, NTDs have enormous educational and economic impacts, keeping children out of school and adults out of work. At the start of this millennium, it was estimated that in India alone, an average of USD 1 billion was lost to lymphatic filariasis each year due to healthcare costs and loss of productivity. Research has shown that school children infected with intestinal worms had a 20% lower probability of school enrolment and, subsequently, a 40% reduction in income as an adult4. The landscape of neglected disease control is continuously changing. Climate change is driving diseases beyond their traditional geographies, resulting in outbreaks of dengue and Chagas disease beyond the tropics. Furthermore, complex changes in demography, such as urbanization and globalization, impact upon the spread of disease, as illustrated by the recent outbreaks of Chikungunya, Ebola and Zika virus. NTDs mire communities in a cycle of poverty, and hinder progress towards the sustainable development agenda. The increased commitments from national governments and their partners to achieve the targets of the WHO NTD Roadmap means significant improvements to the health, wealth and quality of life of over 1 billion people worldwide. 4 THE LONDON DECL AR ATION The London Declaration represented a turning point in global efforts to control and eliminate the most common NTDs. The R&D biopharmaceutical industry remains a committed partner in this agenda IFPMA signatories to the London Declaration are AbbVie, Bayer, Bristol-Myers Squibb, Eisai, GlaxoSmithKline, Johnson & Johnson, Merck, MSD, Novartis, Pfizer and Sanofi. COMMITMENTS OF THE LONDON DECL ARATION ON NTDs Sustain, expand and extend programs that ensure the necessary supply of drugs and other interventions to help eradicate some diseases and to help control others by 2020. Advance R&D through partnerships and provision of funding to find next-generation treatments and interventions for neglected diseases. Enhance collaboration and coordination on NTDs at national and international levels through public and private multilateral organizations. Enable adequate funding with endemic countries to implement NTD programs necessary to achieve these goals, supported by strong and committed health systems at the national level. Provide technical support, tools and resources to support NTD-endemic countries to evaluate and monitor programs. AT THE HALFWAY MARK, THE WORLD IS ON TRACK TO DELIVERING ON PROMISES OF THE LONDON DECL ARATION 5 • In 2015, biopharmaceutical companies donated an estimated 2.4 billion tablets, enough for 1.5 billion treatments to prevent and treat NTDs – an increase of 11.7% from 2014. • Between 2012 and 2014, the number of people who needed treatment decreased by 230 million. • Since the London Declaration, there have been over 7.9 billion tablets in pharma donations, which is enough for 5 billion treatments. • 87% of countries in Africa have been fully mapped for the London Declaration’s targeted NTDs. 1 http://www.who.int/neglected_diseases/NTD_RoadMap_2012_Fullversion.pdf 2 h ttp://unitingtocombatntds.org/sites/default/files/resource_file/london_ declaration_on_ntds.pdf 3 http://unitingtocombatntds.org/endorsements 4 h ttp://www.globalnetwork.org/sites/default/files/Social%20and%20 Economic%20Impact%20Review%20on%20Neglected%20Tropical%20 Diseases%20Hudson%20Institute%20and%20Sabin%20Institute%20 November%202012_1.pdf 5 http://unitingtocombatntds.org/report/fourth-report-reaching-unreached 5 DOING OUR PART: COMPREHENSIVE EFFORTS TO FIGHT NTDs Scaling up access to existing treatments Donation of 14 billion treatments over 10 years to help eliminate or control 10 NTDs Strengthening health systems Boosting innovation Over 40 health partnerships to build capacity to fight NTDs where they are endemic 109 active R&D projects to develop the next generation of medicines and vaccines for NTDs NTDs require a multi-stakeholder approach to drive further research tailored to developing needs, improve health policies and access to treatments, and boost healthcare system capacity. That is why the R&D biopharmaceutical industry combats NTDs in an integrated manner. 6 7 1 BOOSTING INNOVATION DISCOV ERY There has been considerable progress in new technologies, including medicines, vaccines, diagnostics and pesticides, to combat NTDs. Since the launch of the London Declaration in 2012, a number of new product approvals helped better address NTD challenges. DENGUE (2015) Dengue is a threat to nearly half of the world’s population, yet until recently there was no specific treatment or vaccine available to reduce the burden of this disease. Dengue is the fastest progressing vector-borne disease and can cause massive outbreaks with a disruptive effect on healthcare systems. Mostly asymptomatic, dengue can also lead to hospitalization, serious illness and death among people leaving in endemic areas in Asia Latin America and Africa. The newly approved dengue vaccine6 presents a major advance towards the achievement of WHO objectives to reducing dengue mortality and morbidity by at least 50% and 25% respectively, by 2020. Additional dengue vaccine candidates are in development. 6 Dengvaxia® (CYD-TDV), developed by Sanofi Pasteur. 7 VERMOX™ chewable (mebendazole chewable 500 mg tablets), developed by Janssen Pharmaceuticals, Inc. 8 Eisai Co., Ltd. received prequalification from the WHO for diethylcarbamazine citrate (DEC) 100 mg tablets in 2013. 8 SOIL-TR ANSMIT TED HELMINTHIA SES (2016) LYMPHATIC FIL ARIA SIS (2013) Soil-transmitted helminthiases, otherwise known as intestinal worms, are a chronic and debilitating illness with particular impact on children, stunting growth, impairing cognitive development and keeping children out of school. Lymphatic filariasis is often referred to as elephantiasis, due to severe disfigurement, disability, and swelling from fluid build-up caused by improper functioning of the lymphatic system. Infection occurs when filarial parasites are transmitted to humans through mosquitoes. An estimated 120 million people worldwide live with the disease. The approval of a chewable formulation of mebendezole7 supports global efforts to reduce the burden of parasitic infections in young children. Donations of this treatment are planned to be rolled out towards the WHO’s objective to provide treatment to over 75% of 870 million at-risk children. The development and distribution of diethylcarbamazine citrate (DEC)8 through large-scale mass drug administration supports the WHO target of eliminating the disease by 2020. 109 7 7 COMPOUNDS FOR NTDs CURRENTLY UNDERGO L ATE STAGE TESTING 109 ACTIVE R&D PROJECTS FOR NTDs To ensure that new generations of improved treatments and interventions are discovered, despite low commercial incentives in the area of NTDs, the biopharmaceutical industry engages in a variety of multi-sectoral research models. The most common model sees NTD R&D through partnerships. This innovative approach has proven to enable the sharing of expertise and acceleration of research, reduced risks and duplications, and sustainable financing. 90 % OVER 90% OF THE ACTIVE R&D PROJECTS FOR NTDs ARE COLL ABOR ATIVE EFFORTS 50 OVER 50 PARTNERS ( UNIVERSITIES, NGOs, PUBLIC AND PRIVATE SECTOR INSTITUTES ) Today, the industry’s NTD research efforts are done in partnership with over 50 organizations, including renowned universities, non-governmental organizations and public and private sector institutes. Biopharmaceutical R&D can be a lengthy process, with instances of life-changing discovery amidst years of hypotheses, setback and recalibrations. As the science becomes more complex, research becomes more challenging. As well as responding to emerging trends such as globalization and climate change, local needs also demand innovation in the space of pediatric formulations and medicines and vaccines that can be distributed outside of the cold chain. Research partnerships help streamline global efforts, identify remaining R&D gaps and preventing the duplication of efforts. Adding to their R&D efforts and donations, companies provide in-kind contributions that are specifically targeted to NTDs R&D. This includes sharing intellectual property assets such as compounds and compounds libraries for research purposes, giving access to research facilities, hosting scientists, and providing training. It also includes transfer of technology, and building technical expertise to develop, manufacture, register and distribute NTDs products. 