Pipeline Insight: HIV
Scope
Report Highlights
Reasons to Purchase
Table of Contents
- ABOUT DATAMONITOR HEALTHCARE - page 2
- About the Infectious Disease pharmaceutical analysis team - page 2
- CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the HIV market - page 3
- Forecasts and assumptions - page 4
- CHAPTER 2 PIPELINE DYNAMICS - page 16
- An overview of the pipeline reveals few Phase III candidates - page 16
- The CCR5 inhibitors could, potentially change the treatment paradigm, redistributing sales share from established products - page 17
- New HIV players are expected to account for the majority of sales by 2015 - page 19
- GSK will see its share drastically reduced, but will still be the leading HIV company - page 20
- Should all three pipeline compounds reach the market, Tibotec/J&J is expected to experience the strongest growth in antiretroviral sales - page 22
- CHAPTER 3 PATIENT POTENTIAL - page 24
- As HIV moves towards a chronic manageable disease, the epidemiology is changing - page 24
- Disease definition - page 24
- Despite awareness campaigns and measures to prevent transmission, HIV incidence in some countries continues to rise - page 25
- Immigration from areas of high prevalence means the need for antiretroviral therapy in the seven major markets will continue to grow - page 26
- Roughly 40% of the HIV/AIDS population in the seven major markets is currently undiagnosed. However, better access to diagnostics has resulted in increased diagnosis and, therefore, treatment rates - page 28
- The perception that HIV is a manageable condition and not a 'death sentence' has led to a rise in risk behavior, particularly among the younger age groups - page 28
- Historically affecting men who have sex with men (MSM) and intravenous drug users (IVDU), HIV incidence is rapidly growing in women - page 30
- The HIV-infected population is growing older - page 31
- Recently, the number of HIV diagnoses in older age groups has increased - page 31
- The widespread use of HAART has led to a life expectancy equivalent to that of the uninfected population - page 33
- A greater number and range of therapies has resulted in a variety of treatment-experienced patients - page 35
- Treatment-naïve patients make up a limited percentage of the overall HIV-treated population - page 35
- In accordance with the US DHHS guidelines, intermediate treatment-experienced patients have been recognized as a rapidly growing group - page 35
- Salvage therapy is becoming further downstream as third, fourth and even fifth lines of therapy become feasible due to new drug launches - page 36
- The two main unmet needs in HIV therapy are resistance to currently available drugs and improved patient quality of life - page 39
- Resistance, both acquired and developed, is becoming the main concern for HIV physicians - page 39
- As HIV patients are living longer, quality of life considerations play a key role in prescription decisions - page 40
- As HIV moves towards a chronic manageable disease, the epidemiology is changing - page 24
- CHAPTER 4 R&D APPROACH - page 42
- Clinical trial endpoints are shifting in response to the newer unmet needs in HIV - page 42
- Early clinical trial endpoints were primarily based upon efficacy - page 42
- With improved understanding of HIV and the advent of HAART therapy, endpoints have changed significantly - page 43
- Activity against resistant virus - a must for most of the HIV pipeline - page 43
- Quality of life considerations - page 44
- Gilead's 903 trial has set new standards in HIV clinical trial design - page 45
- Gilead's 903 trial is the first three-year, international, randomized, double-blind, clinical trial of an HIV drug regimen in treatment-naïve patients - page 45
- Frequently cited as a landmark study, the standard set by the 903 trial is likely to be emulated in future clinical trial design - page 46
- Several backbones are available for use in clinical trials, which is likely to affect future uptake of pipeline drugs - page 48
- Clinical trial endpoints are shifting in response to the newer unmet needs in HIV - page 42
- CHAPTER 5 NRTI LATE-STAGE DRUG ANALYSIS & FORECASTS - page 50
