Between 1990 and 2012, the proportion of new cardiovascular drugs entering into clinical trials declined across all stages of clinical drug development, shows a recent pipeline analysis (JACC Basic Transl Sci. 1, 301–308; 2016).

The analysis, by academic researchers from Harvard University, looked at the size of the cardiovascular pipeline compared with the overall pipeline. In the early 1990s, cardiovascular drugs accounted for 16% of phase I candidates and 21% of phase III candidates. In the years running up to 2012, they accounted for 5% of phase I candidates and 7% of phase III candidates.

When the authors drilled down into the novelty of the pipeline, they found a rise in the proportion of phase III cardiovascular drugs with new mechanisms of action. Novel drugs accounted for 27% of the phase III cardiovascular candidates in 1990, and 57% of the candidates in 2012. “The observed contraction in cardiovascular research output may be driven by fewer follow-on drugs,” the authors note.

An analysis of progression rates showed that cardiovascular drugs are just as likely to successfully complete clinical trials as other drugs, even in phase III.

“Given the increasing burden of cardiovascular disease globally, the declining pipeline of new therapies is concerning. Policymakers should focus their efforts on supporting research aimed at improving gaps in the understanding of the pathophysiological bases for cardiovascular disorders, as well as facilitating translational efforts to develop new cardiovascular therapeutics,” the authors conclude.

The decline in cardiovascular drug development over the past two decades mirrors the decline in central nervous system drug development (Nat. Rev. Drug Discov. 14, 815–816; 2015).