9 THE R&D PROCESS RESEARCH Practical Testing Critical Trials Regulatory Review Scale-up to Manufacturing Post-Marketing Surveillance 4-6 YEARS 1 YEAR PHASE IV 5 PHASE I PHASE II PHASE III 6-7 YEARS NEW DRUG APPLICATION SUBMITTED Target identification (TI) Lead generation (LG) Lead identification (LI) Lead optimization (LO) 250 PATENT APPLICATIONS FILED BASIC RESEARCH & DRUG DISCOVERY 5,000 - 10,000 COMPOUNDS INVESTIGATIONAL DRUG APPLICATION SUBMITTED PHASE 0 Early Phase Research DEVELOPMENT ONE MARKETED MEDICINE 0.5-2 YEARS CONTINUOUS PIPELINE IFPMA companies are involved in 109 active R&D projects for NTDs. Nearing the end of what is on average a 10-15 year R&D process, IFPMA member companies and their partners are approaching imminent NTDs breakthroughs, with late stage testing (Phase III) of treatments and vaccines of 7 compounds, within the disease areas of American Trypanosomiasis (Chagas disease), dengue, Human African trypanosomiasis (sleeping sickness), lymphatic filariasis, rabies, and trachoma. In most cases, research undertaken in partnerships is conducted on a not-for‑profit basis, with effective mechanisms to ensure access to treatments in endemic countries. As stated by the 2016 Access to Medicines Index, there are access plans in place for most high-priority pipeline products9. “Overall, 56% of 151 high-priority, low-incentive products in R&D have access plans in place. As expected, there are more products with access plans toward the end of the pipeline; there is a marked increase as projects move into clinical development, and then again between clinical phases II and III. The majority (72%) of latestage projects have access plans in place.” Access to Medicines Index 2016 9 https://accesstomedicineindex.org/ 10 As more projects progress into later stages of clinical development, continued support in the space of capacity building will be key to ensure that clinical trials and regulatory infrastructures in low- and middle-income countries are capable getting new medicines and vaccines to the people that need them. The final section of this publication provides the most up-to-date record of active research and development for the next generation of medicines and vaccines for the following NTDs: American trypanosomiasis (Chagas disease), Chikungunya, dengue, Human African trypanosomiasis (sleeping sickness), leishmaniasis, lymphatic filariasis, mycetoma, onchocerciasis (river blindness), rabies, schistosomiasis, and trachoma. R&D PIPELINE BY INDUSTRY AND PARTNER S FOR NTDs Schistosomiasis Rabies Current projects: 5 Medicines: 5 Trachoma Current projects: 1 Medicines: 1 Current projects: 1 Vaccines: 1 Onchocerciasis (river blindness) American trypanosomiasis (Chagas disease) Current projects: 28 Medicines: 26 Vaccines: 2 Current projects: 15 Medicines: 15 Mycetoma Current projects: 1 Medicines: 1 Chikungunya Current projects: 4 Medicines: 3 Vaccines: 1 Lymphatic filariasis Current projects: 12 Medicines: 12 Dengue (dengue hemorrhagic fever) Current projects: 12 Medicines: 5 Vaccines: 7 Leishmaniasis Current projects: 21 Medicines: 21 Human African trypanosomiasis (sleeping sickness) Current projects: 9 Medicines: 9 IFPMA companies are involved in 109 active R&D projects for NTDs 11 FUNDING Eliminating NTDs requires sustained funding for research and development of new treatments and vaccines. According to the latest G-FINDER report from Policy Cures Research, which measures global investment into R&D of new products for 39 neglected diseases (including malaria, tuberculosis, and HIV/ AIDs10), USD 3.04 billion was made available for neglected disease research in 2015, as well as an additional USD 631 million invested in Ebola and other African viral hemorrhagic fever (VHF) research. “2015 was the fourth year in a row that industry has increased its investment in neglected disease R&D – the only sector to have recorded year-on-year growth for such a stretch.” Policy Cures Research, G-FINDER 2016 • Industry investment in neglected disease R&D in 2015 was the highest ever recorded in the G-FINDER survey. • In 2015 the pharmaceutical industry contributed USD 471 million to funding for neglected disease research. 10 Full list of diseases on page 11 of the G-FIN D ER report. 12 13 DEDIC ATED INTERNATIONAL INITIATIV ES FOR NTD RESE ARCH GLOBAL HE ALTH INNOVATIV E TECHNOLOGY FUND (GHIT ), FACILITATING INTERNATIONAL R&D The first of its kind in Japan, the GHIT Fund is a public-private partnership between the Japanese government, multiple pharmaceutical companies, the Bill & Melinda Gates Foundation, the Wellcome Trust, and United Nations Development Programme (UNDP). GHIT Fund invests and manages a portfolio of development partnerships aimed at neglected diseases that afflict the world’s poorest people. GHIT Fund mobilizes Japanese and international pharmaceutical companies and academic and research organizations to engage in the effort to get new medicines, vaccines, and diagnostic tools to people who need them most. IFPMA member companies involved in GHIT are: Astellas, Chugai, Eisai, Daiichi Sankyo, Merck, Otsuka, Shionogi, and Takeda. For more information please visit www.ghitfund.org WIPO RE:SE ARCH, A COLL ABORATIVE PL ATFORM TO BOOST R&D WIPO Re:Search was established in October 2011 by the World Intellectual Property Organization (WIPO) in collaboration with BIO Ventures for Global Health (BVGH) and with the active participation of leading pharmaceutical companies. The consortium now consists of over 100 organizations from both the private and public sectors, including non-profit organizations and academic research institutes. WIPO Re:Search member organizations share their intellectual property assets such as compounds and compound libraries, technologies, expertise, samples, and data to bridge research gaps, reduce costs of product development, and advance drug, vaccine, and diagnostic research and development for NTDs, malaria, and tuberculosis. To date BVGH has established 105 research collaborations through WIPO Re:Search. Collaborations cover a range of areas that include the sharing of data and services (such as access to company research facilities, screening of compounds, hosting of scientists) as well as other forms of expertise. IFPMA member companies involved in WIPO Re:Search are: Eisai, GlaxoSmithKline, Janssen (Johnson & Johnson), Merck, MSD, Novartis, Pfizer, Sanofi, and Takeda11. THE EUROPE AN & DE V ELOPING COUNTRIES CLINIC AL TRIAL S PARTNER SHIP ( EDC TP ) & THE SPECIAL PROGR AMME FOR RESE ARCH AND TR AINING IN TROPIC AL DISE A SES ( WHO/TDR ), SUPPORTING RESEARCHERS AND CLINIC AL TRIAL RESEARCH TEAMS FROM LOW- AND MIDDLE- INCOME COUNTRIES ( LMICs) EDCTP and WHO/TDR offer a Clinical Research and Development Fellowship. The overall objective is to strengthen collaboration between research institutions, researchers and clinical staff in LMICs, pharmaceutical companies, and Product Development Partnerships (PDPs)12. By working together, they ensure harmonization and synergy through a Joint Call for Proposals. The host organizations, pharmaceutical companies and PDPs train scientists, for a period of up to 24 months to develop specialist product development skills not readily taught in academic centers or public research institutions. The fellows are expected to become an important resource for institutional capacity development, to undertake and manage clinical research in accordance with international regulatory requirements and standards13. The fellowship has increased the number of individuals trained and helped facilitate common communication with researchers and clinical staff, pharmaceutical companies, PDPs and research institutions. IFPMA member companies involved in training fellows for the year 2015/2016 are: Astellas, Bayer, GlaxoSmithKline, Janssen (Johnson & Johnson), Merck, Novartis, and Sanofi. For more information please visit EDTCP: www.edctp.org/call/edctp-tdr-clinical-research-development-fellowships-2/ For more information please visit TDR: www.who.int/tdr/capacity/strengthening/career_development/en/ WIPO: www.wipo.int/research/en/ Dedicated centers for NTD research 11 http://www.wipo.int/research/en/ 12 http://www.edctp.org/web/app/uploads/2016/07/EDCTP2-Workplan-2016.pdf 13 http://www.edctp.org/call/edctp-tdr-clinical-research-development-fellowships-2/ 14 PHARMACEUTIC AL INDUSTRY CENTER S DEDIC ATED TO NTDs R&D COMPANY R&D CENTER LOCATION SINCE AbbVie AbbVie North Chicago, IL 2009 Cambridge Biomedical Campus (CBC) Cambridge, UK 2015 Alderley Park* Macclesfield, UK 1999 Celgene Celgene Global Health Summit, NJ, USA 2009 GlaxoSmithKline Diseases of the Developing World center Tres Cantos, Spain 2002 Merck R&D Translational Innovation Platform “Global Health” Geneva, Switzerland 2014 MSD (operated as Merck & Co., Inc. in the USA and Canada) MSD Wellcome Trust Hilleman Laboratories New Delhi, India 2009 Novartis Institute for Tropical Diseases (NITD) Singapore** 2002 Novartis Institutes for BioMedical Research (NIBR) Emeryville, CA, USA 2016 Genomics Institute of the Novartis Research Foundation (GNF) La Jolla, USA 2010 Eisai Inc. Andover Research Institute Andover, MA, USA 1987 Eisai Pharmaceuticals