Barriers to new drug development in respiratory disease.

Abstract

The recent article by Barnes et al. [1] discussing barriers to new drug development in respiratory disease is particularly pertinent to the concerning situation for new tuberculosis (TB) drugs. In Medecins Sans Frontieres (MSF)'s project in Karakalpakstan, Uzbekistan, 38% of new patients present with multidrug-resistant (MDR)-TB [2]. The need for new TB drugs and regimens has never been greater, with treatment success rates of only 48% for MDR-TB patients and <20% for extensively drug-resistant (XDR)-TB [3]. Despite two new compounds, bedaquiline and delamanid, being approved for the treatment of MDR-TB [4], the pipeline for new TB drugs is inadequate. Many compounds in phase II and IIl development are repurposed antibiotics, and may have pre-existing resistance (figure 1). Innovative solutions are required for TB R&D to ensure the bold targets outlined in the WHO END TB strategy are met