- The NRTIs, being the oldest class with the most marketed drugs, is expected to undergo significant changes in dynamics in the next decade - page 50
- The definition of a gold-standard NRTI is no longer clear cut - page 52
- Traditionally, Combivir was widely regarded as the gold-standard NRTI - page 52
- Viread, with its potent activity, favorable resistance profile and once-daily dosing, is perceived by some as the new gold standard - page 53
- Truvada and Epzicom, launched in 2004, can also be viewed as candidates for the label of gold-standard NRTI - page 55
- Drug resistance is the predominant therapeutic issue in the NRTI class and an unmet need of growing importance - page 57
- Several pipeline NRTIs are expected to reach the market within the next five to 10 years - page 58
- The definition of a gold-standard NRTI is no longer clear cut - page 52
- Within the NRTI class, most pipeline drugs have demonstrated activity against common resistant mutations - page 59
- Several drugs with activity against problematic NRTI resistance mutations are being developed - page 59
- Elvucitabine - demonstrable improvement in M184V patients - page 59
- More frequently, patients with resistant virus are being recruited for NRTI clinical trials - page 64
- Racivir - patients with M184V sought for study RCV-201 - page 64
- Several drugs with activity against problematic NRTI resistance mutations are being developed - page 59
- The treatment-experienced patient pool is likely to offer the greatest opportunities for pipeline NRTIs - page 68
- With Epivir, Viread and the fixed-dose combinations firmly established as early-line therapy, companies are looking to the treatment-experienced patient pool - page 68
- Reverset is being developed primarily for salvage therapy - page 68
- The limited patient pool for new NRTIs has led to some companies out-licensing or ceasing developmental products - page 73
- SPD-754 recently out-licensed to Avexa Ltd (and given fast-track status by the FDA) - page 73
- GlaxoSmithKline terminates research agreement MIV-210 but development still ongoing - page 78
- With Epivir, Viread and the fixed-dose combinations firmly established as early-line therapy, companies are looking to the treatment-experienced patient pool - page 68
- Several early-stage NRTIs have been discontinued in development - page 82
- GS 7340 profile does not support continued development - page 82
- Gilead terminated its licensing agreement for amdoxivir for strategic reasons - page 82
- Boehringer Ingelheim opted to discontinue development of MIV-310 - page 82
- The NRTIs, being the oldest class with the most marketed drugs, is expected to undergo significant changes in dynamics in the next decade - page 50
- CHAPTER 6 PI LATE-STAGE DRUG ANALYSIS AND FORECASTS - page 84
- The PIs have traditionally been associated with a high pill burden and a poor side-effect profile, but new drugs in the class have addressed this problem - page 84
- Despite being challenged by Reyataz, Kaletra is still the PI gold standard - page 85
- Based on recent sales, Reyataz poses a serious challenge as contender for the PI gold standard - page 87
- Key unmet needs in PI therapy are being addressed by the pipeline - page 90
- Despite being not being seen as the main unmet need, PI resistance is the major issue driving new product development - page 91
- Despite PK problems, physicians believe tipranavir will have a valuable role to play in later stage PI therapy - page 93
- Profile - page 93
- Datamonitor analysis - page 98
- TMC-114 - promising clinical data raises possibility of favorable positioning - page 102
- Recent clinical trials show that the presence of I54L/M mutations does not reduce susceptibility to GW-640385 - page 108
- Profile - page 108
- Despite PK problems, physicians believe tipranavir will have a valuable role to play in later stage PI therapy - page 93
- The PIs have traditionally been associated with a high pill burden and a poor side-effect profile, but new drugs in the class have addressed this problem - page 84
- CHAPTER 7 NNRTI LATE-STAGE DRUG ANALYSIS AND FORECASTS - page 113
- Usually the preferred first-line therapy, the NNRTIs can only be used for a limited time before class resistance reduces efficacy - page 113
