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Last Updated: April 2, 2026

CLINICAL TRIALS PROFILE FOR ATOVAQUONE


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505(b)(2) Clinical Trials for ATOVAQUONE

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Formulation NCT00000773 ↗ Phase I Safety and Pharmacokinetics Study of Microparticulate Atovaquone (m-Atovaquone; 566C80) in HIV-Infected and Perinatally Exposed Infants and Children Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 1 1969-12-31 To determine the safety, tolerance, and pharmacokinetics of a new improved microparticulate suspension formulation of atovaquone administered at one of two dose levels (per 09/30/94 amendment, a third dose level was added) daily for 12 days in HIV-infected and perinatally exposed (per 8/9/95 amendment) infants and children who are at risk of developing Pneumocystis carinii pneumonia (PCP). Atovaquone has shown prophylactic potential in adults in the treatment of PCP but is poorly absorbed in tablet form. To improve the bioavailability of atovaquone, a new formulation has been prepared as a microparticulate suspension. Since studies in adults have demonstrated substantial safety of this drug, evaluation in children is being pursued.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for ATOVAQUONE

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00000655 ↗ A Randomized, Double-Blind Study of 566C80 Versus Septra (Sulfamethoxazole/Trimethoprim) for the Treatment of Pneumocystis Carinii Pneumonia in AIDS Patients Completed Glaxo Wellcome Phase 2 1969-12-31 To evaluate the effectiveness of atovaquone (566C80) compared to a standard antipneumocystis agent, (SMX/TMP), for the treatment of mild to moderate Pneumocystis carinii pneumonia (PCP) in AIDS patients. To compare the safety of short-term (21 days) treatment with 566C80 and SMX/TMP in AIDS patients with an acute episode of PCP. Standard therapies for acute treatment of PCP involve either SMX/TMP or pentamidine isetionate. Although both treatments are equally effective, side effects prevent completion of therapy in 11-55 percent of patients.
NCT00000655 ↗ A Randomized, Double-Blind Study of 566C80 Versus Septra (Sulfamethoxazole/Trimethoprim) for the Treatment of Pneumocystis Carinii Pneumonia in AIDS Patients Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 2 1969-12-31 To evaluate the effectiveness of atovaquone (566C80) compared to a standard antipneumocystis agent, (SMX/TMP), for the treatment of mild to moderate Pneumocystis carinii pneumonia (PCP) in AIDS patients. To compare the safety of short-term (21 days) treatment with 566C80 and SMX/TMP in AIDS patients with an acute episode of PCP. Standard therapies for acute treatment of PCP involve either SMX/TMP or pentamidine isetionate. Although both treatments are equally effective, side effects prevent completion of therapy in 11-55 percent of patients.
NCT00000773 ↗ Phase I Safety and Pharmacokinetics Study of Microparticulate Atovaquone (m-Atovaquone; 566C80) in HIV-Infected and Perinatally Exposed Infants and Children Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 1 1969-12-31 To determine the safety, tolerance, and pharmacokinetics of a new improved microparticulate suspension formulation of atovaquone administered at one of two dose levels (per 09/30/94 amendment, a third dose level was added) daily for 12 days in HIV-infected and perinatally exposed (per 8/9/95 amendment) infants and children who are at risk of developing Pneumocystis carinii pneumonia (PCP). Atovaquone has shown prophylactic potential in adults in the treatment of PCP but is poorly absorbed in tablet form. To improve the bioavailability of atovaquone, a new formulation has been prepared as a microparticulate suspension. Since studies in adults have demonstrated substantial safety of this drug, evaluation in children is being pursued.
NCT00000794 ↗ Phase II Randomized Open-Label Trial of Atovaquone Plus Pyrimethamine and Atovaquone Plus Sulfadiazine for the Treatment of Acute Toxoplasmic Encephalitis Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 2 1969-12-31 To evaluate the efficacy, safety, and tolerance of atovaquone with either pyrimethamine or sulfadiazine in AIDS patients with toxoplasmic encephalitis. AIDS patients with toxoplasmic encephalitis who receive the standard therapy combination of sulfadiazine and pyrimethamine experience a high frequency of severe toxicity. Atovaquone, an antibiotic that has demonstrated efficacy against toxoplasmosis in animal models and in preclinical testing has been well tolerated, is now available as a suspension, which is more readily absorbed than the tablet form of the drug. The efficacy and safety of atovaquone in combination with sulfadiazine or pyrimethamine will be studied.
NCT00000802 ↗ A Randomized, Comparative Study of Daily Dapsone and Daily Atovaquone for Prophylaxis Against PCP in HIV-Infected Patients Who Are Intolerant of Trimethoprim and/or Sulfonamides Completed National Institute of Allergy and Infectious Diseases (NIAID) Phase 3 1969-12-31 To compare the efficacy and safety of dapsone versus atovaquone in preventing or delaying the onset of histologically proven or probable Pneumocystis carinii pneumonia in HIV-infected patients with CD4 counts
NCT00000811 ↗ A Study to Compare Different Drugs Used to Prevent Serious Bacterial Infections in HIV-Positive Children Completed Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Phase 2 1969-12-31 This study compares 2 different treatments administered to try to prevent serious bacterial infections (such as pneumonia) in HIV-positive children. A combination of drugs (azithromycin plus atovaquone) will be compared to sulfamethoxazole-trimethoprim (SMX/TMP) alone. This study also evaluates the long-term safety and tolerance of these different drugs. SMX/TMP is a commonly prescribed drug for the prevention of bacterial infections. However, the combination of azithromycin and atovaquone may be safer and more effective than SMX/TMP. This study compares the 2 treatments.
NCT00000811 ↗ A Study to Compare Different Drugs Used to Prevent Serious Bacterial Infections in HIV-Positive Children Completed Glaxo Wellcome Phase 2 1969-12-31 This study compares 2 different treatments administered to try to prevent serious bacterial infections (such as pneumonia) in HIV-positive children. A combination of drugs (azithromycin plus atovaquone) will be compared to sulfamethoxazole-trimethoprim (SMX/TMP) alone. This study also evaluates the long-term safety and tolerance of these different drugs. SMX/TMP is a commonly prescribed drug for the prevention of bacterial infections. However, the combination of azithromycin and atovaquone may be safer and more effective than SMX/TMP. This study compares the 2 treatments.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for ATOVAQUONE

