Metronidazole

Some four months after the White House inked the last of its expected drug pricing deals with 17 of the industry’s top players, the U.S. government is back for round 2, this time lining up agreements with a host of medium-sized biopharmas under President Trump’s ‘most favored nation’ agenda. Up at the dealmaking table for this round are Alcon, Astellas Pharma, BeOne Medicines, BridgeBio, CSL, Kyowa Kirin, Sun Pharma, Teva Pharmaceuticals and UCB, according to a White House fact sheet issued Monday afternoon. Notably, the new list includes companies from further afield than Europe and the U.S.—which dominated the first 17 MFN accords struck from last year through late April of 2026—with Sun based in India, Teva hailing from Israel, and Astellas and Kyowa Kirin headquartered in Japan, not to mention CSL in Australia. Under the terms laid out in the fact sheet, the agreements are set to curb Medicaid prices on drugs for conditions like hemophilia, Parkinson’s disease, macular degeneration, glaucoma, liver disease, skin conditions and multiple types of cancer. Details are mostly thin on which of the companies’ specific drugs are included in the pricing agreements and the precise discounts in the offering. The President’s MFN drug pricing campaign has broadly sought to realign prescription costs in the U.S. based on what certain high-income comparator countries pay. Specifically, the administration has worked toward MFN prices by utilizing net prices paid in Canada, Denmark, France, Germany, Italy, Japan, Switzerland and the U.K. While the administration has made big claims about the scope of savings its pricing measures could deliver, the fine details of the previous government-industry deals remain murky, with their true impact on medicine affordability for U.S. patients a continuing topic of debate. As with previous MFN deals, the midsized drugmakers lining up to sign have made financial commitments to their U.S. operations, too, boasting a collective investment pledge of at least $19.6 billion in American production in the near term, according to the fact sheet. Several of the firms have also agreed to donate active pharmaceutical ingredients (APIs) for certain products to the U.S. Strategy Active Pharmaceutical Ingredients Reserve (SAPIR), which the White House says will help curb reliance on foreign suppliers and bolster supplies in the event of a potential emergency. While many companies have agreed to onshore or expand certain portions of their manufacturing processes to the U.S. in recent years, the fundamental step of producing drug ingredients remains largely concentrated overseas in countries like China and India. Belgium’s UCB has agreed to contribute 163 tons of API for the seizure drug levetiracetam, while Sun will throw in 71.4 tons and 6.75 tons of the antibiotics clindamycin and doxycycline, respectively. For its part, Teva is pitching in 45 tons of the antibiotic metronidazole and 4.8 tons of the hypertensive drug amlodipine, while Astellas is adding 25 kg of the immunosuppressant tacrolimus to the SAPIR. While the White House release did not allude to tariffs on Monday, the cudgel of trade duties has been ever present in the deals struck so far. In the first round of agreements, of which Regeneron was the last to sign on in April, Big Pharma companies from Pfizer and AstraZeneca to Roche, Novartis and Johnson & Johnson made a combination of drug pricing commitments and domestic investment pledges to win temporary immunity from the Trump administration’s drug import tariffs . Midsized companies were not involved in the first round of dealmaking. Individual company press releases Monday, like UCB’s, suggest that tariff immunity is still very much part of the MFN equation. Oncology specialist BeOne also said it locked down an exemption from Section 232 pharmaceutical tariffs because of its investments in U.S. manufacturing. The company leaned on its participation in GENEROUS, an industry-government negotiation framework laid out early this year under which manufacturers provide rebates to participating states for certain drugs. Although the company sells multiple products in the U.S., currently only PD-1 inhibitor Tevimbra is subject to the Medicaid program. Meanwhile, BridgeBio will also expand state Medicaid access to Attruby under the GENEROUS model . The drug for transthyretin amyloid cardiomyopathy is the California company’s only commercial brand. Thanks to the new agreement, the company said Monday that it “does not expect to be subject to future pricing mandates.” Reporting $502.1 million in full-year revenues in 2025, BridgeBio is notably smaller than many of the other “mid-sized” pharmas who have lined up for this second round of deals. CSL, for its part, tied the agreement with the government to a recently disclosed