New Path for Drug Development

The 1960s was a decade that witnessed humans setting foot on the moon and a bloody war that changed the history. In between these events, a drug that would be the mainstay for doctors for decades to fight a smart bug, was born. Rifampicin was the last novel class of antibiotics against Mycobacterium tuberculosis till the arrival of bedaquiline at the fag end of 2012. Discovered in 1965, Rifampicin was marketed in Italy in 1968 and was approved by the US regulatory body in 1971. Half-a-century later, it still remains one of the best bets in the hands of doctors to treat the dreaded bacteria that kill millions around the world.

Notwithstanding its efficacy, Rifampicin and other medicines used for the first line treatment of tuberculosis (TB) come with a problem. They form a treatment regimen that lasts for six to nine months for standard cases and close to two years for drug resistant ones. The medicine’s effectiveness is compromised because of the long duration of the treatment, which leads to poor adherence and subsequent development of drug resistance.

The limitations are more evident in resource-poor countries like India, which is driving many researchers to look for a short and simple drug regimen that is effective, safe and robust. However, this is easier said than done for various reasons. For one, pharmaceutical companies are not interested because TB is a poor man’s disease. TB was left to publicly-funded scientists, who simply didn’t have the wherewithal to convert the laboratory leads into a commercial drug. Drug development is an expensive business with a failure-success ratio of nearly 5000:1. That’s why even though the first genome sequences of the TB bacteria came in 1998 there was little follow-up action for almost a decade...