SHIONOGI

Shionogi & Co., Ltd. and its European subsidiary, Shionogi B.V. (hereafter "Shionogi"), today announces that its innovative antibiotic, cefiderocol, is now available in Denmark for the treatment of infections due to aerobic Gram-negative bacteria in adults (18 years or older) with limited treatment options.¹

Pharmacies in Denmark are expected to place orders for cefiderocol via the online ordering portal, Serviceløsningerne (further details below).

Since its European Commission approval in 2020, over 23,000 patients in total have now been treated with cefiderocol throughout Europe. Data from multinational surveillance studies for cefiderocol have demonstrated potent in vitro activity against a broad spectrum of aerobic Gram-negative pathogens including all three WHO critical priority pathogens: carbapenem-resistant Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacterales,^2,3 as well as Stenotrophomonas maltophilia.⁶ Cefiderocol has also demonstrated in vitro activity against certain bacteria that contain very problematic resistant enzymes such as ESBLs, AmpC, serine- and metallo-carbapenemases.^7,8

Data from three clinical studies: APEKS-cUTI, APEKS-NP, and CREDIBLE-CR support the indication of cefiderocol in adult patients with limited treatment options for the treatment of infections due to aerobic Gram-negative organisms.¹ One of the studies included patients with Gram-negative infections caused by multidrug-resistant pathogens including carbapenem-resistant bacteria from the WHO priority list.²

“This launch in Denmark is an important step in rapidly expanding access to cefiderocol across Europe, where we are seeing an increasing trend in the number of antibiotic-resistant infections. Our goal is to ensure availability to clinicians of our new treatment option for all adult patients experiencing aerobic Gram-negative organisms who have limited treatment options.” said Huw Tippett, CEO, Shionogi Europe.

AMR is a major health burden which urgently needs to be addressed. Between 2016 and 2020, a significant increasing trend in the estimated number of antibiotic-resistant infections was observed in Denmark, with 4,000 cases in 2020 alone.⁵ Infections caused by carbapenem-resistant Gram-negative bacteria are often associated with a high mortality rate,⁹ resulting in ~35,000 deaths per year in the EU.¹⁰ If no action is taken, antibiotic resistance is predicted to kill 10 million people every year globally by 2050, at a cumulative cost to loss of global economic output of as much as 100 trillion USD.¹¹

Denmark manages AMR from a One Health perspective, taking a more holistic view of human and animal health, in addition to consideration for the environment.¹² In 1995, Denmark was the first country to establish a systematic monitoring program of antimicrobial drug consumption and AMR in animals, food, and humans, the Danish Integrated Antimicrobial Resistance Monitoring and Research Program (DANMAP).¹³ Significant efforts have gone into reducing antibiotic consumption in animal production in particular through schemes such as, the Yellow Card Initiative on Antibiotics, which uses surveillance and warning cards to reverse the trend of the increasing antibiotic consumption in pig production.¹⁴ The Danish Veterinary and Food Administration launched a new Action Plan in 2021 against Antimicrobial Resistance in Animals and Food, aiming to implement the One Health strategy within the veterinary and food production sectors to reduce veterinary antimicrobial consumption.¹⁵

Pharmacies can use the online ordering portal (Serviceløsningerne) to place orders, as most pharmacies will have access to this platform. However, orders can also be accepted by phone or email; customer service is available in four local departments.

Copenhagen
Email: kundeservice.kobenhavn@nomeco.dk
Phone: +45 7022 4494

Odense
Email: odense@nomeco.dk
Phone: +45 6615 5599

Aarhus
Email : aarhus@nomeco.dk
Phone: +45 8745 1500

Aalborg
Email : aalborg@nomeco.dk
Phone : +45 9632 1632

Resistant Gram-negative infections
The increasing resistance of many infections caused by Gram-negative bacteria to existing therapies, including carbapenem-resistant Enterobacterales and non-fermenting species such as P. aeruginosa, A. baumannii, and S. maltophilia, makes them difficult to treat and results in high mortality rates.^16,17 The World Health Organization have identified carbapenem-resistant strains of Enterobacterales, P. aeruginosa and A. baumannii as the top priority in the research and development of new antibiotics.² Cefiderocol is the first antibiotic to address all three major mechanisms of carbapenem-resistance and is an important treatment option to address this urgent unmet need.¹⁸

Cefiderocol
Cefiderocol is the first siderophore cephalosporin antibiotic with a unique mechanism of entry through the outer membrane of Gram-negative pathogens by using the bacteria’s own iron uptake system to gain cell entry, acting like a Trojan horse.4 In addition to entering cells by passive diffusion through porin channels,¹⁹ cefiderocol binds to ferric iron and is actively transported into bacterial cells through the outer membrane via the bacterial iron transporters, which function to incorporate this essential nutrient for bacteria.²⁰ These mechanisms allow cefiderocol to achieve higher concentrations in the periplasmic space where it can bind to penicillin-binding proteins and inhibit cell wall synthesis in the bacterial cells.4

Carbapenem resistance (CR) in Gram-negative bacteria is due to three main mechanisms:

• Beta-lactamases which cause enzymatic breakdown of beta-lactams
• Changes in porin channels (through mutations and decrease in number) through which beta-lactams and other antibiotics diffuse into cells,
• Overexpression of efflux pumps which occurs post-exposure and pumps antibiotics out of cells²¹

As a result of its unique structure and mechanism of cell uptake, cefiderocol can overcome these three major mechanisms of CR.

