Women ex­pel on av­er­age about 2 to 3 ta­ble­spoons of blood dur­ing their time of the month. But with uter­ine fi­broids, heavy bleed­ing is typ­i­cal — a third of a cup or more. Drug­mak­ers have been work­ing on oral ther­a­pies to try and stem the flow, and as ex­pect­ed, Ab­b­Vie and their part­ners at Neu­ro­crine Bio­sciences are the first to make it across the fin­ish line.

Known chem­i­cal­ly as elagolix, the drug is al­ready ap­proved as a treat­ment for en­dometrio­sis un­der the brand name Orilis­sa. It tar­gets the GnRH re­cep­tor to de­crease the pro­duc­tion of es­tro­gen and prog­es­terone.

Now, elagolix in com­bi­na­tion with two hor­mone drugs — estra­di­ol and norethin­drone ac­etate — has been ap­proved by the FDA. Ab­b­Vie will sell the twice-dai­ly reg­i­men as Ori­ahnn.

Mean­while, com­peti­tors such as My­ovant and Ob­sE­va al­so have ri­val oral GnRH re­cep­tor an­tag­o­nists wait­ing in the wings.

Char­lotte Owens, Ab­b­Vie

“In the ab­sence of head-to-head com­par­isons … it’s re­al­ly hard for us to com­pare and con­trast with drugs that are cur­rent­ly in de­vel­op­ment right now,” said Char­lotte Owens, med­ical di­rec­tor of gen­er­al med­i­cine at Ab­b­Vie, in an in­ter­view.

Ori­ahnn’s ap­proval was based on two six-month piv­otal stud­ies — each study re­quired the reg­i­men to gen­er­ate a sta­tis­ti­cal­ly sig­nif­i­cant im­pact on re­duc­ing blood loss by at least 50% in pa­tients. Each study al­so had an elagolix monother­a­py arm.

In one late-stage study, 68.5% (p<0.001) of elagolix com­bo-treat­ed women with uter­ine fi­broids hit that goal com­pared to place­bo (8.7%), in the sec­ond tri­al 76.2% elagolix com­bo-treat­ed women achieved the end­point com­pared to place­bo (10.1%). How­ev­er, the drug’s side ef­fect pro­file caused pause large­ly due to the loss of bone den­si­ty in pa­tients who re­ceived the Ab­b­Vie drug.

An­a­lysts have sug­gest­ed the Ob­sE­va and My­ovant ther­a­pies could have an edge over the Ab­b­Vie drug, if ap­proved.  But the two ri­vals will have been beat­en to mar­ket and nei­ther have the com­mer­cial prowess that a be­he­moth like Ab­b­Vie can boast of.

Ob­sE­va has test­ed its GnRH drug lin­zagolix in pa­tients with and with­out ABT. Late last year, the Swiss drug­mak­er post­ed da­ta from the PRIM­ROSE 2 tri­al, which test­ed two dos­es of the drug against a place­bo. The re­sults showed 93.9% for women re­ceiv­ing 200 mg of the drug with ABT tri­al saw more than 50% re­duc­tion in bleed­ing, and 56.7% for women re­ceiv­ing 100 mg with­out ABT achieved the same goal, com­pared to 29.4% in the place­bo group.

Al­though an­a­lysts have been en­cour­aged by the pos­i­tive da­ta in pa­tients who re­spond­ed well to the drug de­spite the lack of ABT (women pre­dis­posed to high BMI, CV risk and di­a­betes are typ­i­cal­ly not pre­scribed ABT) in the drug’s safe­ty pro­file, par­tic­u­lar­ly bone den­si­ty loss, did vex in­vestors. The com­pa­ny has an­oth­er piv­otal study that is ex­pect­ed to read out in the com­ing months.

Mean­while, My­ovant Sci­ences is al­so in the mix with its of­fer­ing: re­l­u­golix. The drug, like the Ab­b­Vie reg­i­men, is de­signed for use in com­bi­na­tion with ABT. Cur­rent­ly un­der FDA re­view, the reg­i­men was al­so test­ed in two phase III stud­ies, with the same main goal: 50% or more re­duc­tion in blood loss.

In one study, 71.2% of women re­ceiv­ing re­l­u­golix reg­i­men achieved the clin­i­cal re­sponse they were look­ing for, com­pared to on­ly 14.7% in the con­trol arm. In the oth­er, 73.4% of women on the re­l­u­golix arm achieved the same goal, com­pared with 18.9% of women re­ceiv­ing place­bo.  Cru­cial­ly, though, My­ovant’s did no sig­nif­i­cant dif­fer­ences in terms of bone min­er­al den­si­ty.

“The re­sponse rates demon­strat­ed in these tri­als were com­pa­ra­ble to those shown by Ab­b­Vie’s ap­proved GnRH in­hibitor, Orilis­sa, while main­tain­ing a sta­ble bone min­er­al den­si­ty pro­file with a once-dai­ly op­tion,” Baird’s Bri­an Sko­r­ney wrote in a note ear­li­er this month.

End­points News has con­tact­ed Ab­b­Vie for com­ment on Ori­ahnn pric­ing.

In a press release issued in early June announcing a BLA acknowledgment letter from the FDA, CytoDyn CEO Nader Pourhassan said he is hopeful about getting a PDUFA date for its lead drug, leronlimab, on July 10.

Instead, they received a refuse-to-file letter today.

The company said the agency is just looking for “certain information needed to complete a substantive review.” No clinical trials are necessary; all that’s needed is additional analysis and a meeting with the FDA.

For now, the big focus in the hemophilia A gene therapy race has been centered on frontrunner BioMarin, with an expected OK just weeks away, and the crew from Sangamo/Pfizer, which has been looking to play catch-up with a pivotal study in the works.

But now Roche’s new gene therapy division at Spark has updated its own schedule, saying they’re looking at a Phase III start sometime next year as they optimize the dose and immunomodulatory regimen in order to avoid any future mishaps that could derail the program.

Roche’s hit-and-miss record on Tecentriq has posted another miss.

The pharma giant reported this morning that the PD-L1 checkpoint failed a Phase III trial for women with advanced, front line ovarian cancer, one of several hard-to-hit cancers that’s defied a variety of approaches. Much of the new R&D in ovarian cancer remains focused on PARP, where AstraZeneca’s Lynparza holds sway.

In this trial Roche combined their PD-L1 Tecentriq with Avastin. But it’s been one of dozens of Phase III trials in the works for the checkpoint crew, as more companies angle to jump into the market behind the two leaders — Merck’s Keytruda and Bristol-Myers Squibb’s Opdivo.