Thomas Schall, ChemoCentryx CEO

Af­ter skep­ti­cism and tight vote at ad­comm, FDA ap­proves Chemo­Cen­tryx's rare dis­ease drug

Af­ter a tight ad­vi­so­ry com­mit­tee vote back in May that tilt­ed just slight­ly in fa­vor of ap­prov­ing Chemo­Cen­tryx’s ava­co­pan, the FDA has of­fi­cial­ly cleared the drug to treat a rare and se­ri­ous dis­ease known as an­ti-neu­trophil cy­to­plas­mic au­toan­ti­body (AN­CA)-vas­culi­tis.

The ap­proval makes ava­co­pan — now mar­ket­ed as Tavneos — the first new drug in a decade for AN­CA-as­so­ci­at­ed vas­culi­tis, ac­cord­ing to tri­al in­ves­ti­ga­tor Pe­ter Merkel.

AN­CA-as­so­ci­at­ed vas­culi­tis refers to a group of au­toim­mune dis­eases char­ac­ter­ized by in­flam­ma­tion and dam­age to small blood ves­sels. It’s of­ten caused by AN­CAs, self-re­ac­tive an­ti­bod­ies that bind to a type of white blood cells called neu­trophils and over­ac­ti­vate them.

It’s a po­ten­tial­ly fa­tal con­di­tion that’s no­to­ri­ous­ly ex­pen­sive to treat. Back in 2019, Rit­ux­an, a cur­rent stan­dard of care, made ICER’s list of top price-hike of­fend­ers. Ac­cord­ing to CEO Thomas Schall, Tavneos’ price will fall some­where be­tween $150,000 to $200,000 per pa­tient per year.

The drug, a small mol­e­cule an­tag­o­nist of the C5a re­cep­tor, was ap­proved based on da­ta from the Phase III AD­VO­CATE tri­al, which en­rolled 331 pa­tients in one of two arms: one group re­ceived 30 mg of oral ava­co­pan, while the oth­er re­ceived oral pred­nisone on a ta­per­ing sched­ule. All of the pa­tients re­ceived ei­ther cy­clophos­phamide (fol­lowed by aza­thio­prine) or rit­ux­imab.

Re­searchers were able to show that Tavneos was non-in­fe­ri­or to the pred­nisone ta­per at Week 26 (the pri­ma­ry end­point), and su­pe­ri­or to the ta­per with re­spect to sus­tained re­mis­sion at the one-year mark.

But those num­bers didn’t im­press some ad­comm mem­bers, who raised con­cerns about re­ly­ing on the sin­gle tri­al as ev­i­dence, the in­suf­fi­cient amount of safe­ty da­ta, and ques­tions on whether the tri­al was sta­tis­ti­cal­ly ro­bust enough.

The agency al­so ques­tioned if the oth­er drugs used in the study may have con­tributed to the ef­fi­ca­cy seen for ava­co­pan.

“In this case, both treat­ment arms re­ceived back­ground ther­a­py in the form of cy­clophos­phamide or rit­ux­imab. The ben­e­fit of glu­co­cor­ti­coids on top of cy­clophos­phamide or rit­ux­imab is not well un­der­stood,” FDA sta­tis­ti­cal re­view­er Yu­ra Kim said back in May. “As a re­sult, it is dif­fi­cult to de­ter­mine if sim­i­lar re­mis­sion rates ob­served on both arms can sup­port a con­clu­sion that ava­co­pan is ef­fec­tive or if sim­i­lar­i­ties can be pri­mar­i­ly at­trib­uted to both arms re­ceiv­ing rit­ux­imab or cy­clophos­phamide.”

The com­mit­tee end­ed up vot­ing 10-8 to rec­om­mend ap­prov­ing the drug; 9-9 on whether the ef­fi­ca­cy da­ta sup­port ap­proval; and 10-8 that the safe­ty pro­file of ava­co­pan is ad­e­quate enough to sup­port ap­proval.