- One pill, once-daily Sustiva is the NNRTI gold standard - page 114
- Class resistance is the major unmet need for the NNRTIs - page 116
- The development of certain resistance mutations results in patients no longer being susceptible to the entire NNRTI class - page 116
- Pipeline NNRTI compounds, with activity against these resistance mutations, may enable patients to use this class in second- and even third-line therapy - page 117
- TMC-125's activity against NNRTI-resistant virus is generating clinical and market interest in the compound's potential - page 118
- Profile - page 118
- Key clinical trial overview - page 120
- Trial results - page 120
- Datamonitor analysis - page 121
- TMC-278 - efficacy in naïve patients could mean potential for first-line positioning - page 122
- Profile - page 122
- Key clinical trial overviews - page 123
- Trial results - page 124
- Datamonitor analysis - page 125
- GW-695634 - positive preliminary data but will it be enough to challenge the Tibotec compounds? - page 126
- Profile - page 126
- Key clinical trial overview - page 127
- Trial results - page 128
- Datamonitor analysis - page 128
- Pharmacokinetic issues have had to be overcome to ensure the continued development of some NNRTIs - page 129
- Surprising rates of failure on capravirine clouds future potential - page 129
- Profile - page 129
- Key clinical trial overview - page 132
- Trial results - page 132
- Datamonitor analysis - page 134
- Phase II/III trials planned but no apparent progress for calanolide A - page 136
- Profile - page 136
- Key clinical trial overview - page 138
- Trial results - page 138
- Datamonitor analysis - page 138
- Surprising rates of failure on capravirine clouds future potential - page 129
- Usually the preferred first-line therapy, the NNRTIs can only be used for a limited time before class resistance reduces efficacy - page 113
- CHAPTER 8 EI AND OTHERS LATE-STAGE DRUG ANALYSIS AND FORECASTS - page 140
- The emergence of a new class of antiretrovirals could lead to changes in accepted treatment paradigms - page 140
- The launch of Fuzeon made the effective treatment and increased survival of patients with advanced stage disease a realistic option - page 141
- Although Fuzeon has provided 'proof of concept', it cannot be considered a true comparator with all stages of therapy being targeted by the EI pipeline drugs - page 143
- The EI and others pipeline encompasses a wide range of products, with a variety of targets and mechanisms of action being investigated - page 144
- As the two main co-receptors essential for HIV entry into uninfected cells, CCR5 and CXCR4 receptors have become important antiretroviral targets - page 145
- UK-427, 857 - resistance profile looks promising but concerns abound regarding viral tropism - page 147
- Combination therapy with GW873140 - data proves promising - page 151
- SCH-417690 (SCH-D) - CCR5 antagonist with potent antiviral effect - page 156
- AMD070 - will the CXCR4 tropic virus be a large enough niche? - page 159
- Monoclonal antibodies, being investigated in heavily treatment-experienced patients, could increase salvage therapy options - page 162
- TNX-355 - a last resort for triple-class experienced patients? - page 163
- PRO-542 - being positioned in highly treatment-experienced patients, but limited advances in clinical trials - page 167
- PRO-140 - a second approach by Progenics - page 170
- Other potential targets being investigated include attachment, maturation and integrase inhibition - page 171
- PA-457's totally novel mechanism of action warrants FDA fast-track status - page 171
- BMS-488043 - proof of concept for first in class likely to lead to development of follow-up compounds - page 174
- Integrase inhibitors represent a key hope for the future, but toxicity issues are clouding their immediate development - page 178
- As the two main co-receptors essential for HIV entry into uninfected cells, CCR5 and CXCR4 receptors have become important antiretroviral targets - page 145
- Discontinued drugs - page 178
- Viraldon - Phase II/III trials discontinued due to failure to complete recruitment - page 178
- Profile - page 178
- Viraldon - Phase II/III trials discontinued due to failure to complete recruitment - page 178