India Pvt. Ltd. Visakhapatnam, India 2007 Tsukuba Research Laboratories (Ibaraki Prefecture) Japan 1982 Marcy l’Etoile Research & development Campus Lyon, France Vaccines (dengue) since the 90s Medicines since 2015 AstraZeneca Novartis Eisai Sanofi The biopharmaceutical industry’s efforts are supported by R&D centers which are dedicated solely to diseases that disproportionately affect people in low- and middle-income countries. Some companies integrate these R&D activities within their broader R&D organization while others provide financial and technical support to independent organizations. * T he facility is planned to cease its operations in late 2016/early 2017; currently ongoing projects are those involving AWOL, malaria and tuberculosis. ** In October 2016, Novartis has announced that NITD will move its operations to Emeryville, California, where it will be co-located with the Infectious Disease Research team. 15 2 SCALING UP ACCESS TO EXISTING TREATMENTS As we search for the next generation of treatments and vaccines, we need to continue to utilize to their full power the existing cost-effective and high-impact treatments for NTDs. The R&D biopharmaceutical industry is to delivering on its London Declaration pledge of 14 billion treatments through 2020 to address the 10 diseases responsible for more than 90% of the global neglected disease burden. In 2015 alone, biopharmaceutical companies donated an estimated 1.5 billion treatments to prevent and treat neglected tropical diseases – an increase of 11.7% from 2014 and reaching 850 million people worldwide14. By 2020, nearly USD 18 billion worth of medicines will have been distributed, the largest medicine donation the world has ever seen. By 2020, nearly USD 18 billion worth of medicines will have been distributed, the largest medicine donation the world has ever seen. Five of the 10 NTDs covered in the London Declaration can be controlled through what is known as mass drug administration (MDA) – large-scale population treatment with safe and effective medicines to all people living in high-risk areas. These diseases include: lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiases (hookworm, roundworm, and whipworm), and trachoma. The success of these drug distribution campaigns relies on an integrated treatment approach. In the past, many countries used to conduct separate treatment campaigns for individual diseases. Now, many programs provide treatments for several diseases at the same time. For example, a national program can treat all children in a region for intestinal worms, onchocerciasis and lymphatic filariasis in a single school visit. This provides immediate relief to any children that happen to carry the parasites, while at the same time halting the spread of these diseases within a community. After a few years of systematic mass drug administrations, a disease can be eradicated from a country, and even eliminated entirely across the world. Additionally, these large-scale campaigns offer a fantastic opportunity to reach people with other health interventions. Partners are also looking at ways to use these community distribution platforms in a more coordinated way with other health programs. The other five NTDs can be controlled by what is known as innovative and intensified disease management (IDM) – individual diagnosis, treatment and rehabilitation of people that have been infected. These include Chagas disease, Guinea worm disease, Human African trypanosomiasis (sleeping sickness), leprosy and visceral leishmaniasis. 14 http://unitingtocombatntds.org/impact. 16 17 3 STRENGTHENING HEALTH SYSTEMS NTDs control and elimination is a challenging task with a need for a variety of locally-tailored solutions. Adding to their research and development efforts and donations, IFPMA member companies are also involved in over 40 partnerships to assist countries to bolster the capacity of their health workforce and medical infrastructures to meet the needs of people with NTDs. Political commitment and leadership from national programs are paramount. All projects involve collaboration with national governments and community-based platforms. Political commitment and leadership from national programs are paramount. All projects involve collaboration with national governments and community-based platforms. Programs focus on building health services that are accessible and staffed with qualified healthcare workers to enable the delivery of medicines and vaccines down the last mile. They also provide people living in endemic areas information to help prevent the spread of infection, and infrastructure programmes to address water, sanitation and hygiene. So that every effort is made to support the WHO and national governments in meetings targets of the NTD Roadmap, the R&D biopharmaceutical industry is committed to finding new ways to address gaps, share best practices and advance solutions. These partnerships include supporting local NGOs in establishing campaigns around identifying the symptoms of dengue, supporting public health institutes in development of clinical guidelines on treatment of leprosy, and supporting governments in setting up mobile intervention teams that can rapidly respond to outbreaks of Human African trypanosomiasis. For more information about these programs, and to learn of many other initiatives, please visit the IFPMA Health Partnerships Directory (www.partnerships.ifpma.org), the most comprehensive international database for health development programs involving the R&D biopharmaceutical industry. Each partnership profile offers valuable insights into why a specific program was developed, and the ways in which it is helping to make a difference to communities around the world. 18 19 AMERICAN TRYPANOSOMIASIS Chagas disease DISE A SE IMPAC T 15,16 American trypanosomiasis is caused by the kinetoplastid protozoan parasite Trypanosoma cruzi, which is primarily transmitted by a triatomine bug – an insect vector. The vector-borne transmission occurs primarily in the Americas. Other ways of transmission are blood transfusion, organ transplantation, congenital and oral transmissions. The disease has two clinical stages: acute and chronic. Acute is characterized by fever, malaise, facial oedema, generalized lymphadenopathy, and hepatosplenomegaly. Chronic asymptomatic disease shows no signs of the disease, yet the parasite remains transmittable to others. Chronic symptomatic disease develops in 10% to 30% of infected patients. Trypanosoma cruzi infection is curable if treatment is initiated soon after infection. In the chronic phase antiparasitic treatment can also prevent or curb disease progression. KE Y FAC TS17, 18 • A n estimated 6 million to 7 million people are infected worldwide, with the disease being endemic, but not limited to 21 countries across Latin America. •5 % of children die with the acute stage of the disease, while chronic asymptomatic disease can last 10 years to lifetime. • Up to 30% of chronically infected people develop cardiac alterations and up to 10% develop digestive, neurological or mixed alterations, which may require specific treatment. • Vector control is the most useful method to prevent Chagas disease in Latin America. 15 http://www.dndi.org/diseases-projects/chagas/ 16 http://www.who.int/mediacentre/factsheets/fs340/en/ 20 17 http://www.dndi.org/diseases-projects/chagas/ 18 http://www.who.int/mediacentre/factsheets/fs340/en/ CURRENT R&D PROJEC TS COMPA COMPAN NYY PA PARTNER RTNERSS PROJECTT PROJEC PHAASE SE PH PE TTYYPE AbbVie AbbVie DNDi DNDi Compoundscreening, screening,preclinical preclinicalsupport, support, Compound technicalconsulting consulting technical Leadidentification identification Lead Medicine Medicine Astellas Astellas AIST AIST Discovery Discoveryof ofanti-protozoan anti-protozoanparasite parasitedrugs drugsfor for Trypanosoma Trypanosomacruzi cruzi Discovery Discovery Medicine Medicine AstraZeneca AstraZeneca DNDi DNDi Focused Focusedcompound compoundlibrary libraryscreening screeningat atSwiss Swiss TPH, TPH,Inst. Inst.Pasteur PasteurKK Lead Leadidentification identification Medicine Medicine Bayer Bayer Company company Lampit, Lampit,Nifurtimox Nifurtimoxpediatric pediatric(dosing (dosingin inchildren) children) Phase PhaseIII III Medicine Medicine Development of treatments Development of treatments Lead optimization Lead optimization Medicine Medicine Screening program Screening program Screening program (Natural Products Library) Screening program (Natural Products Library) E1224 E1224 Hit identification Hit identification Hit identification Hit identification Phase II Phase II Medicine Medicine Medicine Medicine Medicine Medicine DNDi, GHIT (Shionogi, DNDi, GHIT, (Shionogi,GHIT) Takeda, AstraZeneca, Takeda, AstraZeneca, GHIT) NTD Drug Discovery Booster (DDB-Chagas) NTD Drug