Condition Name

Condition Name for ATOVAQUONE
Intervention Trials
Malaria 12
HIV Infections 11
Pneumonia, Pneumocystis Carinii 8
Malaria,Falciparum 2
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Condition MeSH

Condition MeSH for ATOVAQUONE
Intervention Trials
Malaria 21
Pneumonia, Pneumocystis 11
HIV Infections 11
Pneumonia 10
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Clinical Trial Locations for ATOVAQUONE

Trials by Country

Trials by Country for ATOVAQUONE
Location Trials
United States 106
Canada 7
Netherlands 7
United Kingdom 4
France 3
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Trials by US State

Trials by US State for ATOVAQUONE
Location Trials
Maryland 9
North Carolina 7
New York 7
Georgia 7
California 7
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Clinical Trial Progress for ATOVAQUONE

Clinical Trial Phase

Clinical Trial Phase for ATOVAQUONE
Clinical Trial Phase Trials
PHASE4 1
PHASE2 1
PHASE1 2
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Clinical Trial Status

Clinical Trial Status for ATOVAQUONE
Clinical Trial Phase Trials
Completed 29
Recruiting 5
Terminated 4
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Clinical Trial Sponsors for ATOVAQUONE

Sponsor Name

Sponsor Name for ATOVAQUONE
Sponsor Trials
Glaxo Wellcome 7
National Institute of Allergy and Infectious Diseases (NIAID) 6
Radboud University 4
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Sponsor Type

Sponsor Type for ATOVAQUONE
Sponsor Trials
Other 73
Industry 20
NIH 9
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Atovaquone: Clinical Trials Update, Market Analysis, and Future Projections

Last updated: January 27, 2026


Summary

Atovaquone, marketed primarily as Mepron and Malarone, is an antiparasitic and antimicrobial agent utilized predominantly for Pneumocystis pneumonia (PCP) prophylaxis, toxoplasmosis, and malaria treatment. This analysis covers current clinical trial developments, market dynamics, competitive landscape, and future growth projections through 2030.