- The emergence of a new class of antiretrovirals could lead to changes in accepted treatment paradigms - page 140
- APPENDIX A - PIPELINE PRODUCT PROFILES - page 179
- NRTI profiles - page 179
- Elvucitabine - page 179
- Clinical trial overview - page 179
- Racivir - page 180
- Clinical trial overview - page 180
- Reverset - page 181
- Clinical trial overview - page 181
- SPD-754 - page 183
- Trial reference 2 - page 183
- Elvucitabine - page 179
- PI profiles - page 184
- TMC-114 - page 184
- Clinical trial overview - page 184
- TMC-114 - page 184
- NNRTI profiles - page 186
- TMC-125 - page 186
- Clinical trial overview - page 186
- Calanolide A - page 188
- Clinical trial overview - page 188
- Capravirine - page 190
- Clinical trial overview - page 190
- TMC-125 - page 186
- EI profiles - page 192
- TNX-355 - page 192
- Clinical trial overview - page 192
- UK-427, 857 - page 193
- Clinical trial overview - page 193
- GW873140 - page 194
- Clinical trial overview - page 194
- PRO-542 - page 195
- Clinical trial overview - page 195
- TNX-355 - page 192
- NRTI profiles - page 179
- APPENDIX B - page 197
- Bibliography - page 197
- Press releases - page 209
- Websites - page 210
- Conferences - page 211
- Miscellaneous sources - page 212
- Report methodology - page 213
- APPENDIX B - page 214
- About Datamonitor - page 214
- About Datamonitor Healthcare - page 214
- Datamonitor Healthcare's therapy area capabilities - page 215
- Disclaimer - page 216
- About Datamonitor - page 214
- List of Tables
- Table 1: HIV pipeline by company, 2005 - page 20
- Table 2: Age at diagnosis in Western Europe, 1999-2003 - page 31
- Table 3: US guidelines recommended first-line (treatment-naïve) therapy, 2004 - page 38
- Table 4: Efficacy of a tenofovir containing regime compared to one containing stavudine in treatment-naïve patients - page 46
- Table 5: Overview of the currently marketed NRTIs - page 51
- Table 6: Key products in late-stage R&D pipeline for NRTIs - page 59
- Table 7: Elvucitabine clinical trial summary - page 60
- Table 8: Elvucitabine: Phase II trial summary - page 61
- Table 9: Racivir clinical trial summary - page 64
- Table 10: Racivir: Phase II trial summary - page 65
- Table 11: Racivir: Phase II trial summary - page 66
- Table 12: Reverset clinical trial summary - page 69
- Table 13: Reverset: Phase IIb trial summary - page 70
- Table 14: SPD-754 clinical trial summary - page 74
- Table 15: SPD-754: Phase II trial summary - page 75
- Table 16: SPD-754: Phase II trial summary - page 76
- Table 17: MIV-210 clinical trial summary - page 79
- Table 18: MIV-210: Phase I trial summary - page 80
- Table 19: Overview of the PIs - page 85
- Table 20: Kaletra: key facts - page 86
- Table 21: Reyataz: key facts - page 88
- Table 22: Key PIs in late-stage development - page 91
- Table 23: Tipranavir: clinical trial summary - page 94
- Table 24: Tipranavir: RESIST-1 trial summary - page 95
- Table 25: Tipranavir: RESIST-2 trial summary - page 97
- Table 26: Percentage of patients achieving a treatment response* - page 99
- Table 27: TMC-114 clinical trial summary - page 104
- Table 28: TMC-114: Phase IIb trial summary - page 105
- Table 29: TMC-114: Phase IIa trial summary - page 106
- Table 30: GW-640385: clinical trial summary - page 109
- Table 31: GW-640385: Phase I trial summary - page 110
- Table 32: Overview of the NNRTIs - page 113
- Table 33: Key products in late-stage R&D pipeline for NRTIs, 2005 - page 117
- Table 34: TMC-125: clinical trial summary - page 119
- Table 35: TMC-125: resistance testing data - page 120
- Table 36: TMC-278: clinical trial summary - page 123
- Table 37: TMC-278: Phase IIa trial summary - page 123
- Table 38: TMC-278: Phase IIa trial summary - page 124
- Table 39: GW-695634: clinical trial summary - page 127
- Table 40: GW-695634: Phase I trial summary - page 127
- Table 41: Capravirine: clinical trial summary - page 131
- Table 42: Capravirine: Phase II trial summary - page 132
- Table 43: Capravirine: Phase IIb trial summary - page 133
- Table 44: Calanolide A: clinical trial summary - page 137
- Table 45: Calanolide A: Phase II trial summary - page 138
- Table 46: Key products in late-stage R&D pipeline for EIs & others - page 145