plan for a $1.5 billion manufacturing plant expansion near Chicago. The company specified that under the deal, it will provide Medicaid access to its drugs at prices on par with other developed countries, alongside a pledge to similarly price any new therapies for all payers in the U.S. “These agreements provide a sustainable and stable access framework to important medicines for people living with rare diseases and serious conditions while strengthening the manufacturing capabilities, supply infrastructure and scientific innovation required to deliver those therapies reliably,” Diego Sacristan, CSL’s commercial chief, said in a statement. Recognizing the lack of similarly positioned firms at the table, 10 U.S. biotechs forged the Midsized Biotech Alliance of America (MBAA) back in February, taking aim at Trump’s MFN policy writ large. The group, whose original lineup included Alkermes, Alnylam, Ardelyx, BioMarin, Exelixis, Incyte and Neurocrine Biosciences, argued at the time that midsized companies are less well-positioned to weather MFN than resource-stocked Big Pharma, given that they’re often reliant on a single marketed product targeting more niche patient needs.

Omega-3 and low-dose aspirin matched the effectiveness of antibiotics in a year-long study of patients with severe gum disease, with both approaches helping about 58% reach the treatment goal. The unexpected result could point to a new way to treat some patients while reducing reliance on antibiotics and the growing problem of antibiotic resistance.A combination of omega-3 and low-dose acetylsalicylic acid (ASA) performed about as well as antibiotics in a yearlong study of people with severe periodontitis, raising the possibility of an alternative treatment for some patients. The research was conducted by scientists affiliated with Albert Einstein Israelite Hospital, Guarulhos University (UNG), the University of Taubaté (UNITAU), and the Ribeirão Preto School of Dentistry at USP (FORP-USP) in Brazil, along with Harvard University in the United States. The findings were published in the Journal of Periodontology. Researchers say the results could eventually help reduce antibiotic use in selected patients, an important consideration as bacterial resistance becomes an increasingly serious global health problem. Severe Periodontitis Can Damage Bone and Teeth Supported by FAPESP (projects 20/05874-2 and 20/05875-9), the clinical study included 109 people with advanced periodontitis who were followed for one year. Periodontitis is a chronic inflammatory disease that develops when bacteria accumulate below the gumline and damage the tissues that hold teeth in place. In advanced cases, the disease can destroy supporting bone, loosen teeth, and eventually cause tooth loss. "Patients with severe disease have very deep pockets, which act as reservoirs for bacteria associated with the disease. It's a very challenging condition to treat," says dental surgeon Nídia Cristina Castro dos Santos, the first author of the study and a professor and researcher at Einstein. Researchers Compared Four Treatment Strategies The participants were randomly divided into four groups. Everyone received subgingival instrumentation, popularly known as scaling, which is a standard treatment for periodontitis. The procedure removes bacterial deposits and other material from below the gums. What differed among the groups was the additional treatment they received. Participants in the control group were given placebo versions of the antibiotics, omega-3, and ASA, packaged in capsules that looked like the active treatments. A second group received the antibiotics metronidazole and amoxicillin. This combination has some of the strongest scientific evidence supporting its use in severe periodontitis. Patients took the antibiotics three times per day for 14 days. A third group received three grams of omega-3 each day along with a daily dose of aspirin for six months. The fourth group received both approaches, taking antibiotics for two weeks while also following the omega-3 and ASA regimen for six months. Researchers assessed the participants again after three, six, and twelve months. Omega-3 and Aspirin Nearly Matched Antibiotics After one year, about 58% of patients treated with antibiotics had reached the clinical target established by the researchers. That goal was defined as having no more than four remaining deep periodontal pockets. The omega-3 and ASA group achieved a nearly identical result, with 57.7% of participants reaching the same target. The difference compared with standard treatment alone was substantial. Among patients who received scaling plus placebo, only 23.1% met the clinical goal. Surprisingly, using antibiotics together with omega-3 and ASA did not produce any additional benefit over either strategy