Back from the dead: Nek­tar hunts a block­buster deal as opi­oid '181 looks less ad­dic­tive than oxy

Af­ter whip­ping up some up­beat an­a­lyst as­sess­ments in March with a pos­i­tive late-stage ef­fi­ca­cy study for their mu-opi­oid pain ther­a­py NK­TR-181, Nek­tar Ther­a­peu­tics has now put the fin­ish­ing touch­es to its deal pack­age on the drug with more Phase III da­ta to po­si­tion this as a first-of-its-kind opi­oid that ad­dicts can’t abuse, no mat­ter what they do to it, while ef­fec­tive­ly com­bat­ing pain.

With a big fo­cus on on­col­o­gy, Nek­tar $NK­TR has made it clear that they don’t plan to han­dle this so­lo, look­ing to ei­ther li­cens­ing it out com­plete­ly or work­ing on a co-mar­ket­ing pact. But CEO Howard Robin clear­ly wants to do this on the ba­sis that NK­TR-181 is the so­lu­tion to the opi­oid cri­sis that has been grab­bing head­lines from coast-to-coast.

And that calls for a block­buster deal, to hear him tell it.

“We’re go­ing to be fair­ly soon tak­ing all of our da­ta to the FDA,” Robin tells me.  “We have fast track sta­tus and there’s cer­tain­ly a great de­sire at the agency to see our re­sults. The reg­u­la­to­ry au­thor­i­ties un­der­stand that this is po­ten­tial­ly a so­lu­tion to the opi­oid abuse in our coun­try. No oth­er mol­e­cule like this is avail­able.”

In March the news from Nek­tar was that NK­TR-181 beat out a place­bo in re­duc­ing pain. The com­par­i­son da­ta weren’t stel­lar, but it was sig­nif­i­cant. To­day, Nek­tar wants you to know that a wide range of com­par­isons on lik­a­bil­i­ty with a range of dos­es in a head-to-head with oxy demon­strat­ed that there was a con­sis­tent and sig­nif­i­cant­ly low­er at­tach­ment to their opi­oid. Again, the da­ta points didn’t hit the ball out of the park, but they came in pos­i­tive — with the ex­cep­tion of one com­par­i­son with a 40 mg dose of oxy.

Study the end­points, says Robin, and it’s clear that this drug takes much longer than mar­ket­ed opi­oids to take ef­fect. So there’s no im­me­di­ate rush that ad­dicts are look­ing for.

“If some­one wants to abuse a drug,” he says, “they don’t want to wait 3 hours to get there. They want that 10-minute rush.”

That’s some­thing a ma­jor mar­ket­ing group could do well with in the on­go­ing cri­sis en­vi­ron­ment.

“First, you know this is pret­ty much a pri­ma­ry care mar­ket,” says Robin, and Nek­tar’s not in a po­si­tion to mar­ket to a large pri­ma­ry care au­di­ence. We’re an R&D com­pa­ny at this stage, look­ing for a part­ner who can do this. While it is an opi­oid, it’s nov­el and dif­fer­ent.” A deal “could range from a pure out-li­cens­ing agree­ment with a very sig­nif­i­cant up­front and very sig­nif­i­cant back end, or a joint ven­ture and we keep our hand in sales and mar­ket­ing.”

“This is not a for­mu­la­tion or a coat­ing,” adds the CEO. “It’s tak­en as a tablet or liq­uid with the ex­act same ef­fect. There’s re­al­ly no way to al­ter its prop­er­ties. Ap­ply any chem­istry you like. You can make it in­ef­fec­tive but you can’t sep­a­rate the opi­oid from the over­all mol­e­cule. No eu­pho­ria is as­so­ci­at­ed with 181. Chop it up. Dice it up. Turn it in­to a liq­uid. In­ject it… It’s a new opi­oid mol­e­cule that is high­ly ef­fi­ca­cious and just not like­able. For me it is a ma­jor break­through; a crit­i­cal step.”

Re­mark­ably, ‘181 failed a Phase II study in 2013. But Jef­feries’ David Stein­berg not­ed af­ter the ef­fi­ca­cy da­ta came out in March that this one was back from the dead. This pain ther­a­py could be par­tic­u­lar­ly ef­fec­tive deal­ing with chron­ic pain, es­pe­cial­ly low­er back pain. He not­ed:

As such, peak sales could be in the $1B+ range and pos­si­bly much high­er. Our new mod­el as­sumes NDA sub­mis­sion in late 2019, launch in 2H20 and 30% roy­al­ty (sim­i­lar to Amikacin In­hale) with a sig­nif­i­cant up­front and mile­stones in ex­cess of $200M.

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.