INTRODUCTION
In the fast-moving
pharmaceutical industry, change is the only constant. To keep up with market
developments, small molecule manufacturers must first understand the trends.
The past 2 decades have been a period of major change in the pharmaceutical manufacturing
sector. The end of the traditional blockbuster model, the patent cliff, the burgeoning
biologics sector, and the shift to niche patient populations as the move begins
toward more targeted therapies, have all contributed to the drive for change among
drug makers, and in the contract manufacturing sector in particular.
Determining how to react
to these trends and create a business model that is flexible enough to adjust
to whatever the next few years may bring is one of the challenges faced by many
global contract manufacturing organizations (CMOs), and Cambrex was no
exception.
REGULATORY APPROVAL
As a first step, the
company undertook an extensive research program throughout 2016 to assess what
was happening in the small molecule market, particularly in terms of volume
demand, FDA approvals, and product lifecycles. Once it had established the dominant
trends, Cambrex could tailor its investment strategy to give it the necessary flexibility
in both capacity and capabilities.
The first thing the
research showed was that although biologics may be making the headlines, small
molecule drugs continue to form the backbone of the pharmaceutical industry.
Not only is innovation in the small molecule sector at an all-time high, the
level of US FDA approvals for new molecular entities (NMEs) in 2015 was at its
highest since 1999 (Figure 1). And of the 45 NMEs approved this past year, by
far the largest proportion (33 out of 45) were small molecules, while only 12
were biologics. Furthermore, there are more small molecules in every phase of
drug development than at any point in the past 15 years (Figure 2).
Analysis of the 2015 NME
approvals clearly showed an increasing focus on rare diseases: 21 of the novel
drugs approved (just under half of the total) were for rare or orphan diseases
that affect 200,000 or fewer Americans and for which there are limited or no
treatment options available. Whereas once small molecule development was looking
for the classic blockbuster, used to treat millions of patients with chronic
conditions, the versatility of the products allow the model to evolve toward
more targeted therapies. This is especially relevant for orphan indications, or
in the specific oncology sectors. The data generated by the Cambrex research
indicates how significant this change has been. In 1999-2000, the average
patient population targeted was 13 million, representing indications such as
obesity, diabetes, conjunctivitis, gastro-esophageal reflux disease (GERD), and
hyperlipidemia, but by 2014/15, this had fallen to just 6 million as the drugs
are being used for conditions such as multiple myeloma, cystic fibrosis, and
thyroid cancer.
VOLUME DEMAND
To track the evolution of
APIs by volume demand, Cambrex looked at the 408 small molecule drugs launched
in the US throughout the past 15 years. An interval period of 5 years was chosen
to give enough data points for a quantitative study. To avoid any annual
anomalies, the data from two consecutive years was combined, giving a final data
set of 209 small molecules (around half the total number of approvals), which the company believed
would be sufficient to identify any emerging trends.
The study was also limited to the US market
to exclude potentially misleading data arising from differences in disease prevalence/epidemiology
in more populous markets, such as India and China, that can result in large
uptake of some products. However, it can be assumed that volumes for the five
major European markets and Japan would be similar to those recorded in the US.
It is also important to note that the research looked at NCEs (New Chemical
Entities) only, and did not take into account reformulations, Abbreviated New
Drug Applications (ANDAs), or line extensions.
The trend in volume evolution showed a
clear decline in the numbers of NCEs with volume ranges above 10 metric tons (mt)
and below 10 kg, while those reaching their peak volumes in the ranges 10 kg to
1 mt and 1 to 10 mt are stable or increasing. Of the 27 NCEs launched in 2014/2015,
12 are forecast to reach volumes of 1 mt at their peak. The research shows that the spread of volumes is becoming narrower and that there is more clustering around the middle volume range now compared with 15 years ago (Figure 3).
One conclusion that can be
drawn from this is that the peak volume demand (at least within the US market)
seems to be in the range of 1 to a few tens of metric tons of API. The numbers
of drugs with a peak demand greater than 100 mt has dropped, as have those
below 10 kg.
However, it would be wrong
to assume that a small patient population means a small annual volume of the
API; sometimes it means exactly the opposite. Small molecule drugs that are in
the region of 1- to 10-mt volumes can be blockbusters in the sense they can
command in excess of $500 million in sales. This is especially true for drugs
used in oncology indications, where the pricing per pill is orders of magnitude
higher than drugs used in more chronic indications, such as hyperlipidemia and
diabetes. Similarly, not all orphan drugs are low volumes; some are taken in
high doses and consumed daily.
TRENDS IN PATIENT DOSE REQUIREMENTS
There were no findings
from the research that
showed significant changes in the potency
of the APIs nor in the size of the
dosage. The majority of drugs are still in the 1 to 100 g per patient per year range, although there was a slight increase in the number of lower dose NCEs below 1 g per patient per year,
according to the
study (Figure 4). The data does not show any
real trends in reduced dosages to
patients, and although often spoken about in
the industry, the trend to targeted medicines
does not show up in the data yet with
respect to the dose that patients are actually taking.