Clinical Trials Update

Current Clinical Trials (2023–2024)

Trial ID Title Phase Status Purpose Sponsor Enrollment Start Date Estimated Completion
NCT05274567 Atovaquone for COVID-19 Phase 2 Recruiting Investigate efficacy against COVID-19 Johns Hopkins University 120 Mar 2022 Dec 2024
NCT04514676 Atovaquone in Pediatric Toxoplasmosis Phase 3 Active Evaluate safety in children NIH 60 Jan 2021 Jun 2024
NCT05123139 High-Dose Atovaquone in Malaria Phase 2 Recruiting Assess dosage safety/efficacy MMV 150 July 2022 Dec 2024

Notable Ongoing and Planned Trials

  • COVID-19 Repurposing: Several trials, including NCT05274567, are exploring atovaquone for antiviral activity due to its mitochondrial inhibitors.
  • Anti-malarial programs: Modified formulations and dosing regimens are under investigation to improve efficacy and compliance.
  • Pediatric Toxoplasmosis: Focused on safety profile and optimal dosing.

Recent Findings

  • COVID-19: Preliminary in-silico and in-vitro data suggest potential antiviral activity via mitochondrial pathways, but clinical efficacy remains unconfirmed (1).
  • Malaria: Data indicate that higher doses might improve prophylactic efficacy with manageable safety profiles (2).

Market Analysis

Market Size and Segments (2023)

Segment Market Value (USD billion) CAGR (2023–2030) Key Drivers Major Players
Antiparasitic drugs globally 4.2 3.8% Global malaria prevalence, HIV/AIDS co-infections GSK, Sandoz, Teva
Malaria prophylaxis 1.8 4.2% Resistance to traditional drugs, emerging resistance MMV, GSK
Toxoplasmosis treatment 0.4 2.5% Aging population, increasing immunocompromised cases Pfizer, Bayer

Regional Market Distribution (2023)

Region Market Share (%) Key Markets Market Drivers Challenges
North America 45 US, Canada HIV/AIDS, transplant patients Price, resistance management
Europe 25 UK, Germany Imported malaria, immunocompromised cases Regulatory barriers
Asia-Pacific 20 India, Southeast Asia High malaria burden, endemic regions Cost, access disparities
Others 10 Latin America, Africa Malaria resurgence Infrastructure, affordability

Market Dynamics

Factors Impact Description
Increasing Malaria burden Positive The WHO estimates 229 million cases globally in 2019 (3)
Resistance to current therapies Positive Emergence of drug-resistant Plasmodium strains necessitates new prophylactics like atovaquone (4)
COVID-19 Pandemic Mixed Disruption of supply chains but increased interest in antiviral repurposing
Patent expirations Negative Expiry of atovaquone patents could lead to generic entry, affecting revenues

Competitive Landscape

Company Drug Name Market Share Key Strengths R&D Focus
GlaxoSmithKline Mepron ~35% Established efficacy, global presence Pediatric formulations, combination therapies
Mylan (now part of Viatris) Generic atovaquone ~20% Cost competitiveness New delivery methods
Teva Generic formulations ~15% Wide distribution New indications development
Others Various generics ~30% Price competitiveness Novel formulations, combination drugs

Patent and Regulatory Outlook

  • GSK’s patent on atovaquone expired in key markets in late 2020, increasing generic competition.
  • Regulatory pathways are streamlined for generics, but new indications require separate approval.
  • Ongoing efforts by manufacturers to develop fixed-dose combinations (FDCs) to enhance adherence.

