BioVersys AG announced that the European Medicines Agency Committee for Orphan Medicinal Products (EMA COMP) has granted orphan designation for the combination of alpibectir and ethionamide (AlpE) for tuberculosis treatment. The designation follows a successful clinical Phase 2a proof of concept trial and FDA's Orphan Drug Designation granted in 2023.
Novel Mechanism Addresses Drug Resistance Crisis
Alpibectir represents a novel therapeutic approach to combat tuberculosis drug resistance. The small molecule acts through a unique mode of action, significantly potentiating the activity of ethionamide, an existing antibiotic. This combination strategy offers a new concept for overcoming resistance mechanisms that have rendered many TB treatments less effective.
According to the 2024 WHO TB report, an estimated 10.8 million people developed TB in 2023, with 1.25 million deaths worldwide. WHO estimates indicate 400,000 new cases with rifampicin resistance, most classified as multidrug-resistant (MDR). Currently, only 68% of MDR-TB patients receive successful treatment, highlighting the urgent need for new therapeutic options.
Clinical Development Progress
The alpibectir development program emerged from a successful public-private collaboration involving GSK, the Pasteur Institute of Lille, and the University of Lille. Currently, alpibectir is being studied in a Phase 2 trial for pulmonary TB in combination with first-line TB drugs through the European Union's IMI2 UNITE4TB project with partner GSK. A Phase 2 trial for meningeal TB is anticipated to begin dosing in early 2026.
Dr. Glenn Dale, Chief Development Officer of BioVersys, stated: "The EMA orphan designation validates our mission to deliver urgently needed therapies for TB patients, who face prolonged treatment durations and unacceptably high mortality rates."
Regulatory Benefits and Market Impact
The EMA orphan designation provides significant advantages including reduced regulatory fees, research grants, clinical protocol support, and 10-year market exclusivity in the EU. Orphan designation applies to drugs addressing life-threatening or chronically debilitating diseases affecting fewer than 5 in 10,000 EU residents.
Dr. David Barros-Aguirre, VP and Head of Global Health Medicines R&D at GSK, commented: "The EMA orphan drug designation is an important step towards addressing drug resistance in TB treatment. This collaboration highlights GSK's commitment to working with partners to bring essential medicines and vaccines to those who need them."
Ongoing Research Initiatives
The ENABLE study will evaluate the 14-day early bactericidal activity, safety, tolerability, and dose-response of AlpE combinations in adults with newly diagnosed, drug-susceptible pulmonary TB. The study aims to optimize AlpE dosing and evaluate safety for potential use as an alternative regimen for isoniazid mono-resistant TB.
Clinical development has received support from multiple European grants, including the EU IMI2 TRIC-TB Project, EU IMI2 UNITE4TB project, and the European & Developing Countries Clinical Trials Partnership (EDCTP2 program). The UNITE4TB initiative conducts regulatory standard Phase 2 clinical trials using innovative adaptive trial designs, treatment response biomarkers, and artificial intelligence techniques to accelerate TB drug evaluation.
Global Disease Burden
Tuberculosis remains one of the leading causes of death by infectious diseases globally, with two-thirds of cases concentrated in eight countries: India (26%), Indonesia (10%), China (6.8%), the Philippines (6.8%), Pakistan (6.3%), Nigeria (4.6%), Bangladesh (3.5%), and the Democratic Republic of the Congo (3.1%). Additionally, 3.2% of new TB cases and 16% of recurring cases are classified as MDR/RR-TB, representing a significant public health crisis.