- Table 47: UK-427, 857: clinical trial summary - page 148
- Table 48: UK-427, 857: Phase II trial summary - page 149
- Table 49: GW873140: clinical trial summary - page 152
- Table 50: GW873140: Phase II trial summary - page 153
- Table 51: GW873140: Phase II trial summary - page 154
- Table 52: SCH-417690: clinical trial summary - page 157
- Table 53: SCH-417690: Phase I trial summary - page 158
- Table 54: AMD070: clinical trial summary - page 160
- Table 55: AMD070: Phase Ia trial summary - page 160
- Table 56: TNX-355: clinical trial summary - page 164
- Table 57: TNX-355: Phase II trial summary - page 165
- Table 58: PRO-542: clinical trial summary - page 168
- Table 59: PRO-542: Phase I/II trial summary - page 169
- Table 60: PRO-140: clinical trial summary - page 171
- Table 61: PA-457: clinical trial summary - page 172
- Table 62: PA-457: Phase I/II trial summary - page 173
- Table 63: BMS-488043: clinical trial summary - page 175
- Table 64: BMS-488403: Phase IIa trial summary - page 176
- Table 65: BMS-488403: Phase I trial summary - page 177
- Table 66: Elvucitabine: Phase I trial summary - page 179
- Table 67: Racivir: Phase I trial summary - page 180
- Table 68: Reverset: Phase IIa trial summary - page 181
- Table 69: Reverset: Phase I trial summary - page 182
- Table 70: TMC-114: Phase IIb trial summary - page 184
- Table 71: TMC-125: Phase IIa trial summary - page 186
- Table 72: TMC-125: Phase IIa trial summary - page 187
- Table 73: Calanolide A: Phase I/II trial summary - page 188
- Table 74: Capravirine: Phase II trial summary - page 190
- Table 75: Capravirine: Phase II trial summary - page 191
- Table 76: TNX-355: Phase Ib trial summary - page 192
- Table 77: UK-427, 857: Phase I trial summary - page 193
- Table 78: GW873140: Phase I trial summary - page 194
- Table 79: PRO-542: Phase I trial summary - page 195
- List of Figures
- Figure 1: The HIV pipeline, 2005 - page 16
- Figure 2: CCR5 forecasted sales 2010-15 - page 19
- Figure 3: 2004 antiretroviral sales by company - page 21
- Figure 4: HIV market share*, 2004 and 2015 - page 22
- Figure 5: 2015 antiretroviral sales by company - page 23
- Figure 6: Estimated number of people living with HIV worldwide, 2000-04 - page 25
- Figure 7: Annual HIV incidence, US, Germany and UK, 1995-2004* - page 26
- Figure 8: UK overseas population by ethnic group, 2001 - page 27
- Figure 9: Newly diagnosed HIV infections in Western Europe by route of transmission, 1999-2003 - page 29
- Figure 10: Age and year of diagnosis of new HIV infection in the UK, 1994--2004 - page 32
- Figure 11: Total AIDS cases per year, seven major markets, 1991-2001 - page 33
- Figure 12: The increased life expectancy due to HAART has led to third and later lines of therapy becoming usual - page 34
- Figure 13: Timeline of the development of the HIV market - page 37
- Figure 14: Viread quarterly uptake since launch - page 47
- Figure 15: Elvucitabine sales forecast, 2005-15 - page 63
- Figure 16: Racivir sales forecast, 2005-15 - page 68
- Figure 17: Where Reverset may be used - page 72
- Figure 18: Reverset sales forecast, 2005-15 - page 73
- Figure 19: SPD-754 sales forecast, 2005-2015 - page 78
- Figure 20: MIV-210 sales forecast, 2005-15 - page 81
- Figure 21: Tipranavir sales forecasts, 2005-15 - page 102
- Figure 22: TMC-114 sales forecasts, 2005-15 - page 108
- Figure 23: GW-640385 sales forecasts, 2005-15 - page 112
- Figure 24: TMC-125 sales forecasts, 2005-15 - page 122
- Figure 25: TMC-278 sales forecasts, 2005-15 - page 126
- Figure 26: GW-695634 sales forecasts, 2005-15 - page 129
- Figure 27: Capravirine sales forecasts, 2005-15 - page 135
- Figure 28: Calanolide A sales forecasts, 2005-15 - page 139
- Figure 29: HIV infection of target cells takes place via chemokine receptors - page 146
- Figure 30: UK-427,857 sales forecasts, 2005-15 - page 151
- Figure 31: GW873140 sales forecasts, 2005-15 - page 156
- Figure 32: SCH-417690 sales forecasts, 2005-15 - page 159
- Figure 33: AMD070 sales forecasts, 2005-15 - page 162
- Figure 34: TNX-355 sales forecasts, 2005-15 - page 166
- Figure 35: PRO-542 sales forecasts, 2005-15 - page 170
- Figure 36: PA-457 sales forecasts, 2005-15 - page 174
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