Discovery Booster (DDB-Chagas) Lead generation Lead generation Medicine Medicine Broad Inst., GHIT Broad Inst., GHIT Focused compound library screening Focused compound library screening Drug discovery Drug discovery (optimization) (optimization) Medicine Medicine SVI, Baylor College, Aeras, SVI, GHITBaylor College, Aeras, GHIT Adjuvant to support vaccine development: Adjuvant to support vaccine development: Chagas vaccine with SVI Chagas vaccine with SVI Adjuvant to support vaccine development: Chagas vaccine with Fiocruz Adjuvant to support vaccine development: Chagas vaccine with Fiocruz Lead optimization project Lead optimization project Lead optimization III for Chagas disease Lead optimization III for Chagas disease Preclinical Preclinical Vaccine Vaccine Preclinical Preclinical Vaccine Vaccine Lead optimization Lead optimization Lead optimization Lead optimization Medicine Medicine Medicine Medicine Lead identification Lead identification Medicine Medicine Lead identification Lead identification Medicine Medicine Discovery Discovery Medicine Medicine Discovery (tool) Basic research Medicine Medicine Lead identification Discovery Medicine Medicine Drug discovery Discovery Medicine Medicine Drug discovery Basic research Medicine Medicine Celgene Celgene Daiichi Sankyo Daiichi Sankyo Eisai Eisai DNDi, Antwerp Antwerp Uni, Uni, Epichem, Epichem, DNDi, Monash Uni Monash Uni GHIT, DNDi GHIT, DNDi DNDi DNDi DNDi, GHIT DNDi, GHIT Fiocruz, GHIT Fiocruz, GHIT GlaxoSmithKline GlaxoSmithKline Dundee Uni Dundee Uni Wellcome Wellcome Wellcome/Dundee Uni (Drug Discovery Unit) Wellcome/Dundee Uni (Drug Discovery Unit) Wellcome Wellcome TCOLF, Calibr TCOLF, Calibr Merck TCOLF,Swiss LSHTM DNDi, TPH MSD DNDi TCOLF, Georgia Uni Hit Hitto tolead Leadidentification identification Wellcome & Dundee Uni (Drug Discovery Unit) Hit to lead identification Hit to Lead identification Wellcome Develop novel therapies to prevent and treat Develop&novel therapies to prevent and treat Chagas leishmaniasis Chagas & leishmaniasis Mode of action and target identification of Concept generation hit finding anti-Chagasic compounds Targeted screening structure–activity Rapid selection of inand vivohit active antirelationship (SAR) development Trypanosoma cruzi compounds company DNDi, Swiss TPH Chagas disease project 1: developing safe Identify new molecules using high throughput treatment for Chagas disease screening of molecular libraries and genotypic targets using CRISPR Cas9 technologies Chagas disease project 2: developing safe treatment for Chagas disease Concept generation hit finding CDIPD (UCSD), WIPO DNDi Re:Search PDE5 In vivoinhibitors POC Drug discovery Discovery Medicine Medicine CONICET DNDi Targeted screening and hit structure–activity Compound screening relationship (SAR) development Leadidentification optimization Lead Medicine Medicine Novartis DNDi Wellcome Focused compound library screening Developing safe treatment for Chagas disease Lead generation Drug discovery Medicine Medicine Shionogi Sanofi GHIT, DNDi DNDi NTD Drug Discovery Booster Focused compound library screening Drug discovery Lead generation Medicine Medicine Shionogi DNDi, GHIT GHIT, DNDi Compound screeningBooster NTD Drug Discovery Drug discovery Drug (leaddiscovery generation) Medicine Medicine DNDi, GHIT GHIT DNDi, Compound screening Booster NTD Drug Discovery Drug Drugdiscovery discovery (lead (leadgeneration) generation) Medicine Medicine DNDi, GHIT trypanosomiasis (Chagas NTD Drug Discovery Booster Total R&D projects for American disease): 27 Drug discovery (lead generation) Medicine Janssen (J&J) Novartis Merck Pfizer MSD Sanofi Takeda Takeda company GHIT, DNDi Total R&D projects for American trypanosomiasis (Chagas disease): 28 21 CHIKUNGUNYA DISE A SE IMPAC T 19,20 Chikungunya is a viral disease usually transmitted to humans by infected mosquitoes Ae. aegypti and Ae. albopictus. Other insect vectors include species of A. furcifer-taylori group and A. luteocephalus. There is evidence that some animals, including non-primates, rodents, birds, and small mammals, may act as reservoirs. The disease causes fever and severe joint pain. Other symptoms include muscle pain, joint swelling, headache, nausea, fatigue, and rash. Chikungunya disease does not often result in death, but the symptoms can be severe and disabling. Some clinical signs are shared with dengue, and it can be misdiagnosed in areas where dengue is common. There is no cure for the disease. Treatment is focused on relieving the symptoms. KE Y FAC TS21, 22 • I n 2016, about 31,000 cases were reported to the Pan American Health Organization. •P eople at highest risk for more severe disease include newborns, elderly (≥65 years old), and people with medical conditions such as high blood pressure, diabetes, or heart disease. •S ymptoms usually begin 3-7 days after being bitten by an infected mosquito. • Ae. aegypti mosquitoes are confined within the tropics and sub-tropics, Ae. albopictus kind has spread from Asia to become established in areas of Africa, Europe, and the Americas, in the recent decades. CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE Sanofi Vanderbilt Uni Discovery: operations research Lead optimization Medicine Celgene A-WOL (Wolbachia), NEB Compound screening Screening Medicine MSD USAMRIID Targeted compound screening Lead identification Medicine Takeda Zydus Cadilla Development Preclinical & Phase I Vaccine Total R&D projects for Chikungunya (C): 4 19 https://www.cdc.gov/chikungunya/symptoms/ 20 http://www.who.int/mediacentre/factsheets/fs327/en/ 22 21 https://www.cdc.gov/chikungunya/symptoms/ 22 http://www.who.int/mediacentre/factsheets/fs327/en/ CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE AbbVie DNDi Compound screening, preclinical support, technical consulting Lead identification Medicine Astellas AIST Discovery of anti-protozoan parasite drugs for Trypanosoma cruzi Discovery Medicine AstraZeneca DNDi Focused compound library screening at Swiss TPH, Inst. Pasteur K Lead identification Medicine Bayer company Lampit, Nifurtimox pediatric (dosing in children) Phase III Medicine Development of treatments Lead optimization Medicine GHIT, DNDi Screening program Hit identification Medicine DNDi Screening program (Natural Products Library) Hit identification Medicine DNDi, GHIT E1224 Phase II Medicine DNDi, GHIT, (Shionogi, Takeda, AstraZeneca, GHIT) NTD Drug Discovery Booster (DDB-Chagas) Lead generation Medicine Broad Inst., GHIT Focused compound library screening Drug discovery (optimization) Medicine SVI, Baylor College, Aeras, GHIT Adjuvant to support vaccine development: Chagas vaccine with SVI Preclinical Vaccine Fiocruz, GHIT Adjuvant to support vaccine development: Chagas vaccine with Fiocruz Preclinical Vaccine Dundee Uni Lead optimization project Lead optimization Medicine Wellcome Lead optimization III for Chagas disease Lead optimization Medicine Wellcome/Dundee Uni (Drug Discovery Unit) Hit to Lead identification Wellcome & Dundee Uni (Drug Discovery Unit) Lead identification Medicine Wellcome Hit to Lead identification Wellcome Lead identification Medicine TCOLF, Calibr Develop novel therapies to prevent and treat Chagas & leishmaniasis Discovery Medicine Merck DNDi, Swiss TPH Concept generation hit finding Basic research Medicine MSD DNDi Targeted screening and hit structure–activity relationship (SAR) development Lead identification Medicine company Chagas disease project 1: developing safe treatment for Chagas disease Drug discovery Medicine company Chagas disease project 2: developing safe treatment for Chagas disease Drug discovery Medicine CDIPD (UCSD), WIPO Re:Search PDE5 inhibitors Drug discovery Medicine CONICET Compound screening Lead optimization Medicine DNDi Focused compound library screening Lead generation Medicine GHIT, DNDi NTD Drug Discovery Booster Drug discovery Medicine DNDi, GHIT Compound screening Drug discovery (lead generation) Medicine DNDi, GHIT NTD Drug Discovery Booster Drug discovery (lead generation) Medicine Celgene Daiichi Sankyo Eisai GlaxoSmithKline DNDi, Antwerp Uni, Epichem, Monash Uni Novartis Pfizer Sanofi Shionogi Takeda Total R&D projects for American trypanosomiasis (Chagas disease): 27 23 DENGUE Dengue hemorrhagic fever DISE A SE IMPAC T 23 Dengue is a mosquito-borne viral infection which causes flu-like illness, and occasionally develops into a potentially lethal complication – severe dengue. The global incidence of dengue has grown dramatically in recent decades. About half of the world’s population is now at risk. There is no specific treatment for dengue/severe dengue. Dengue prevention and control depends on effective vector control measures. A dengue vaccine has been licensed by several National Regulatory Authorities for use in people 9-45 years of age living in endemic settings. KE Y FAC TS24 • An estimated 390 million dengue infections occur worldwide each year, with about 96 million resulting in illness. • Dengue is found in tropical and sub-tropical climates worldwide, mostly in urban and semi-urban areas. • Severe dengue is a leading cause of serious illness and death among children in some Asian and Latin American countries. • Early detection and access to proper medical care lowers fatality rates below 1%. 