Al­ler­gan set to make head­way in crowd­ed CGRP mi­graine mar­ket, as the bat­tle for for­mu­la­ry cov­er­age be­gins

Mil­lions of mi­graine suf­fer­ers could soon get their hands on an oral CGRP drug de­signed to be used as-need­ed, as Al­ler­gan $AGN on Wednes­day said it was on track to file for FDA ap­proval for ubro­gepant in the first quar­ter of next year. The mul­ti-bil­lion dol­lar mi­graine mar­ket is al­ready re­plete with in­jectable med­ica­tions from Te­va $TE­VA, Eli Lil­ly $LLY, and one from Am­gen $AMGN and No­var­tis $NVS, which are all de­signed to be used as pre­ven­ta­tive treat­ments and are cu­ri­ous­ly priced iden­ti­cal­ly.

Last month, Lil­ly se­cured FDA ap­proval for its in­jec­tion Em­gal­i­ty, af­ter the agency grant­ed sim­i­lar ap­provals to Aimovig from Am­gen Inc and No­var­tis, and Te­va’s Ajovy. All three drugs large­ly work in a sim­i­lar man­ner and have demon­strat­ed a sig­nif­i­cant re­duc­tion in mi­graine fre­quen­cy in about half of pa­tients when test­ed in clin­i­cal stud­ies. In­ter­est­ing­ly, each drug­mak­er has al­so priced their of­fer­ings at a list price of $6,900 a year, or $575 per month.

But ear­li­er on Wednes­day, Reuters re­port­ed that the hefty US phar­ma­cy ben­e­fit man­ag­er Ex­press Scripts $ES­RX had de­cid­ed to cov­er new mi­graine drugs from Lil­ly and Am­gen as part of its for­mu­la­ry and ex­clude Te­va, fol­low­ing ne­go­ti­a­tions with all three man­u­fac­tur­ers.

“This puts more pres­sure on Te­va to score for­mu­la­ry wins in the oth­er larg­er plans, which at this point may still be up for grabs. We es­ti­mate peak share of 20% for Ajovy but ac­knowl­edge it will be im­per­a­tive for it to get 1-2 ma­jor wins to get there,” Leerink an­a­lysts wrote in a note.

Te­va shares are down 5%.

A spokesper­son from Al­ler­gan told End­points News that it was pre­ma­ture to com­ment on ubro­gepant’s pric­ing and pay­er dis­cus­sions as the com­pa­ny has not yet filed its mar­ket­ing ap­pli­ca­tion, and that it could not com­ment on its plans for an EMA fil­ing at this time.

Ac­cord­ing to the Mi­graine Re­search Foun­da­tion, mi­graine is the third most preva­lent ill­ness in the world, af­fect­ing about 39 mil­lion in the Unit­ed States and some 1 bil­lion world­wide. The mar­ket for mi­graine drugs is ex­pect­ed to hit $8.7 bil­lion by 2026, ac­cord­ing to Glob­al­da­ta.  Be­fore the slate of ap­provals this year, pa­tients were large­ly treat­ed with a host of drugs in­clud­ing an­ti-de­pres­sants, hy­per­ten­sion med­i­cines and a class of drugs called trip­tans. This new class of bi­o­log­ics, known as CGRP (cal­ci­tonin gene-re­lat­ed pep­tide) in­hibitors, tar­get the CGRP pro­tein that trans­mits pain sig­nals in­to the brain, and is be­lieved to be in­stru­men­tal in gen­er­at­ing and main­tain­ing headaches as­so­ci­at­ed with mi­graine.

For those pa­tients who still ex­pe­ri­ence mi­graine at­tacks while on pre­ven­ta­tive an­ti-CGRP ther­a­py, acute, as-need­ed treat­ments will still be re­quired, which is where Al­ler­gen’s ubro­gepant, which the com­pa­ny ac­quired from Mer­ck $MRK in 2015, could come handy.

If ap­proved, ubro­gepant could po­ten­tial­ly be used in com­bi­na­tion with its an­ti-CGRP in­jectable ri­vals and/or Al­ler­gan’s own ver­sa­tile Botox in­jec­tion, which has been ap­proved for mi­graine pre­ven­tion since 2010.

Al­ler­gan has al­ready re­port­ed pos­i­tive Phase III da­ta on ubro­gepant from two stud­ies ear­li­er this year, and on Wednes­day said that two oth­er stud­ies fur­ther eval­u­at­ing the drug’s safe­ty and tol­er­a­bil­i­ty, in­clud­ing one which eval­u­at­ed the po­ten­tial of he­pat­ic tox­i­c­i­ty in healthy pa­tients, meant that it was on track to file in Q1, 2019. Mi­graine drug de­vel­op­er, Bio­haven $BHVN, how­ev­er is do­ing their safe­ty study in mi­graine pa­tients, as Ever­core’s Umer Raf­fat points out.

Both Bio­haven and Alder $AL­DR are poised to sub­mit their mi­graine drugs for mar­ket­ing ap­proval next year.

It’s fi­nal­ly over: Bio­gen, Ei­sai scrap big Alzheimer’s PhI­I­Is af­ter a pre­dictable BACE cat­a­stro­phe rais­es safe­ty fears

Months after analysts and investors called on Biogen and Eisai to scrap their BACE drug for Alzheimer’s and move on in the wake of a string of late-stage failures and rising safety fears, the partners have called it quits. And they said they were dropping the drug — elenbecestat — after the independent monitoring board raised concerns about…safety.