Dur­ing the in­vestor call, Schall em­pha­sized that Tavneos is in­di­cat­ed as an ad­junc­tive treat­ment in com­bi­na­tion with stan­dard ther­a­py glu­co­cor­ti­coids, and ex­plained the sources of glu­co­cor­ti­coid ex­po­sure in the AD­VO­CATE tri­al.

“Ad­di­tion­al glu­co­cor­ti­coids were al­lowed in both groups, both the Tavneos and the pred­nisone stan­dard of care group, as re­quired for, say for ex­am­ple, pre­med­ica­tion for rit­ux­imab in­fu­sion,” Schall said. “You ac­tu­al­ly have what I call hitch­hik­er glu­co­cor­ti­coid com­ing in with each in­fu­sion of rit­ux­imab.”

“So of course, that’s one of the main sources of glu­co­cor­ti­coid ex­po­sure in AN­CA vas­culi­tis ther­a­py, and it was cer­tain­ly a source in the AD­VO­CATE tri­al and a source that sim­ply could not be elim­i­nat­ed,” he added.

Biotech Half­time Re­port: Af­ter a bumpy year, is biotech ready to re­bound?

The biotech sector has come down firmly from the highs of February as negative sentiment takes hold. The sector had a major boost of optimism from the success of the COVID-19 vaccines, making investors keenly aware of the potential of biopharma R&D engines. But from early this year, clinical trial, regulatory and access setbacks have reminded investors of the sector’s inherent risks.

RBC Capital Markets recently surveyed investors to take the temperature of the market, a mix of specialists/generalists and long-only/ long-short investment strategies. Heading into the second half of the year, investors mostly see the sector as undervalued (49%), a large change from the first half of the year when only 20% rated it as undervalued. Around 41% of investors now believe that biotech will underperform the S&P500 in the second half of 2021. Despite that view, 54% plan to maintain their position in the market and 41% still plan to increase their holdings.

So — that pig-to-hu­man trans­plant; Po­ten­tial di­a­betes cure reach­es pa­tient; Ac­cused MIT sci­en­tist lash­es back; and more

Welcome back to Endpoints Weekly, your review of the week’s top biopharma headlines. Want this in your inbox every Saturday morning? Current Endpoints readers can visit their reader profile to add Endpoints Weekly. New to Endpoints? Sign up here.

We’re incredibly excited to welcome Beth Bulik, seasoned pharma marketing reporter, to the team. You can find much of her work in our new Marketing channel — and in her weekly newsletter, Endpoints PharmaRx, which will launch in early November. Add it to your subscriptions here.

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UP­DAT­ED: Agenus calls out FDA for play­ing fa­vorites with Mer­ck, pulls cer­vi­cal can­cer BLA at agen­cy's re­quest

While criticizing the FDA for what may be some favoritism towards Merck, Agenus on Friday officially pulled its accelerated BLA for its anti-PD-1 inhibitor balstilimab as a potential second-line treatment for cervical cancer because of the recent full approval for Merck’s Keytruda in the same indication.

The company said the BLA, which was due for an FDA decision by Dec. 16, was withdrawn “when the window for accelerated approval of balstilimab closed,” thanks to the conversion of Keytruda’s accelerated approval to a full approval four months prior to its PDUFA date.

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How to col­lect and sub­mit RWD to win ap­proval for a new drug in­di­ca­tion: FDA spells it out in a long-await­ed guid­ance

Real-world data are messy. There can be differences in the standards used to collect different types of data, differences in terminologies and curation strategies, and even in the way data are exchanged.

While acknowledging this somewhat controlled chaos, the FDA is now explaining how biopharma companies can submit study data derived from real-world data (RWD) sources in applicable regulatory submissions, including new drug indications.

