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The efficacy–effectiveness gap describes the difference in drug performance under clinical trial conditions versus real-life conditions. Here, the authors argue that this phenomenon is due to variability in drug responses. They discuss the underlying biological and behavioural reasons for this phenomenon and propose strategies to 'bridge the gap'.
To investigate whether some strategies have been more successful than others in the discovery of new drugs, this article analyses the discovery strategies and the molecular mechanism of action for 259 new drugs that were approved by the US Food and Drug Administration between 1999 and 2008. Observations from this analysis — such as the fact that the contribution of phenotypic screening to the discovery of first-in-class small-molecule drugs exceeded that of target-based approaches in an era in which the major focus was on target-based approaches — could have important implications for efforts to increase the productivity of drug research and development.
The exploitation of natural particulates, such as pathogens and mammalian cells, for drug delivery applications is a rapidly emerging field. Here, Yoo and colleagues discuss recent advances in the design of drug carriers based on natural particulates, provide an overview of their current development status and highlight the various applications and limitations of each approach.
This Review highlights new therapeutic targets (for example, ventricular remodelling) and future perspectives of new drugs that are currently under development for the treatment of heart failure, and the possible explanations for the discrepancy between data from Phase II and Phase III trials.
