The LONGEVITY project will implement product development for long-acting formulations intended for malaria and tuberculosis prevention, and a hepatitis C virus cure for low- and middle-income countries. We will reformulate pre-existing oral medicines injectable medications that require administration far less frequently, and thereby reducing the huge burden that unsustainable oral regimens have on patients.
LONGEVITY can be transformational to the treatment of malaria, tuberculosis and hepatitis C virus therapies in various ways. We will enhance global knowledge in long-acting injectable product development, regulation of the technology and how it should be implemented by healthcare providers.
Find out more about our objectives here;
Malaria is a huge burden in the poorest nations, disproportionately affecting children under five and those residing in rural areas. Approximately 92% of malaria cases and 93% of malaria deaths are within low- and middle-income countries. In 2017 children under five accounted for 61% of malaria deaths worldwide. These numbers can be reduced by tackling the issue of non-adherence and adding to control strategies. A long-acting injectable prophylactic will address the lack of adherence to current oral anti-malarial regimens while adding a key tool to support World Health Organisation control strategies. A long-acting injectable chemoprophylactic will allow transmission control and supplement future strategies to eliminate the disease.
Long oral regimens and poor patient acceptability contribute to ineffective and underutilised prevention therapies. Effective short courses do exist but are costly and require daily or weekly intake resulting in less than 50% completion rate despite the potential for cure. There is also a significant issue with stigma in low- and middle-income communities resulting in a barrier in patients seeking treatment. Long-acting injectable drug delivery will contribute massively to patient acceptability leading to much higher completion rates of therapy by reducing the complexity of treatment. An administration of between one and two injections will replace the current regimen of anywhere between one and thirty-six months and sometimes hundreds of doses of oral medication.
Hepatitis C virus cure
Approximately 75% of people living with hepatitis C reside in low- and middle-income communities with the majority of these communities having limited access to life-saving medication. It is estimated that oral drugs at the point of diagnosis provide a 98% cure rate. If this oral delivery mode was replaced with a long-acting injectable therapy we can provide much better accessibility and simplicity to a curative treatment to those at most risk of hepatitis C, contributing massively to the target set by The World Health Organisation for global elimination of this virus by 2030.
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The value of long-acting drug delivery
Approximately 90% of malaria infections and deaths, 95% of tuberculosis infections and deaths, and 75% of people living with hepatitis C live in low- and middle-income countries with a combined burden estimated at 300 million people with more than two million deaths per year in these regions.
One of the critical issues with treating and preventing these diseases is adherence to daily medication with stigma, pill burden and complex delivery modes all contributing to individual and global mortality and emerging drug resistance. By replacing chronic oral dosing with an injectable alternative that requires administration far less frequently, we can improve adherence and completion rates of therapy.
Long-acting injectable medicines have already shown great promise for HIV therapy and prevention and have demonstrated impact in several other applications such as contraception and schizophrenia. This sets a precedent for the wide-ranging and currently untapped impact achievable across malaria prophylaxis, tuberculosis prevention and hepatitis C virus cure.
Several technologies exist for long-acting drug delivery, each presenting different development, financial, clinical and logistical challenges and opportunities. Examples include injectables, implants and microarray patches currently at different stages of development. Implants are highly successful for potent drugs, but for most infectious disease therapies, the required concentrations are too high. Microneedle patches have shown early promise but may benefit from delivery of the formulations that ultimately control drug release.
The University of Liverpool received funding from Unitaid to implement the LONGEVITY project
The LONGEVITY project also involves critical partners and collaborators in Johns Hopkins University, the University of Nebraska Medical Center, the Clinton Health Access Initiative, Treatment Action Group, Medicines Patent Pool and Tandem Nano Ltd.
Solid Drug Nanoparticle technology
The project uses Solid Drug Nanoparticle (SDN) technology to facilitate effective exposure to a long-acting drug formulation for a period between one and four months. This new innovation offers potential for rapid development at low cost and with optimal product performance. Our approach will quickly develop cost effective options to deliver high doses of active pharmaceutical ingredients.
SDN technology was the basis for the University of Liverpool spin-out, Tandem Nano Ltd.
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Our project aims to develop revolutionary long acting medicines for infectious diseases that have a major burden across low and middle-income countries. Although drugs exist for malaria and TB prevention and HCV therapy, they rely on individuals taking medication daily. Chronic oral dosing is extremely difficult to maintain over long periods leading to non-adherence that can negatively impact efficacy and exacerbate emergence of antimicrobial resistance.Andrew Owen, Co-coordinator of the LONGEVITY project
A Liverpool led research initiative has been awarded more than £2.2 million ($2.8 million) in funding from Unitaid for AGILE, a project to rapidly identify drugs to help treat and prevent COVID-19. The funding is part of the special investment approved by Unitaid’s Executive Board to bolster the COVID-19 response.