Af­ter hint­ing it was ex­plor­ing the le­gal­i­ty of the FDA’s ap­proval of a ri­val drug from fam­i­ly-run com­pa­ny Ja­cobus Phar­ma­ceu­ti­cals, Cat­a­lyst Phar­ma­ceu­ti­cals on Wednes­day filed a law­suit against the health reg­u­la­tor — ef­fec­tive­ly ac­cus­ing the agency of bow­ing to po­lit­i­cal pres­sure sur­round­ing sky­rock­et­ing drug prices.

Patrick McE­namy Twit­ter

Be­fore Cat­a­lyst’s Fir­dapse (which car­ries an av­er­age an­nu­al list price of $375,000) was sanc­tioned for use in Lam­bert-Eaton myas­thenic syn­drome (LEMS) by the FDA, hun­dreds of pa­tients had been able to ac­cess a sim­i­lar drug from com­pound­ing phar­ma­cies for a frac­tion of the cost, or Ja­cobus’ for free, as part of an FDA-rat­i­fied com­pas­sion­ate use pro­gram. But the ap­proval of the Cat­a­lyst drug — ac­com­pa­nied by mar­ket ex­clu­siv­i­ty span­ning sev­en years — ef­fec­tive­ly pre­clud­ed Ja­cobus and com­pound­ing phar­ma­cies from sell­ing their ver­sions.

Then, in an un­ex­pect­ed twist, weeks ago the FDA en­dorsed New Jer­sey-based Ja­cobus’ ver­sion in pe­di­atric pa­tients, on the ba­sis of adult da­ta — a move that could spark off-la­bel pre­scrip­tion in adults (As far as the FDA is con­cerned, doc­tors can pre­scribe drugs for off-la­bel use when they judge that it is med­ical­ly ap­pro­pri­ate for their pa­tient). Cat­a­lysts’ shares $CPRX sank on the an­nounce­ment and have not since re­vived. Adding fu­el to the fire, ear­li­er this week Ja­cobus re­vealed its drug, Ruzur­gi, will car­ry a list price that is less than half of Fir­dapse’s.

Cat­a­lyst main­tains that typ­i­cal­ly, cov­ered pa­tients pay less than $10 per month out-of-pock­et.

In LEMS pa­tients, the body’s own im­mune sys­tem launch­es an at­tack on the neu­ro­mus­cu­lar junc­tion — which con­nects nerves and mus­cles. The con­di­tion is as­so­ci­at­ed with oth­er au­toim­mune dis­eases, but tends to oc­cur in pa­tients with can­cer. Glob­al­ly it is es­ti­mat­ed to af­fect three per mil­lion in­di­vid­u­als, ac­cord­ing to the FDA, but its pe­di­atric preva­lence is not clear. Cat­a­lyst sug­gest­ed there are 3,000 LEMS US pa­tients, of which 300 are on Fir­dapse. Some es­ti­mates sug­gest there are few­er than three dozen pe­di­atric pa­tients in the Unit­ed States.

Un­der fed­er­al law, the agency is meant to treat all com­pa­nies in the same man­ner. Cat­a­lyst has as­sert­ed the agency un­der­mined the com­pa­ny’s or­phan drug ex­clu­siv­i­ty, and vi­o­lat­ed fed­er­al law by play­ing fa­vorites in con­text of a hy­per­vig­i­lant pric­ing en­vi­ron­ment.

The ap­proval let­ters for Cat­a­lyst and Ja­cobus sug­gest that while the for­mer sub­mit­ted a body of clin­i­cal tri­al ev­i­dence as part of the pack­age the FDA re­viewed, the lat­ter did not sub­mit da­ta from cer­tain tox­i­col­o­gy stud­ies. In­stead, the FDA has asked Ja­cobus to pro­vide these da­ta as a post-mar­ket­ing re­quire­ment.

“We felt that the FDA’s ap­proval of Ruzur­gi was ar­bi­trary, capri­cious and not in ac­cord with the Food, Drug & Cos­met­ic Act,” Cat­a­lyst chief Patrick McE­nany told End­points News. 

“We be­lieve the FDA was im­prop­er­ly in­flu­enced in mak­ing this de­ci­sion by po­lit­i­cal pres­sures with re­gard to high drug pric­ing and we think it sets a hor­ri­ble prece­dent for oth­er com­pa­nies work­ing to de­vel­op drugs to treat rare dis­eases — it could in fact dis­cour­age com­pa­nies from in­vest­ing mil­lions of dol­lars and spend­ing many years to do this,” he said.

Ear­li­er this year, Ver­mont Sen­a­tor Bernie Sanders — ahead of his an­nounce­ment to make a sec­ond at­tempt at the pres­i­den­cy — spot­light­ed Cat­a­lyst for the “im­moral ex­ploita­tion of pa­tients.”

McE­nany em­pha­sized that Cat­a­lyst has spent more than $100 mil­lion dol­lars in de­vel­op­ing the drug over the last sev­en years — and that his hope is the law­suit will cul­mi­nate in the with­draw­al of the Ruzur­gi ap­proval.

An FDA spokesper­son said the agency does not com­ment on pend­ing lit­i­ga­tion. End­points News has con­tact­ed Ja­cobus for com­ment.

Im­age: An­drew Harnik, AP Im­ages

For years, the idea of protein degradation — utilizing the cell’s natural garbage disposal system to mark problematic proteins for destruction — remained an elegant but technically difficult concept. But now established as a promising clinical strategy, with major biopharma players such as Bayer, Gilead and Vertex trying to grab a foothold via partnership deals, a San Diego startup is looking to exploit it and push its limits.

Medical animation has in recent years become an increasingly important tool for conveying niche information to a varied audience, particularly to those audiences without expertise in the specialist area. Science programmes today, for example, have moved from the piece-to-camera of the university professor explaining how a complex disease mechanism works, to actually showing the viewer first-hand what it might look like to shrink ourselves down to the size of an ant’s foot, and travel inside the human body to witness these processes in action. Effectively communicating a complex disease pathophysiology, or the novel mechanism of action of a new drug, can be complex. This is especially difficult when the audience domain knowledge is limited or non-existent. Medical animation can help with this communication challenge in several ways.
Improved accessibility to visualisation
Visualisation is a core component of our ability to understand a concept. Ask 10 people to visualise an apple, and each will come up with a slightly different image, some apples smaller than others, some more round, some with bites taken. Acceptable, you say, we can move on to the next part of the story. Now ask 10 people to visualise how HIV’s capsid protein gets arranged into the hexamers and pentamers that form the viral capsid that holds HIV’s genetic material. This request may pose a challenge even to someone with some virology knowledge, and it is that inability to effectively visualise what is going on that holds us back from fully understanding the rest of the story. So how does medical animation help us to overcome this visualisation challenge?