23 http://www.who.int/mediacentre/factsheets/fs117/en/ 24 https://www.cdc.gov/chikungunya/symptoms/ 24 CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE COMPA N Y AbbVie PA RTNER S DNDi PROJEC T Compound screening, preclinical support, technical consulting PH A SE Lead identification T Y PE Medicine Astellas Celgene AIST A-WOL (Wolbachia), NEB Discovery of anti-protozoan parasite drugs for Trypanosoma cruzi Compound screening Discovery Screening Medicine Medicine AstraZeneca DNDi Focused compound library screening at Swiss TPH, Inst. Pasteur K Lead identification Medicine Bayer company WRAIR, Fiocruz DNDi, Antwerp Uni, Epichem, Lampit, pediatric (dosing in children) Dengue Nifurtimox purified and inactivated virus vaccine candidate Phase Phase III I (WRAIR antigens) Medicine Vaccine Development of treatments Lead optimization Medicine DNDi, GHIT E1224 Hit identification Preclinical (GlaxoSmithKline Hit identification antigens) Phase II Medicine WRAIR, Fiocruz DNDi Screening program Dengue purified and inactivated virus Screening program (Natural Products Library) vaccine candidate Celgene Daiichi Sankyo GlaxoSmithKline Monash Uni GHIT, DNDi Vaccine Medicine Medicine DNDi, GHIT, (Shionogi, Takeda, AstraZeneca, GHIT) WRAIR, Fiocruz Broad Inst., GHIT Dengue therapeutic antibody Focused compound library screening SVI, Baylor College, Aeras, GHIT Wellcome, KU Leuven Adjuvant to support vaccine development: Chagas vaccine with SVI Discovery new anti-viral small molecules Preclinical Discovery Vaccine Medicine Fiocruz, GHIT Adjuvant to support vaccine development: Chagas vaccine with Fiocruz Preclinical Vaccine Dundee Uni Company Wellcome Lead optimization project Tetravalent subunit Lead optimization III for Chagas disease Lead optimization Phase I Lead optimization Medicine Vaccine Medicine Wellcome/Dundee Uni (Drug Discovery Unit) NIAID Wellcome Hit to Lead identification Wellcome & Dundee Uni (Drug Discovery Unit) Tetravalent live attenuated Hit to Lead identification Wellcome Lead identification Late stage preclinical Lead identification Medicine Vaccine Medicine TCOLF, Calibr Develop novel therapies to prevent and treat Chagas & leishmaniasis Discovery Medicine Merck USAMRIID DNDi, Swiss TPH Target compound Concept generation hit finding Lead identification Basic research Medicine Medicine MSD DNDi Targeted screening and hit structure–activity relationship (SAR) development Lead identification Medicine Novartis Company company Discovering newproject anti-viral treatmentssafe Chagas disease 1: developing treatment for Chagas disease Drug discovery Drug discovery Medicine Medicine Medicine PDE5 inhibitors Drug discovery Phase III (efficacy completed) Drug discovery CONICET Compound screening Lead optimization Medicine Hokkaido University DNDi Discovering new anti-viral treatment Focused compound library screening Drug discovery Lead generation Medicine Medicine Shionogi GHIT, DNDi NTD Drug Discovery Booster Drug discovery Medicine Takeda Takeda DNDi, GHIT Company Four-strain screening recombinant viral vaccine Compound (TAK003) Drug discovery Phasegeneration) III (lead Medicine Vaccine DNDi, GHIT NTD Drug Discovery Booster Drug discovery (lead generation) Medicine Eisai Janssen (J&J) GlaxoSmithKline MSD Novartis company Sanofi Pfizer Sanofi Shionogi Company CDIPD (UCSD), WIPO Re:Search NTD Drug Discovery Booster (DDB-Chagas) Chagas disease project 2: developing safe treatment for Chagas disease Tetravalent live attenuated chimeric vaccine Lead generation Late state preclinical Drug discovery (optimization) Medicine Vaccine Medicine Vaccine Medicine Total R&D projects for American trypanosomiasis (Chagas 27 dengue/dengue hemorrhagic fever: disease): 12 25 HUMAN AFRICAN TRYPANOSOMIASIS Sleeping sickness DISE A SE IMPAC T 25 Human African trypanosomiasis (HAT), also known as “sleeping sickness”, is a parasitic disease transmitted by the bite of the “Glossina” insect (tsetse fly). The disease invades the central nervous system, and is predominantly found among the poor populations living in remote rural areas of Africa, exposed to the tsetse fly though activities such as agriculture, fishing, animal husbandry, or hunting. Other methods of transmission include mother-tochild infection through the placenta, mechanical transmission through other blood-sucking insects, and transmission of the parasite through sexual contact.Diagnosis and treatment of the disease is complex and requires specifically skilled staff. Untreated, it is usually fatal. HAT exists in two forms, depending on the parasite involved. Trypanosoma brucei gambiense infects a person for months or years without major signs or symptoms of the disease. The other form, Trypanosoma brucei rhodesiense causes an acute infection with first symptoms appearing within weeks or months. KE Y FAC TS26, 27 • The disease occurs in 36 sub-Saharan Africa countries, with 3,796 cases recorded in 2014. • Trypanosoma brucei gambiense is found in 24 countries and accounts for more than 98% of reported cases. • Trypanosoma brucei rhodesiense is found in 13 countries in eastern and southern Africa and accounts for under 2% of reported cases. • Uganda is the only country that presents both forms of the disease in separate zones. 25 http://www.who.int/trypanosomiasis_african/disease/en/ 26 http://www.who.int/trypanosomiasis_african/disease/en/ 26 27 http://www.who.int/mediacentre/factsheets/fs259/en/ CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE COMPA N Y AbbVie PA RTNER S DNDi Compound PROJEC T screening, preclinical support, technical consulting PH A SE Lead identification TMedicine Y PE Astellas AIST Discovery of anti-protozoan parasite drugs for Trypanosoma cruzi Discovery Medicine AstraZeneca AbbVie DNDi Focused compound library screening at Swiss Compound screening TPH, Inst. Pasteur K Lead identification Screening Medicine Medicine Bayer company Lampit, Nifurtimox pediatric (dosing in children) Phase III Medicine Celgene DNDi, Antwerp Uni, Epichem, Monash Uni DNDi, Antwerp Uni, Epichem, Monash Uni GHIT, DNDi Development of treatments Lead optimization Medicine Development of treatments Screening program Lead optimization Hit identification Medicine Medicine DNDi Screening program (Natural Products Library) Hit identification Medicine DNDi, GHIT E1224 Phase II Medicine TCOLFGHIT, (Shionogi, DNDi, Takeda, AstraZeneca, GHIT) Drug discovery NTD Drug Discovery Booster (DDB-Chagas) Discovery Lead generation Medicine Medicine Broad Inst., GHIT Focused compound library screening Drug discovery (optimization) Medicine SVI, Baylor College, Aeras, TCOLF, NEU, CSIC GHIT Adjuvant to support vaccine development: T. brucei drug discovery: ADMET and PK Chagas with SVI supportvaccine for hit-to-lead optimization Preclinical Lead optimization Vaccine Medicine Fiocruz, GHIT Adjuvant to support vaccine development: Chagas vaccine with Fiocruz Preclinical Vaccine Dundee Uni Lead optimization project Lead optimization Medicine Wellcome TCOLF, Monash Uni Hit tooptimization lead optimization kinetoplastid Lead III for for Chagas disease diseases: single agents for Chagas and HAT Lead optimization Discovery Medicine Medicine Wellcome/Dundee Uni (Drug Discovery Unit) Hit to Lead identification Wellcome & Dundee Uni (Drug Discovery Unit) Lead identification Medicine Wellcome Hit to Lead identification Wellcome Lead identification Medicine Merck DNDi, Swiss TCOLF, CalibrTPH Develop novel therapies to prevent and treat Concept generation hit finding Chagas & leishmaniasis Basic research Discovery Medicine Medicine Merck DNDi, Swiss TPH Concept generation hit finding Basic research Medicine MSD DNDi Targeted screening and hit structure–activity relationship (SAR) development Discovering (D) new affordable and adaptable NCEsproject 1: developing safe Chagas disease treatment for Chagas disease Lead identification Drug discovery (lead optimization) Drug discovery Medicine Medicine company Chagas disease project 2: developing safe treatment for Chagas disease Drug discovery Medicine CDIPD DNDi (UCSD), WIPO Re:Search Fexinidazole (antiprotozoal compound) PDE5 inhibitors Phasediscovery II / III Drug Medicine Medicine CONICET Compound screening Lead optimization Medicine DNDi Focused compound library screening Lead generation Medicine DNDi, DNDi GHIT GHIT, Compound screeningBooster NTD Drug Discovery Lead identification Drug discovery Medicine Medicine DNDi, GHIT