Rising Drug Resistance is Driving Early-Line Use of Powerful Antibiotics Such as Carbapenems for Gram-Negative Infections, According to Surveyed EU5 Physicians

BURLINGTON, Mass., June 12, 2013 /PRNewswire/ -- Decision Resources, one of the world's leading research and advisory firms for pharmaceutical and healthcare issues, finds that more than half of surveyed physicians from the EU5 (France, Germany, Italy, Spain and the United Kingdom) prescribe carbapenems, especially meropenem (Cubist/AstraZeneca's Merrem/Meronem; Dainippon Sumitomo's Meropen; generics) and imipenem/cilastatin (Merck's Primaxin/Tienam; generics), as first- or second-line therapy for Gram-negative infections (GNIs) due to ESBL-producing Enterobacteriaceae. Such early-line use of these agents is indicative of the wider prescribing practices that fuel drug resistance and that have led to higher prevalence of carbapenem-resistant Gram-negative pathogens (GNPs), such as KPC-producing Enterobacteriaceae.

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The new European Physician and Payer Forum report entitled Drug-Resistant Gram-Negative Infections: How Will the Threat of Multidrug-Resistant Gram-Negative Pathogens Impact Market Access for Current and Emerging Antibiotics in the EU5? finds that nearly a third of surveyed physicians prescribe combinations of tigecycline (Pfizer's Tygacil), piperacillin/tazobactam (Pfizer's Zosyn/Tazocin; generics), carbapenems, aminoglycosides and polymyxins early in the treatment algorithm for infections due to multi-drug-resistant (MDR) GNPs, like KPC-producing Enterobacteriaceae or MDR-Pseudomonas. Reflective of physician concern over growing prevalence of these MDR pathogens and limited treatment options currently, over three-quarters of those surveyed anticipate prescribing emerging beta-lactam/beta-lactamase inhibitors CAZ-AVI (Forest/AstraZeneca) and CXA-201 (Cubist), primarily as a carbapenem-sparing therapy and as step therapy for patients failing anti-pseudomonal cephalosporin treatment, respectively.

The report also finds that economic hardships in Europe have translated to increasingly constrained hospital budgets. While the most expensive antibiotics are still cheap compared with biologics used in other therapy areas, interviewed payers warn that increasing patient numbers amid tightening budgets may result in insufficient diagnosis-related group reimbursement rates for overall treatment costs of GNIs, thereby forcing careful budget balancing in busy public institutions. Under pressure to optimize hospital and regional formularies by providing a diverse but cost-effective selection of antibiotics, these payers report that evidence of geographically tailored, cost-efficacy benefit is a key market access lever that will allow them to assess the benefits of novel premium-priced antibiotics against the backdrop of a highly genericized market.

"Interviewed Italian payers believe that even though hospitals are under pressure to reduce costs, they are eager for new therapies that effectively target drug-resistant Gram-negative pathogens," said Decision Resources Analyst Maria Ascano, Ph.D. "Novel therapies with such activity have the potential for rapid regional and hospital formulary inclusion; however manufacturers must be prepared for rigorous health technology assessments across the EU5, and must balance pricing expectations against potential uptake in this highly cost-constrained market."

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