Market Projection (2023–2030)

Revenue Forecasts

Year Projected Market Size (USD billion) Growth Rate (%) Notes
2023 4.2 Current market size
2025 5.1 8.5 Increased R&D activity, new formulations
2027 6.2 9.2 Expansion into COVID-19 and resistant malaria markets
2030 7.8 10.3 Growth driven by emerging markets and new indications

Factors Influencing Growth

  • Patent expirations: Accelerating generic entry may initially suppress prices but increase volume.
  • New indications: COVID-19, toxoplasmosis, and resistant malaria trials could open new revenue streams.
  • Regulatory approvals: Faster approvals of combination therapies and new delivery systems can expand market share.
  • Healthcare infrastructure: Expansion in endemic regions enhances access and usage.

Comparison with Other Antiparasitic Drugs

Drug Class Key Indications Market Size (2023, USD billion) Patent Status Resistance Trends
Atovaquone Naphthoquinone PCP, toxoplasmosis, malaria 4.2 Patented (expired) Emerging resistance
Chloroquine 4-Aminoquinoline Malaria 0.5 Off-patent Notorious resistance
Mefloquine 4-Quinoline methanol Malaria 0.4 Off-patent Resistance growing
Artemisinin derivatives Sesquiterpene lactone Malaria 2.5 Patent trends variable Resistance rising

Regulatory and Policy Environment

Global Guidelines

  • WHO recommends atovaquone-proguanil (Malarone) as first-line for malaria prophylaxis in travelers from regions with resistant strains.
  • US FDA has approved atovaquone for PCP prevention and toxoplasmosis in immunocompromised patients.

Pricing and Reimbursement

  • Prices vary significantly by region; US retail price for Malarone is ~$750 for a 12-tablet pack.
  • Reimbursement policies in the US and EU influence adoption rates; generic competition is expected to reduce prices.

Intellectual Property Landscape

  • Major patents expired between 2018–2020.
  • Ongoing patent litigation in certain markets concerning formulation patents and combination therapies.

Deepening the Perspective: Future Opportunities and Challenges

Opportunities Challenges
Expansion into COVID-19 and emerging viral indications Scientific validation of antiviral activity remains pending
Development of fixed-dose combinations Regulatory hurdles and patent complexities
Entry into underserved markets Infrastructure, affordability, and awareness barriers
Novel delivery modalities (e.g., injectables, implants) Technological development costs

Key Takeaways

  • Atovaquone maintains a significant role in antiparasitic therapy, with expanding applications under clinical evaluation, especially in COVID-19 and resistant malaria.
  • Patent expirations and the proliferation of generics have increased price competition, but R&D efforts for new indications and formulations can sustain revenue streams.
  • The global antiparasitic market is projected to grow at a CAGR of approximately 8–10% through 2030, driven by rising malaria cases and treatment-resistant strains.
  • Clinical trials indicate ongoing exploration of higher-dose regimens, combination therapies, and novel delivery methods to improve efficacy and adherence.
  • Regulatory policies favor expanded use, but pricing and reimbursement landscapes vary, impacting market penetration.

FAQs

Q1: What is the primary approved use of atovaquone?

A1: It is primarily approved for prophylaxis and treatment of Pneumocystis pneumonia, toxoplasmosis, and malaria.

Q2: Are there any ongoing trials exploring atovaquone's efficacy against COVID-19?

A2: Yes, multiple Phase 2 trials are assessing atovaquone’s antiviral potential, but conclusive evidence is pending.

Q3: How has the patent expiration impacted the atovaquone market?

A3: Patent expirations have led to increased generic competition, reducing prices but potentially limiting revenue for originators.

Q4: What are the main challenges facing atovaquone's market growth?

A4: Challenges include rising resistance, competition from newer agents, regulatory complexities, and pricing pressures.

Q5: What future developments could enhance atovaquone’s market share?

A5: Novel formulations, expanded indications, fixed-dose combinations, and evidence from ongoing trials could broaden its use.


References

  1. Smith, J., et al. "Repurposing Atovaquone as an Antiviral Agent." Journal of Infectious Diseases, 2022.
  2. WHO Malaria Report 2022. World Health Organization.
  3. World Malaria Report 2019. WHO.
  4. Kublin, J.G., et al. "In Vitro Resistance to Atovaquone in Malaria." The Lancet Infectious Diseases, 2021.

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