Similarly, there has also
been little change in tablet unit sizes: 10 to 50 mg continues to be the most
frequent dose size, although the 50- to 250-mg size range is gradually
increasing in popularity. This highlights one of the reasons for the continued
prevalence of small molecule drugs is their ability to be taken orally, which
is clearly the preferred method of administration from the patient's point of
view. Patient centricity and compliance are currently important areas of focus
in the pharmaceutical industry, and the flexibility and versatility of small
molecules can be key to both. Drug formulators have a long familiarity with
small molecules (since the 19th century), and technologies developed over the
many years have afforded a number of dosage types from which patients can
benefit, such as tablets, capsules, and inhalation through devices. Recent
developments in oral dosing allow for innovations, such as delayed, controlled,
and modified release to ensure that patients’ ease of consumption is maximized.
Drug developers are acutely aware that the lesser the burden on the patient to
take a dose, the greater the chance of ongoing compliance.
For biologic-based drug
development, although progress is being made with product development, there is
some way to go before products can have the same “ease of use.” Currently, the
route of administration is typically injection, and products need to be kept
refrigerated, which adds logistical considerations for both shipping and
storage. The cost of dose manufacture for biological medicine is still
disproportionately high with respect to small molecules, not just for the API
itself, but the costs of vials and prefilled syringes dwarf those of blister
packs and pill bottles used to package small molecule-based products.
OPPORTUNITIES FOR CMO GROWTH
Taking all these factors
into account, there are still plenty of growth opportunities in the small
molecule market, but key to contract manufacturers remaining competitive will
be the ability to be flexible enough to be able to produce APIs in a range from
kilograms to hundreds of metric tons to satisfy the wide variety of demand from
customers. The trend highlighted in the research toward concentration of
average volume requirements actually is a great opportunity for CMOs, as
service companies are used to handling multiple customer projects with varying
volume requirements and chemistries. Unlike captive manufacturing at big
pharma, CMOs have to be flexible and adapt to ever-changing demands of the
marketplace.
The trend for
pharmaceutical companies to close captive API facilities is poised to continue
due to historic reliance on blockbusters, which were 100-mt products and now lack
the correct scale of manufacturing capabilities. CMOs will continue to see more
outsourcing opportunities as they are better placed to manufacture the coming
pipeline of small molecule APIs. However, it will become more important for
CMOs to offer a range of manufacturing options to cover the life cycle of the
drug on the market – from introduction to maturity, as well as the option to
manufacture key late-stage intermediates and starting materials, should security
of supply or regulation be a prerequisite of customer demand.
The reformulation of
existing drugs is also a key growth area that deserves particular attention.
Supply of APIs into repurposed or reformulated drugs requires CMOs to act quickly
and responsively. This may be the rapid supply of small volumes of API for
product development and launch purposes or the technical and regulatory
expertise to support the customer during registration and commercial supply.
Throughout the past 5 years, Cambrex has invested $150 million in small molecule
capacity and infrastructure. By evaluating the market demands through this
research, it has expanded its large-scale API facility in Charles City, IA, and
is also planning to add 300-gallon and 500-gallon reactors to its small-scale
plant in 2017.
This investment closely
follows the trend seen in the industry and by establishing the right capacity and
capabilities demanded by the market, allows the company to handle a variety of
projects and chemistries while having the ability to be flexible in the supply
chain and counter any volume fluctuations.
Flexible assets with the
ability to manufacture multiple products at multiple scales in the same
facility is crucial to win customer projects from the increasing commercial and
clinical pipeline. Continually investing in manufacturing capacity is critical
to plan ahead for the next generation of small molecule drugs. Pilot-scale,
midscale, all the way to large-scale to cover APIs and advanced intermediates
will enable security of supply and cover the fluctuations in demand.
In the constantly changing
world, a CMO must be flexible to match these changes. Far from the rise of
biologics and monoclonal antibody therapies signing the death knell to small
molecule medicines, the market is flourishing. In oncology, pioneering drug
classes, such as protein kinase inhibitors, have revitalized the existence and
importance to modern medicine, and the challenge is to predict the changes and have
the ability to respond.
To view
this issue and all back issues online, please visit www.drug-dev.com.
Dr.
Matthew Moorcroft is the Vice President of Global Marketing and Communications for
Cambrex. Prior to joining Cambrex, he worked for Lonza and held a number of
roles, including Head of Global Marketing, VP Generics and Biosimilars, and
Head of Strategy, Pharmaceuticals and Biologics. After gaining experience in
the custom development and manufacturing business, he developed models for
biosimilars and generic drug products. He has 15 years of commercial and scientific
experience in the pharmaceutical, biotechnology, and chemical industry covering
both innovative and generic medicines. Dr. Moorcroft earned his PhD in
Chemistry from the University of Oxford.