Shionogi’s commitment to fighting antimicrobial resistance
Shionogi has a strong heritage in the field of anti-infectives and has been developing antimicrobial therapies for more than 60 years. Shionogi is proud to be one of the few large pharmaceutical companies that continues to focus on research and development in anti-infectives. The company invests the highest proportion of its pharmaceutical revenues in relevant anti-infectives R&D compared to other large pharmaceutical companies.²²

About Shionogi
Shionogi & Co., Ltd. is a 142-year-old global, research driven pharmaceutical company headquartered in Osaka, Japan, that is dedicated to bringing benefits to patients based on its corporate philosophy of “supplying the best possible medicine to protect the health and wellbeing of the patients we serve.” The company currently markets products in several therapeutic areas including anti-infectives, pain, CNS disorders, cardiovascular diseases and gastroenterology. Shionogi’s research and development currently target two therapeutic areas: infectious diseases, and pain/CNS disorders.

For more information on Shionogi & Co., Ltd., please visit http://www.shionogi.co.jp/en/.

Shionogi B.V. is the European headquarters of Shionogi & Co., Ltd. For more information on Shionogi B.V., please visit www.shionogi.eu.

Forward Looking Statement
This announcement contains forward-looking statements. These statements are based on expectations in light of the information currently available, assumptions that are subject to risks and uncertainties which could cause actual results to differ materially from these statements. Risks and uncertainties include general domestic and international economic conditions such as general industry and market conditions, and changes of interest rate and currency exchange rate. These risks and uncertainties particularly apply with respect to product-related forward-looking statements. Product risks and uncertainties include, but are not limited to, completion and discontinuation of clinical trials; obtaining regulatory approvals; claims and concerns about product safety and efficacy; technological advances; adverse outcome of important litigation; domestic and foreign healthcare reforms and changes of laws and regulations. Also for existing products, there are manufacturing and marketing risks, which include, but are not limited to, inability to build production capacity to meet demand, lack of availability of raw materials and entry of competitive products. The company disclaims any intention or obligation to update or revise any forward-looking statements whether as a result of new information, future events or otherwise.

FETCROJA SMPC: https://www.ema.europa.eu/en/documents/product-information/fetcroja-epar-product-information_en.pdf

Job bag number: NP-DK-FDC-0002
Preparation date: February 2023

© 2023 Shionogi Europe. London, WC2B 6UF. All Rights Reserved.

References

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² World Health Organization. WHO publishes list of bacteria for which new antibiotics are urgently needed. February 27, 2017. Retrieved from https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed. Last accessed January 2023
³ World Health Organization. 2019 Antibacterial Agents in Clinical Development. 2019. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/330420/9789240000193-eng.pdf Last accessed January 2023
⁴ Tillotson GS. Trojan Horse Antibiotics—A Novel Way to Circumvent Gram-Negative Bacterial Resistance? Infectious Diseases: Research and Treatment. 2016;9:45-52 doi:10.4137/IDRT.S3156
⁵ European Centre for Disease Prevention and Control (ECDC). Assessing the health burden of infections with antibiotic-resistant bacteria in the EU/EEA, 2016–2020. Annex 2: Individual country results. 2022. Retrieved from https://www.ecdc.europa.eu/sites/default/files/documents/Annex_2_burden_estimates_country_sheets.pdf. Accessed January 2023
⁶ M Hackel, M Tsuji, Y Yamano, et al. In Vitro Activity of the Siderophore Cephalosporin, Cefiderocol, Against a Recent Collection of Clinically Relevant Gram-Negative Bacilli from North America and Europe, Including Carbapenem Non-Susceptible Isolates: The SIDERO-WT-2014 Study. Antimicrob Agents Chemother. 2017 Sep; 61(9): e00093-17.
⁷ K Kazmierczak et al. In vitro activity of cefiderocol, a siderophore cephalosporin, against a recent collection of clinically relevant carbapenem-non-susceptible Gram-negative bacilli, including serine carbapenemase- and metallo-β-lactamase-producing isolates (SIDERO-WT-2014 Study). Int J Antimicrob Agents. 2019 Feb;53(2):177-184
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⁹ Perez F, et al. ‘Carbapenem-Resistant Enterobacteriaceae: A Menace to our Most Vulnerable Patients’. Cleve Clin J Med. Apr 2013; 80(4): 225–33
¹⁰ European Centre for Disease Prevention and Control (ECDC). 35 000 annual deaths from antimicrobial resistance in the EU/EEA. Available at: https://www.ecdc.europa.eu/en/news-events/eaad-2022-launch#:~:text=More%20than%2035%20000%20people,a%20new%20report%20released%20today. Accessed January 2023
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¹⁴ Ministry of Food, Agriculture and Fisheries of Denmark. Special provisions for the reduction of the consumption of antibiotics in pig holdings (the yellow card initiative). 2017. Retrieved from https://www.foedevarestyrelsen.dk/english/SiteCollectionDocuments/Dyrevelfaerd%20og%20veterinaermedicin/Veterin%C3%A6rmedicin/Yellow%20Card,%20English%20version,%20180517.pdf. Accessed January 2023
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