Compound screening Drug discovery (lead generation) Medicine Drug discovery (lead generation) Medicine Celgene Daiichi Sankyo Eisai GlaxoSmithKline GlaxoSmithKline Novartis Wellcome company Novartis Sanofi Pfizer Sanofi Takeda Shionogi Takeda DNDi, GHIT NTD Drug Discovery Booster Total R&D projects for Human African trypanosomiasis (sleeping sickness): 9 Medicine Total R&D projects for American trypanosomiasis (Chagas disease): 27 27 LEISHMANIASIS DISE A SE IMPAC T 28,29 Leishmaniasis exists in three main forms – visceral (also known as “kala-azar”), a lethal form of the disease, cutaneous (the most common), and mucocutaneous. Cutaneous leishmaniasis usually presents as ulcers on exposed body parts (arms, legs, face). Mucocutaneous leishmaniasis affects the skin and mucous membrane causing severe deformations. Leishmaniasis is caused by the protozoan Leishmania parasites, which are transmitted by the bite of infected female phlebotomine sandflies. The disease affects some of the poorest people on earth, and is associated with malnutrition, population displacement, poor housing, a weak immune system and lack of financial resources. Leishmaniasis is also linked to environmental changes such as deforestation, building of dams, irrigation schemes, and urbanization. KE Y FAC TS30, 31 • A n estimated 900,000 to 1.3 million new cases occur annually with around 20,000 to 30,000 deaths occurring in 98 countries. • More than 20 species of the kinetoplastid protozoan parasite Leishmania can be transmitted to humans by some 30 species of phlebotomine sandflies. • O ver 90% of new cases of visceral leishmaniasis occur within the 7 most affected countries – Bangladesh, Brazil, Ethiopia, India, Kenya, Nepal, and Sudan. • The majority of cases of cutaneous leishmaniasis occur in 10 countries – Afghanistan, Algeria, Brazil, Colombia, Costa Rica, Ethiopia, Iran, Peru, Syria, and Sudan. 28 http://www.dndi.org/diseases-projects/leishmaniasis/ 29 http://www.who.int/mediacentre/factsheets/fs375/en/ 28 30 http://www.dndi.org/diseases-projects/leishmaniasis/ 31 http://www.who.int/mediacentre/factsheets/fs375/en/ CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE AbbVie DNDi Compound screening, preclinical support, technical consulting Discovery Medicine AstraZeneca DNDi Focused compound library screening at Inst. Pasteur K, Dundee Uni, Swiss TPH Lead identification Medicine Celgene LSHTM, DNDi Development of treatments Lead optimization Medicine GHIT, DNDi Screening program Hit identification Medicine DNDi Screening program (Natural Products Library) Hit identification Medicine DNDi, GHIT (Shionogi, Takeda, AstraZeneca) NTD Drug Discovery Booster (DDBLeishmaniasis) Lead generation Medicine Wellcome/ Dundee Uni (Drug Discovery Unit) Hit to lead identification Lead identification Medicine Wellcome Hit to lead identification Lead identification Medicine TCOLF, Calibr Develop novel therapies to prevent and treat Chagas & leishmaniasis Discovery Medicine Wellcome/ Dundee Uni (Drug Discovery Unit) Lead optimization I for visceral leishmaniasis Lead optimization Medicine Wellcome/ Dundee Uni (Drug Discovery Unit) Lead optimization II for visceral leishmaniasis Lead optimization Medicine TCOLF, Uni Leon, CBMSO In-vitro screening for treating leishmaniasis Discovery Medicine Merck DNDi, Swiss TPH Concept generation hit finding Basic research Medicine MSD DNDi Target screening and hit structure–activity relationship (SAR) development Lead identification Medicine Novartis Wellcome Leishmaniasis project: discovering a superior treatment Drug discovery Medicine DNDi Focused compound library screening Lead generation Medicine DNDi Compound screening Lead identification Medicine GHIT, DNDi NTD Drug Discovery Booster Drug discovery Medicine DNDi, GHIT Compound screening Drug discovery (lead generation) Medicine DNDi, GHIT NTD Drug Discovery Booster Drug discovery (lead generation) Medicine DNDi, GHIT Lead optimization of the aminopyrazole series for visceral leishmaniasis Drug discovery (lead optimization) Medicine Daiichi Sankyo Eisai GlaxoSmithKline Sanofi Shionogi Takeda Total R&D projects for leishmaniasis: 21 29 LYMPHATIC FILARIASIS DISE A SE IMPAC T 32 Lymphatic filariasis (elephantiasis) is caused by infection with nematode parasites (roundworms) of the family Filariodidea. There are three types of these thread-like filarial worms: Wuchereria bancrofti, Brugia malayi, and Brugia timori. The disease can result in an altered lymphatic system and the abnormal enlargement of body parts (lymphedema), causing pain, severe disability, and social stigma. Infection occurs when filarial parasites are transmitted to humans through mosquitoes. Infection is usually acquired in childhood causing hidden damage to the lymphatic system and leading to eventual permanent disability. Lymphatic filariasis can be eliminated by stopping the spread of infection through preventive chemotherapy with single doses of two medicines for persons living in areas where the infection is present. A basic, recommended package of care can alleviate suffering and prevent further disability among lymphatic filariasis patients. KE Y FAC TS33 • A n estimated 15 million people are afflicted with lymphedema globally. • 1.10 billion people in 55 countries worldwide remain threatened by lymphatic filariasis and require preventive chemotherapy to stop the spread of this parasitic infection. • 5.63 billion treatments have been delivered to stop the spread of infection since 2000. • Wuchereria bancrofti is responsible for 90% of the cases. • 25 million men globally suffer with genital form of the disease. • 8 out of 73 endemic countries are currently under surveillance to demonstrate that elimination has been achieved. 32 http://www.dndi.org/diseases-projects/chagas/ 33 http://www.who.int/mediacentre/factsheets/fs102/en/ 30 CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE LSTM Collaborative preclinical development program Discovery Medicine DNDi Compound screening Lead identification Medicine A-WOL, LSTM Focused compound library screening and DMPK support Lead identification Medicine Monclair State Uni, DNDi, NPIMR, Bonn Uni Development of treatments Lead optimization Medicine A-WOL (Wolbachia), NEB Compound screening Screening Medicine UCSD, UCSF, LSTM, Bonn Uni, AbbVie, Anacor, Johnson & Johnson, Eisai, Merck, Calibr, DNDi, BMGF Development of Macrofilaricide Drug Accerelator (MacDA) Lead identification Medicine Company Development of diethylcarbamazine citrate (DEC) Post-approval surveillance (stability study for shelf-life extension) Medicine LSTM, Liv Uni, GHIT Novel compounds for anti-Wolbachia Lead optimization Medicine DNDi, NPIMR Concept generation hit finding Basic research Medicine DNDi Target compound screening Lead identification Medicine DNDi In vivo POC studies macrofilaricide drug accelerator Discovery Medicine DNDi Focused compound library screening Lead generation Medicine AbbVie AstraZeneca Celgene Eisai Merck MSD Sanofi Total R&D projects for lymphatic filariasis: 12 31 MYCETOMA DISE A SE IMPAC T 34,35 Mycetoma (also known as Madura foot / maduromycosis / maduramycosis) is a slow-growing bacterial or fungal infection, which exists in two forms: Actinomycetoma and Eumycetoma. It is a chronic, progressively destructive morbid inflammatory disease usually of the foot but any part of the body can be affected. Infection is most probably acquired when the causative organisms of Mycetoma enter the body through minor trauma or a penetrating injury. The disease is characterized by a triad of painless subcutaneous mass, multiple sinuses, and discharge containing grains. It usually spreads to involve the skin, deep structures, and bone, resulting in destruction, deformity, and loss of function, which may be fatal. Mycetoma commonly involves the extremities, back, and gluteal region. There is a clear relationship between Mycetoma and individuals who walk barefoot. The disease has numerous adverse medical, health and socioeconomic impacts on patients, communities, and health authorities. KE Y FAC TS36, 37 •M ycetoma commonly affects young adults, particularly males aged between 20 and 40 years. •A ctinomycetoma form is a bacterial infection with an approximate 90% cure rate using antibiotics, Eumycetoma form is a fungal infection with a 25-35% cure rate with antifungals and surgery. •A pproximately 40% of Mycetoma cases worldwide are Eumycotic. •C ausative organisms of Mycetoma are distributed worldwide but are endemic in tropical and subtropical areas in the “Mycetoma belt”, which includes the Bolivarian Republic of Venezuela, Chad, Ethiopia, India, Mauritania, Mexico, Senegal, Somalia, Sudan, and Yemen. CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE Eisai DNDi E1224 Clinical (preparation for phase II) Medicine Total R&D projects for mycetoma: 1 34 