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NYU surgeon transplants an engineered pig kidney into the outside of a brain-dead patient (Joe Carrotta/NYU Langone Health)

No, sci­en­tists are not any clos­er to pig-to-hu­man trans­plants than they were last week

Steve Holtzman was awoken by a 1 a.m. call from a doctor at Duke University asking if he could put some pigs on a plane and fly them from Ohio to North Carolina that day. A motorcyclist had gotten into a horrific crash, the doctor explained. He believed the pigs’ livers, sutured onto the patient’s skin like an external filter, might be able to tide the young man over until a donor liver became available.

David Livingston (Credit: Michael Sazel for CeMM)

Renowned Dana-Far­ber sci­en­tist, men­tor and bio­phar­ma ad­vi­sor David Liv­ingston has died

David Livingston, the Dana-Farber/Harvard Med scientist who helped shine a light on some of the key molecular drivers of breast and ovarian cancer, died unexpectedly last Sunday.

One of the senior leaders at Dana-Farber during his nearly half century of work there, Livingston was credited with shedding light on the genes that regulate cell growth, with insights into inherited BRCA1 and BRCA2 mutations that helped lay the scientific foundation for targeted therapies and earlier detection that have transformed the field.

Marty Duvall, Oncopeptides CEO

On­copep­tides stock craters as it pulls can­cer drug Pepax­to from the mar­ket

Shares of Oncopeptides crashed more than 70% in early Friday trading after the company said it’s pulling its multiple myeloma drug Pepaxto (melphalan flufenamide) from the US market after failing a confirmatory trial. The move will force the company to close its US and EU business units and enact significant layoffs.

The FDA had scheduled an adcomm meeting next Thursday to discuss Pepaxto, which first won accelerated approval in February and costs about $19,000 per course of treatment. The committee was to weigh in on whether the confirmatory trial demonstrated a worse overall survival in the treatment arm compared to the control arm.

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Pfiz­er pitch­es its Covid-19 vac­cine for younger chil­dren ahead of ad­comm next week

Pfizer will present its case to the FDA’s vaccine adcomm next week, seeking authorization for a lower-dose version of its Covid-19 vaccine for kids ages 5 through 12, which the Biden administration said will likely begin rolling out early next month.

Two primary doses of the 10 µg vaccine (the dose for those ages 12 and up is 30 μg) given 3 weeks apart in this group of children “have shown a favorable safety and tolerability profile, robust immune responses against all variants of concern including Delta, and vaccine efficacy of 90.7% against laboratory-confirmed symptomatic COVID-19,” the company said in briefing documents ahead of next Tuesday’s meeting of the FDA’s Vaccines and Related Biological Products Advisory Committee.

No­vo CEO Lars Fruer­gaard Jør­gensen on R&D risk, the deal strat­e­gy and tar­gets for gen­der di­ver­si­ty


I kicked off our European R&D summit last week with a conversation involving Novo Nordisk CEO Lars Fruergaard Jørgensen. Novo is aiming to launch a new era of obesity management with a new approval for semaglutide. And Jørgensen had a lot to say about what comes next in R&D, how they manage risk and gender diversity targets at the trendsetting European pharma giant.

John Carroll: I’m here with Lars Jørgensen, the CEO of Novo Nordisk. Lars, it’s been a really interesting year so far with Novo Nordisk, right? You’ve projected a new era of growing sales. You’ve been able to expand on the GLP-1 franchise that was already well established in diabetes now going into obesity. And I think a tremendous number of people are really interested in how that’s working out. You have forecast a growing amount of sales. We don’t know specifically how that might play out. I know a lot of the analysts have different ideas, how those numbers might play out, but that we are in fact embarking on a new era for Novo Nordisk in terms of what the company’s capable of doing and what it’s able to do and what it wants to do. And I wanted to start off by asking you about obesity in particular. Semaglutide has been approved in the United States for obesity. It’s an area of R&D that’s been very troubled for decades. There have been weight loss drugs that have come along. They’ve attracted a lot of attention, but they haven’t actually ever gained traction in the market. My first question is what’s different this time about obesity? What is different about this drug and why do you expect it to work now whereas previous drugs haven’t?

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