We don’t know exactly what researchers found in this latest catastrophe, but the companies noted in their release that investigators had determined that the drug was flunking the risk/benefit analysis.

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Lisa M. DeAngelis, MSKCC

MSK picks brain can­cer ex­pert Lisa DeAn­ge­lis as its next CMO — fol­low­ing José Basel­ga’s con­tro­ver­sial ex­it

It’s official. Memorial Sloan Kettering has picked a brain cancer expert as its new physician-in-chief and CMO, replacing José Baselga, who left under a cloud after being singled out by The New York Times and ProPublica for failing to properly air his lucrative industry ties.

His replacement, who now will be in charge of MSK’s cutting-edge research work as well as the cancer care delivered by hundreds of practitioners, is Lisa M. DeAngelis. DeAngelis had been chair of the neurology department and co-founder of MSK’s brain tumor center and was moved in to the acting CMO role in the wake of Baselga’s departure.

Penn team adapts CAR-T tech, reengi­neer­ing mouse cells to treat car­diac fi­bro­sis

After establishing itself as one of the pioneer research centers in the world for CAR-T cancer therapies, creating new attack vehicles to eradicate cancer cells, a team at Penn Medicine has begun the tricky transition of using the basic technology for heart repair work.

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Tal Zaks. Moderna

The mR­NA uni­corn Mod­er­na has more ear­ly-stage hu­man da­ta it wants to show off — reach­ing new peaks in prov­ing the po­ten­tial

The whole messenger RNA field has attracted billions of dollars in public and private investor cash gambled on the prospect of getting in on the ground floor. And this morning Boston-based Moderna, one of the leaders in the field, wants to show off a few more of the cards it has to play to prove to you that they’re really in the game.

The whole hand, of course, has yet to be dealt. And there’s no telling who gets to walk with a share of the pot. But any cards on display at this point — especially after being accused of keeping its deck under lock and key — will attract plenty of attention from some very wary, and wired, observers.

“In terms of the complexity and unmet need,” says Tal Zaks, the chief medical officer, “this is peak for what we’ve accomplished.”

Moderna has two Phase I studies it wants to talk about now.

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It's not per­fect, but it's a good start: FDA pan­elists large­ly en­dorse Aim­mune's peanut al­ler­gy ther­a­py

Two days after a fairly benign review from FDA staff, an independent panel of experts largely endorsed the efficacy and safety of Aimmune’s peanut allergy therapy, laying the groundwork for approval with a risk evaluation and mitigation strategy (REMS).

Traditionally, peanut allergies are managed by avoidance, but the threat of accidental exposure cannot be nullified. Some allergists have devised a way to dose patients off-label with peanut protein derived from supermarket products to wean them off their allergies. But the idea behind Aimmune’s product was to standardize the peanut protein, and track the process of desensitization — so when accidental exposure in the real world invariably occurs, patients are less likely to experience a life-threatening allergic reaction.

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Rit­ter bombs fi­nal PhI­II for sole lac­tose in­tol­er­ance drug — shares plum­met

More than two years ago Ritter Pharmaceuticals managed to find enough silver lining in its Phase IIb/III study — after missing the top-line mark — to propel its lactose intolerance toward a confirmatory trial. But as it turned out, the enthusiasm only set the biotech and its investors up to be sorely disappointed.

This time around there’s little left to salvage. Not only did RP-G28 fail to beat placebo in reducing lactose intolerance symptoms, patients in the treatment group actually averaged a smaller improvement. On a composite score measuring symptoms like abdominal pain, cramping, bloating and gas, patients given the drug had a mean reduction of 3.159 while the placebo cohort saw a 3.420 drop on average (one-sided p-value = 0.0106).

Ear­ly snap­shot of Ad­verum's eye gene ther­a­py sparks con­cern about vi­sion loss

An early-stage update on Adverum Biotechnologies’ intravitreal gene therapy has triggered investor concern, after patients with wet age-related macular degeneration (AMD) saw their vision deteriorate, despite signs that the treatment is improving retinal anatomy.

Adverum, on Wednesday, unveiled 24-week data from the OPTIC trial of its experimental therapy, ADVM-022, in six patients who have been administered with one dose of the therapy. On average, patients in the trial had severe disease with an average of 6.2 anti-VEGF injections in the eight months prior to screening and an average annualized injection frequency of 9.3 injections.

Alex Ar­faei trades his an­a­lyst's post for a new role as biotech VC; Sanofi vet heads to Vi­for

Too often, Alex Arfaei arrived too late. 

An analyst at BMO Capital Markets, he’d meet with biotech or pharmaceutical heads for their IPO or secondary funding and his brain, trained on a biology degree and six years at Merck and Endo, would spring with questions: Why this biomarker? Why this design? Why not this endpoint? Not that he could do anything about it. These execs were coming for clinical money; their decisions had been made and finalized long ago.

Arde­lyx bags its first FDA OK for IBS, set­ting up a show­down with Al­ler­gan, Iron­wood

In the first of what it hopes will be a couple of major regulatory milestones for its new drug, Ardelyx has bagged an FDA approval to market Ibsrela (tenapanor) for irritable bowel syndrome.

The drug’s first application will be for IBS with constipation (IBS-C), inhibiting sodium-hydrogen exchanger NHE3 in the GI tract in such a way as to increase bowel movements and decrease abdominal pain. This comes on the heels of two successful Phase III trials.