The demise of Achaogen has been blamed on the peculiar features of the antibiotics market,
rather than the poor business decisions of its managers.
The low number of cases that are suitable for potential treatment with novel antibiotics makes it hard to recruit enough patients for clinical trials.
Take carbapenem-resistant Enterobacteriaceae (or CRE for short), which Achaogen went after.
These bacteria kill half of those whose bloodstream they infect. But CREs cause only a tiny fraction of bacterial infections in American hospitals.
Firms get around this by having their new antibiotics approved for more common ailments treatable with existing drugs, such as urinary-tract infections.
At the same time, they publish results from small observational trials of the new drugs showing good recovery rates for hospital patients with CRE infections
—counting on doctors to prescribe the medicines off-label for CRE.
In the case of Achaogen, a small study showed that plazomicin was indeed safer and more effective for CRE than colistin,
a highly toxic antibiotic of last resort from the 1950s. Yet plazomicin did not make a dent in colistin use.
A CRE antibiotic by Melinta that has been on the market for over a year is not selling well, either.
That could be because few doctors know about the new treatments.
The firms which sell them lack the marketing dollars that big pharma firms shower on new drugs,
says Alan Carr, an analyst at Needham, an asset manager in New York.
It takes time for new antibiotics to make it into clinical guidelines,
such as those of the Infectious Diseases Society of America, which are updated infrequently.
American hospitals, meanwhile, avoid new antibiotics because they end up footing the bill, which can run to several thousand dollars per patient.