http://www.who.int/buruli/mycetoma/en/ 35 http://www.dndi.org/diseases-projects/mycetoma/ 32 36 http://www.who.int/buruli/mycetoma/en/ 37 http://www.dndi.org/diseases-projects/mycetoma/ CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE AbbVie DNDi Compound screening, preclinical support, technical consulting Lead identification Medicine Astellas AIST Discovery of anti-protozoan parasite drugs for Trypanosoma cruzi Discovery Medicine AstraZeneca DNDi Focused compound library screening at Swiss TPH, Inst. Pasteur K Lead identification Medicine Bayer company Lampit, Nifurtimox pediatric (dosing in children) Phase III Medicine Development of treatments Lead optimization Medicine GHIT, DNDi Screening program Hit identification Medicine DNDi Screening program (Natural Products Library) Hit identification Medicine DNDi, GHIT E1224 Phase II Medicine DNDi, GHIT, (Shionogi, Takeda, AstraZeneca, GHIT) NTD Drug Discovery Booster (DDB-Chagas) Lead generation Medicine Broad Inst., GHIT Focused compound library screening Drug discovery (optimization) Medicine SVI, Baylor College, Aeras, GHIT Adjuvant to support vaccine development: Chagas vaccine with SVI Preclinical Vaccine Fiocruz, GHIT Adjuvant to support vaccine development: Chagas vaccine with Fiocruz Preclinical Vaccine Dundee Uni Lead optimization project Lead optimization Medicine Wellcome Lead optimization III for Chagas disease Lead optimization Medicine Wellcome/Dundee Uni (Drug Discovery Unit) Hit to Lead identification Wellcome & Dundee Uni (Drug Discovery Unit) Lead identification Medicine Wellcome Hit to Lead identification Wellcome Lead identification Medicine TCOLF, Calibr Develop novel therapies to prevent and treat Chagas & leishmaniasis Discovery Medicine Merck DNDi, Swiss TPH Concept generation hit finding Basic research Medicine MSD DNDi Targeted screening and hit structure–activity relationship (SAR) development Lead identification Medicine company Chagas disease project 1: developing safe treatment for Chagas disease Drug discovery Medicine company Chagas disease project 2: developing safe treatment for Chagas disease Drug discovery Medicine CDIPD (UCSD), WIPO Re:Search PDE5 inhibitors Drug discovery Medicine CONICET Compound screening Lead optimization Medicine DNDi Focused compound library screening Lead generation Medicine GHIT, DNDi NTD Drug Discovery Booster Drug discovery Medicine DNDi, GHIT Compound screening Drug discovery (lead generation) Medicine DNDi, GHIT NTD Drug Discovery Booster Drug discovery (lead generation) Medicine Celgene Daiichi Sankyo Eisai GlaxoSmithKline DNDi, Antwerp Uni, Epichem, Monash Uni Novartis Pfizer Sanofi Shionogi Takeda Total R&D projects for American trypanosomiasis (Chagas disease): 27 33 ONCHOCERCIASIS River blindness DISE A SE IMPAC T 38 Onchocerciasis or “river blindness” is caused by the parasitic worm Onchocerca volvulus. It is transmitted to humans through exposure to repeated bites of infected blackflies of the genus Simulium. Symptoms are caused by the microfilariae, which move around the human body in the subcutaneous tissue and induce intense inflammatory responses when they die. Infected people commonly suffer from severe itching, disfiguring skin conditions, and visual impairment, as well as permanent blindness. KE Y FAC TS39 • More than 99% of infected people live in 31 African countries. • In July 2015, Mexico became the third country in the world after Colombia in 2013 and Ecuador in 2014 to be declared free of onchocerciasis after successfully implementing elimination activities for decades. 38 http://www.who.int/mediacentre/factsheets/fs374/en/ 39 http://www.who.int/mediacentre/factsheets/fs374/en/ 34 CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE LSTM Collaborative discovery program Discovery Medicine DNDi Compound screening Discovery Medicine LSTM, DNDi Preclinical candidate, scientific engagement Preclinical Medicine Macrofilaricide Drug Accelerator (MacDA) Compound screening Discovery Medicine AstraZeneca A-WOL, LSTM Focused library screening and DMPK support Lead identification Medicine Bayer DNDi Development of emodepside Preclinical Medicine Monclair State Uni, DNDi, NPIMR, Bonn Uni Development of treatments Lead optimization Medicine A-WOL (Wolbachia), NEB Compound screening Screening Medicine LSTM, Liv Uni, GHIT Novel compounds for anti-Wolbachia Lead optimization Medicine UCSD, UCSF, LSTM, Bonn Uni, AbbVie, Anacor, Johnson & Johnson, Eisai, Merck, Calibr, DNDi, BMGF Development of treatments with Macrofilaricide Drug Accelerator (MacDA) Lead identification Medicine DNDi, NPIMR Concept generation hit finding Basic research Medicine Buea Uni, WIPO Re:Search Screening for macrofilaricides for onchocerciasis Screening Medicine Macrofilaricide Drug Accelerator (MacDA) Compound Discovery Medicine DNDi Target compound screening Lead identification Medicine DNDi Focused compound library screening Lead generation Medicine AbbVie Celgene Eisai Merck MSD Sanofi Total R&D projects for onchocerciasis: 15 35 RABIES DISE A SE IMPAC T40 The rabies virus is contracted through wounds (e.g. scratches from an infected animal) or by direct contact with mucosal surfaces (e.g. bite from an infect animal). Once inside the body, the virus replicates in the bitten muscle and gains access to motor endplates and motor axons to reach the central nervous system. The virus then travels to the central nervous system, where a majority of the clinical symptoms manifest as an acute encephalitis or meningoencephalitis. Half of the global population lives in canine rabiesendemic areas and is considered at risk for contracting rabies. KE Y FAC TS 41 •A n average of 60,000 people die from rabies annually, and more than 15 million people receive post-exposure prophylaxis every year, averaging to 40% of children in Asia and Africa aged 5-14 years. • I n more than 99% of all cases of human rabies, the virus is transmitted via dogs. •T he incubation period averages 2-3 months and death occurs within 2 weeks after the appearance of clinical symptoms if intensive care is not sought. •4 out of every 10 deaths due to rabies occur in children younger than 15 years old. CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE Sanofi Company VRVg: purified serum-free vero cell rabies vaccine Phase III Medicine Total R&D projects for rabies: 1 40 http://www.who.int/rabies/human/en/ 41 http://www.who.int/rabies/human/en/ 36 CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE AbbVie DNDi Compound screening, preclinical support, technical consulting Lead identification Medicine Astellas AIST Discovery of anti-protozoan parasite drugs for Trypanosoma cruzi Discovery Medicine AstraZeneca DNDi Focused compound library screening at Swiss TPH, Inst. Pasteur K Lead identification Medicine Bayer company Lampit, Nifurtimox pediatric (dosing in children) Phase III Medicine Development of treatments Lead optimization Medicine GHIT, DNDi Screening program Hit identification Medicine DNDi Screening program (Natural Products Library) Hit identification Medicine DNDi, GHIT E1224 Phase II Medicine DNDi, GHIT, (Shionogi, Takeda, AstraZeneca, GHIT) NTD Drug Discovery Booster (DDB-Chagas) Lead generation Medicine Broad Inst., GHIT Focused compound library screening Drug discovery (optimization) Medicine SVI, Baylor College, Aeras, GHIT Adjuvant to support vaccine development: Chagas vaccine with SVI Preclinical Vaccine Fiocruz, GHIT Adjuvant to support vaccine development: Chagas vaccine with Fiocruz Preclinical Vaccine Dundee Uni Lead optimization project Lead optimization Medicine Wellcome Lead optimization III for Chagas disease Lead optimization Medicine Wellcome/Dundee Uni (Drug Discovery Unit) Hit to Lead identification Wellcome & Dundee Uni (Drug Discovery Unit) Lead identification Medicine Wellcome Hit to Lead identification Wellcome Lead identification Medicine TCOLF, Calibr Develop novel therapies to prevent and treat Chagas & leishmaniasis Discovery Medicine Merck DNDi, Swiss TPH Concept generation hit finding Basic research Medicine MSD DNDi Targeted screening and hit structure–activity relationship (SAR) development Lead identification Medicine company Chagas disease project 1: developing safe treatment for Chagas disease Drug discovery Medicine company Chagas disease project 2: developing safe treatment for Chagas disease Drug discovery Medicine CDIPD (UCSD), WIPO Re:Search PDE5 inhibitors Drug discovery Medicine CONICET Compound screening Lead optimization Medicine DNDi Focused compound library screening Lead generation Medicine GHIT, DNDi NTD Drug Discovery Booster Drug discovery Medicine DNDi, GHIT Compound screening Drug discovery (lead generation) Medicine DNDi, GHIT NTD Drug Discovery Booster Drug discovery (lead generation) Medicine Celgene Daiichi Sankyo Eisai GlaxoSmithKline DNDi, Antwerp Uni, Epichem, Monash Uni