US FDA approves Innoviva's oral antibiotic for gonorrhea

 The FDA has approved Nuzolvence (zoliflodacin; Innoviva Specialty Therapeutics), a new, single-dose oral treatment indicated for uncomplicated urogenital gonorrhea in adults and children 12 years and older who weigh at least 77 pounds. The product is administered as a single oral dose and represents 1 of 2 newly approved treatment options for uncomplicated urogenital gonorrhea in nearly 2 decades, per the approval announcement.1

“These approvals mark a significant milestone for treatment options for patients with uncomplicated urogenital gonorrhea,” said Adam Sherwat, M.D., director of the Office of Infectious Diseases in the FDA’s Center for Drug Evaluation and Research (CDER).2

According to Innoviva Specialty Therapeutics, the approval reflects a collaboration with the Global Antibiotic Research and Development Partnership, which sponsored and led the pivotal clinical trial that formed the basis for regulatory review.

Pavel Raifeld, CEO of Innoviva, stated, “The FDA’s approval of Nuzolvence marks a pivotal moment for patients and the broader healthcare community managing gonorrhea infections. For the first time in decades, both patients and their health care providers will have a single-dose, oral treatment option for uncomplicated urogenital gonorrhea.”

Rising rates and limited treatment alternatives

Uncomplicated urogenital gonorrhea is among the most common sexually transmitted bacterial infections worldwide, with more than 82 million cases estimated annually. In the United States, more than 500,000 cases are reported each year, and the highest rates are observed in sexually active young adults.3

Without timely treatment, gonorrhea may lead to reproductive or systemic complications. The approval announcement emphasized that “Gonorrhea is the second most common sexually transmitted bacterial infection worldwide,” and noted persistent transmission among sexually active populations.

Antimicrobial resistance and evolving therapeutic need

The emergence of antimicrobial resistance has contributed to the diminishing effectiveness of established therapeutic options. The announcement stated that the World Health Organization has identified antimicrobial resistance as one of the most critical global health threats, driven partly by widespread resistance among Neisseria gonorrhoeae strains.

Edward Hook, MD, of the University of Alabama at Birmingham, reported, “The decades-long absence of new gonorrhea treatments, combined with rising global antibiotic resistance, has created significant challenges in managing this common but potentially serious sexually transmitted infection.”

Some patients require alternative approaches because of medication allergies or limited access to injectable therapy. Hook added, “A new antibiotic that does not require injection and can be used for patients who are allergic to penicillin or related drugs meets 2 important unmet needs in the treatment of gonorrhea.”

Clinical trial evidence informing approval

The FDA approval was supported by multinational clinical data evaluating the safety and efficacy of a single oral dose of zoliflodacin compared with the current standard injectable combination therapy. The approval press release stated, “In the pivotal phase 3 study, Nuzolvence demonstrated non-inferiority compared to the current standard injectable therapy, including in infections caused by drug-resistant strains, while offering the convenience of a single oral dose.”4

Previous results published in The Lancet also demonstrated non-inferiority of oral zoliflodacin relative to ceftriaxone with azithromycin among adolescent and adult participants with uncomplicated urogenital infection, with similar microbiologic outcomes at extragenital sites. Those findings were part of the largest clinical trial conducted to date for a new treatment targeting Neisseria gonorrhoeae infection.4

Mechanism of action and indication

Nuzolvence is a bacterial type II topoisomerase inhibitor with a mechanism distinct from currently approved antibiotics. The product was approved for adults and pediatric patients 12 years and older who weigh at least 35 kg for the treatment of uncomplicated urogenital gonorrhea due to Neisseria gonorrhoeae, including strains resistant to first-line therapies.

According to the announcement, Nuzolvence “demonstrated activity against drug-resistant Neisseria gonorrhoeae” and offers a single-dose oral approach at a time when injectable therapy remains the only recommended first-line option in the United States.

Implications for clinical practice

Approval of a single-dose oral therapy may expand access to treatment and provide an alternative for individuals unable to receive injectable agents. For clinicians, the availability of an oral medication may facilitate timely management in settings where in-office administration of intramuscular therapy is not feasible.

Hook noted, “In the pivotal phase 3 study, Nuzolvence demonstrated non-inferiority compared to the current standard injectable therapy,” while emphasizing the broader clinical need associated with emerging resistance and limited therapeutic innovation.

Continued implementation and post-approval experience will determine how Nuzolvence is incorporated into treatment strategies for uncomplicated urogenital gonorrhea and its role in addressing antimicrobial resistance trends.

https://www.contemporaryobgyn.net/view/fda-approves-zoliflodacin-nuzolvence-for-uncomplicated-gonorrhea