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INNOSC Theranostics and
Pharmacological Sciences Drug repositioning for NTDs treatment

for NTDs. Each of these drugs has the potential to evolve challenging, necessitating robust ethical frameworks to
into new therapies aimed at eradicating these diseases. address these concerns.
These efforts align with the World Health Organization’s To mitigate all these risks, several strategies can be
(WHO) 2021 – 2030 roadmaps for the elimination of employed. Expanding the drug repositioning pipeline by
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NTDs, emphasizing the global commitment to eradicate including compounds from diverse therapeutic areas can
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these illnesses. enhance the discovery of potential candidates. Encouraging
Therefore, it is imperative to make a concerted effort open-access databases and fostering collaborations
to integrate drug repositioning into NTD research and to between academia, industry, and non-profit organizations
advance the stages of development and clinical trials of are essential steps in this direction (vide infra).
repositioned drugs, specifically targeting these parasitic Addressing intellectual property challenges requires the
diseases. Achieving this goal requires increased funding, active involvement of governments and international
robust international collaboration, and effective public– organizations to facilitate agreements that overcome patent
private partnerships to facilitate the identification and barriers. Creating patent pools and offering incentives for
development of repurposed drugs. 27 companies to share intellectual property can help mitigate
legal and financial obstacles. In addition, extending market
3. Limitations of drug repositioning and exclusivity for repositioned drugs can provide financial
mitigation strategies incentives for pharmaceutical companies.

Despite its significant potential, drug repositioning Streamlining regulatory pathways specifically for
faces several limitations that hinder its application. 12,23 A drug repositioning can accelerate the approval process.
significant challenge is the limited pool of drugs available Regulatory agencies can establish dedicated frameworks
for repurposing. Most existing drugs were developed for recognizing the lower risk profile of repurposed drugs
diseases prevalent in high-income countries, which may due to existing safety data, implementing conditional
not directly translate to effective treatments for NTDs. approvals and adaptive licensing to expedite access to these
This limitation reduces the likelihood of finding suitable therapies. Innovative funding models, such as public–
candidates for repositioning. In addition, intellectual private partnerships and advanced market commitments,
property and financial considerations pose substantial can attract investment in drug repositioning for NTDs.
hurdles. Patents on existing drugs may restrict their use Leveraging financial instruments such as social impact
for new indications, creating legal and financial barriers. bonds and global health funds can provide the necessary
Moreover, the financial incentives for pharmaceutical resources to support clinical trials and development efforts.
companies to invest in NTDs are limited due to the low Combining repositioned drugs with existing therapies
market potential in affected regions. can enhance their efficacy and mitigate the risk of

Regulatory challenges further complicate the drug resistance. Research should focus on identifying synergistic
repositioning process. Each repurposed drug must drug combinations and exploring novel delivery methods
undergo rigorous clinical trials to ensure efficacy and to improve treatment outcomes. Continuous monitoring
safety for the new indication, making the regulatory of resistance patterns and adaptive treatment protocols are
pathway as complex and lengthy as that for new drug essential to ensure long-term effectiveness. Establishing
development. This process can be time-consuming robust ethical frameworks for conducting clinical trials in
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and costly. Repositioned drugs often target well-known vulnerable populations is critical. Ensuring transparency,
molecular mechanisms, making the patients susceptible informed consent, and community engagement can build
to drug resistance, particularly when the molecular targets trust and promote equitable access to the benefits of drug
are conserved across species (e.g., humans and parasites); repositioning. Collaborating with local health authorities
this challenge is not exclusive to repositioned therapies. and stakeholders can help align trial designs with the needs
Newly developed drugs face similar risks of resistance. and priorities of affected communities.
To mitigate these risks, both repositioned and new drugs By proactively addressing these limitations through
require careful monitoring and, where appropriate, the targeted mitigation strategies, we can fully realize the
use of adaptive treatment strategies, such as combination potential of drug repositioning. This approach offers a
therapies (vide infra). Ethical considerations also play a pragmatic and efficient pathway to develop new therapies
crucial role, particularly when conducting clinical trials for NTDs, accelerating the availability of effective treatments
in vulnerable populations. Ensuring informed consent and aligning with global health goals to improve outcomes
and equitable access to the benefits of such trials can be for millions affected by these debilitating diseases.

Volume 7 Issue 4 (2024) 3 doi: 10.36922/itps.3721