alone. "The use of antibiotics isn't considered the gold standard of treatment. Although metronidazole and amoxicillin yield good results in the most severe cases, their use should be evaluated on a case-by-case basis due to risks related to bacterial resistance and possible adverse effects," says Castro dos Santos. Earlier Research Pointed to Omega-3's Potential The findings build on previous work examining omega-3 and inflammation in periodontal disease. In an earlier FAPESP-supported study published in Scientific Reports, researchers found that omega-3 supplementation reduced inflammation and bone loss associated with periodontal disease in rats. The effect was particularly noticeable when supplementation was combined with physical exercise. Because that research used an animal model, it could not establish whether the same effects would occur in people. However, it provided evidence that omega-3 might influence inflammatory processes involved in oral disease. Helping the Body Resolve Inflammation According to Castro, omega-3 works differently from conventional anti-inflammatory medications. Rather than simply blocking particular inflammatory pathways, omega-3 can contribute to the production of molecules that help the body naturally bring inflammation to an end and promote tissue repair. Low-dose ASA was included because it can enhance the production of these inflammation-resolving molecules. Researchers therefore suspected that combining omega-3 with ASA might help the body gain better control over the persistent inflammation associated with periodontitis. "We imagined that the combination of antibiotics and omega-3 would be most effective in controlling periodontitis in these patients. We also believed that the results for the group that used omega-3 with ASA would be slightly lower than those for the antibiotic group. The result was surprising because the two therapies performed very similarly, paving the way for it to become a treatment option for these patients," says Castro. Benefits Continued After Treatment Ended The researchers were also struck by how long the apparent benefits lasted. Participants who had taken omega-3 and ASA continued to show results similar to those seen at the end of treatment even six months after supplementation had stopped. According to Castro, the persistence of the effect raises the possibility that changing the way the body responds to inflammation could produce longer-lasting benefits. Researchers are still investigating exactly how this might happen. For dental surgeon Magda Feres, the lead author of the study and a full professor at the Harvard School of Dental Medicine and the Graduate Program in Dentistry at UNG, the results suggest that targeting the inflammatory response could provide another option for certain patients. "The combination of omega-3 and low-dose aspirin achieved clinical benefits comparable to those of the metronidazole and amoxicillin protocol, opening up a real alternative for those who can't take antibiotics, especially patients with allergies or intolerance to these medications," she says. A Possible Way to Reduce Antibiotic Use The potential to treat some cases without antibiotics is particularly relevant because antibiotic resistance is considered one of the major threats to global public health. When bacteria are repeatedly exposed to antibiotics, strains that can survive the drugs may spread, making infections more difficult to treat. Reducing unnecessary antibiotic use is therefore an important public health goal. "Demonstrating that it's possible to treat severe periodontitis by modulating the body's own response is new and relevant information that helps preserve antibiotics for when they are truly indispensable," says Feres. More Evidence Is Needed Despite the promising results, the researchers stress that omega-3 and aspirin should not yet be viewed as a routine replacement for antibiotics in severe periodontitis. The clinical trial included patients who did not have significant systemic or oral diseases. Additional studies will be needed to determine whether the findings hold true in broader and more diverse populations, and to establish which patients are most likely to benefit from each treatment strategy. Researchers are also conducting microbiological analyses to understand what happens to bacteria inside periodontal pockets during treatment. Preliminary findings suggest that the therapies may reduce bacterial species associated with periodontal disease while increasing microorganisms linked to healthier gums. "It's an important step forward, but not the end of the story. Therefore, the message is one of cautious optimism: we have a promising, scientifically plausible alternative to antibiotics in select cases. Routine replacement will require more evidence," she concludes.