Novartis Pfizer Sanofi Shionogi Takeda Total R&D projects for American trypanosomiasis (Chagas disease): 27 37 SCHISTOSOMIASIS DISE A SE IMPAC T42 Schistosomiasis is an acute and chronic parasitic disease caused by blood flukes (trematode worms) of the genus Schistosoma. People are infected during routine agricultural, domestic, occupational and recreational activities, which expose them to infested water. There are two major forms of schistosomiasis – intestinal and urogenital – caused by five main species of blood fluke. Intestinal schistosomiasis can result in abdominal pain, diarrhea, blood in the stool, and enlargement of organs. The urogenital schistosomiasis results in blood in urine, fibrosis of the bladder and ureter, kidney damage, and even bladder cancer among other symptoms. The disease may have long-term irreversible consequences, including infertility. Schistosomiasis control focuses on reducing disease through periodic, large-scale population pharmaceutical treatments, adequate sanitation, and snail control. KE Y FAC TS 43 • The disease causes an estimated 20,000 deaths globally each year. • In 2014, at least 258 million people required preventive treatment for schistosomiasis with 90% of people living in Africa. • More than 61.6 million people were reported to have been treated in 2014. • In 2014, transmission of the disease has been reported from 78 countries. 42 http://www.who.int/mediacentre/factsheets/fs115/en/ 43 http://www.who.int/mediacentre/factsheets/fs115/en/ 38 CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE Astellas & Merck Swiss TPH, Lygature, Fiocruz (Farmanguinhos), Simcyp, SCI Pediatric praziquantel formulation Phase II Medicine Swiss TPH, helminGuard, McGill Uni Concept generation: target to hit optimization Basic research Medicine BRI Pharmacology: praziquantel mode of action Basic research Medicine Company Praziquantel optimization and prequalification Clinical trials (Phase I, bioequivalence) Medicine UCSD Targeted screening Lead identification Medicine Merck MSD Total R&D projects for schistosomiasis: 5 39 TRACHOMA DISE A SE IMPAC T44 Trachoma is a disease of the eye caused by infection with the bacterium Chlamydia trachomatis. The disease causes irreversible blindness or visual impairment in people. Infection spreads through personal contact (via hands, clothes, or bedding) and by flies that have been in contact with discharge from the eyes or nose of an infected person. With repeated episodes of infection over many years, the eyelashes may be drawn in so that they rub on the surface of the eye, with pain and discomfort and permanent damage to the cornea. KE Y FAC TS 45 •T he disease is considered a public health problem in 42 countries. •A n estimated 1.9 million people are left blind or visually impaired as a result of the disease. •O ver 200 million people live in trachoma endemic areas and are at risk of trachoma blindness. • I n 2015, more than 185,000 people received surgical treatment for the advanced stage of the disease, and 56 million people were treated with antibiotics. CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE Pfizer EMCF, ITI International Trachoma Initiative: Azithromycin, Macrolide antibiotic Development (manufacturing) Medicine Total R&D projects for trachoma: 1 44 http://www.who.int/rabies/human/en/ 45 http://www.who.int/rabies/human/en/ 40 CURRENT R&D PROJEC TS COMPA N Y PA RTNER S PROJEC T PH A SE T Y PE AbbVie DNDi Compound screening, preclinical support, technical consulting Lead identification Medicine Astellas AIST Discovery of anti-protozoan parasite drugs for Trypanosoma cruzi Discovery Medicine AstraZeneca DNDi Focused compound library screening at Swiss TPH, Inst. Pasteur K Lead identification Medicine Bayer company Lampit, Nifurtimox pediatric (dosing in children) Phase III Medicine Development of treatments Lead optimization Medicine GHIT, DNDi Screening program Hit identification Medicine DNDi Screening program (Natural Products Library) Hit identification Medicine DNDi, GHIT E1224 Phase II Medicine DNDi, GHIT, (Shionogi, Takeda, AstraZeneca, GHIT) NTD Drug Discovery Booster (DDB-Chagas) Lead generation Medicine Broad Inst., GHIT Focused compound library screening Drug discovery (optimization) Medicine SVI, Baylor College, Aeras, GHIT Adjuvant to support vaccine development: Chagas vaccine with SVI Preclinical Vaccine Fiocruz, GHIT Adjuvant to support vaccine development: Chagas vaccine with Fiocruz Preclinical Vaccine Dundee Uni Lead optimization project Lead optimization Medicine Wellcome Lead optimization III for Chagas disease Lead optimization Medicine Wellcome/Dundee Uni (Drug Discovery Unit) Hit to Lead identification Wellcome & Dundee Uni (Drug Discovery Unit) Lead identification Medicine Wellcome Hit to Lead identification Wellcome Lead identification Medicine TCOLF, Calibr Develop novel therapies to prevent and treat Chagas & leishmaniasis Discovery Medicine Merck DNDi, Swiss TPH Concept generation hit finding Basic research Medicine MSD DNDi Targeted screening and hit structure–activity relationship (SAR) development Lead identification Medicine company Chagas disease project 1: developing safe treatment for Chagas disease Drug discovery Medicine company Chagas disease project 2: developing safe treatment for Chagas disease Drug discovery Medicine CDIPD (UCSD), WIPO Re:Search PDE5 inhibitors Drug discovery Medicine CONICET Compound screening Lead optimization Medicine DNDi Focused compound library screening Lead generation Medicine GHIT, DNDi NTD Drug Discovery Booster Drug discovery Medicine DNDi, GHIT Compound screening Drug discovery (lead generation) Medicine DNDi, GHIT NTD Drug Discovery Booster Drug discovery (lead generation) Medicine Celgene Daiichi Sankyo Eisai GlaxoSmithKline DNDi, Antwerp Uni, Epichem, Monash Uni Novartis Pfizer Sanofi Shionogi Takeda Total R&D projects for American trypanosomiasis (Chagas disease): 27 41 Abbreviations A BBRE VIATION PA RTNER’S FULL N A ME Aeras Aeras Global TB Vaccine Foundation AIST National Institute of Advanced Industrial Science and Technology Antwerp Uni University of Antwerp A-WOL Anti Wolbachia (A-WOL) Consortium based at the LSTM Baylor College Baylor College of Medicine BMGF Bill & Melinda Gates Foundation Bonn Uni Bonn University BRI Biomedical Research Institute Broad Inst. Broad Institute Buea Uni University of Buea Calibr California Institute for Biomedical Research CBMSO Centro de Biologia Molecular Severo Ochoa CSIC Spanish National Council for Research DMPK Drug Metabolism and Pharmacokinetics DNDi Drugs for Neglected Diseases initiative Dundee Uni Dundee University EMCF The Edna McConnell Clark Foundation Epichem Epichem Pty Ltd Farmanguinhos (Fiocruz) Instituto de Technologia em Fármacos (Fundação Oswaldo Cruz) Fiocruz Fundação Oswaldo Cruz Georgia Uni University of Georgia GHIT Global Health Innovative Technology Fund ITI International Trachoma Initiative Inst. Pasteur K Institut Pasteur Korea KU Leuven Rega Institute KU Leuven Liv Uni Liverpool University LSHTM London School of Hygiene and Tropical Medicine A BBRE VIATION PA RTNER’S FULL N A ME LSTM Liverpool School of Tropical Medicine Lygature Lygature, Netherlands MacDA Macrofilaricide Drug Accelerator McGill Uni McGill University Monash Uni Monash University Monclair State Uni Monclair State University NEU Northeastern University NIAID National Institute of Allergy and Infectious Diseases NEB New England BioLabs NPIMR Northwick Park Institute for Medical Research SCI Schistosomiasis Control Initiative (Imperial College London) Simcyp Simcyp Ltd SVI Sabin Vaccine Institute Swiss TPH Swiss Tropical and Public Health Institute TCOLF Tres Cantos Open Lab Foundation UCSD University of California, San Diego UCSF University of California, San Francisco Uni Leon Universidad de León USAMRIID United States Army Medical Research Institute of Infectious Diseases Vanderbilt Uni Vanderbilt University Wellcome Wellcome Trust WHO World Health Organization WIPO World Intellectual Property Organization WRAIR Walter Reed Army Institute of Research Photos on cover and on pages 2, 4, 5, 7, 9, 13, 14, 17, 19 are reproduced with the permission of GlaxoSmithKline. 43 ABOUT IFPMA IFPMA represents the research-based pharmaceutical companies and associations across the globe. The research-based pharmaceutical industry’s over 2 million employees research, develop and provide medicines and vaccines that improve the life of patients worldwide. Based in Geneva, IFPMA has official relations with the United Nations and contributes industry expertise to help the global health community find solutions that improve global health. International Federation of Pharmaceutical Manufacturers & Associations www.ifpma.org Chemin des Mines 9 P.O. Box 195 1211 Geneva 20 Switzerland
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