Overview of the Past and Future Development of Novel Antibiotics in France: Is It Sufficient to Tackle Antimicrobial Resistance?

OBJECTIVES: Antimicrobial Resistance (AMR) is a global public health challenge leading to significant clinical, environmental, and economic burdens. This 'silent pandemic' causes 100 deaths per day in Europe.

Providing an overview of the current and future antibiotics market in France highlighting AMR’s key issues.

METHODS: Descriptive analyses of antibiotics development and access in France from 2013 to 2023 (literature review, Prismaccess®), overview of future antibiotics up to 2030 (PipelineLink®).

RESULTS: From 2013 to 2022, the French health technology assessment body provided 11 opinions for 11 new antibiotics: 5 were granted an insufficient added clinical value (ASMR), 2 a minor ASMR and 4 a moderate ASMR. Among them, 5 targeted WHO critic priority pathogens.

From 2013 to 2023, on retail market 26/50 of the first-in-class antibiotics experienced at least one price reduction, 4/50 experienced a price increase. Median price/box at initial registration was €7 excluding tax with an 8-year delay before the first price reduction.

From 2000 to 2020, 37 antibiotic substances were discontinued affecting all antibiotic classes.

In 2020, the anti-infectives class is the most affected by shortage, accounting for 21% of supply tensions.

From 2011 to 2021, antibiotic consumption decreased in volume by 21% in outpatient settings, 9.1% in hospitals.

By 2030, 22 antibacterial molecules currently in development may obtain a marketing authorization: 14 antibiotics, 7 biologic molecules and 1 non-biologic molecule. Among these antibiotics, 7 target WHO critical priority bacteria.

CONCLUSIONS: The decreasing number of marketed antibiotics in a context of sustained AMR emphasizes the need for innovation and secured access. However, the lack of market attractiveness hinders this evolution. A coordinated European strategy to promote investment and encourage research and development appears essential. In addition, French authorities should consider new mechanisms for the valuation and funding of antibiotics, like those implemented by neighboring European countries.