Covid-19 roundup: FDA re­veals boost­er ad­comm ques­tion; Eli Lil­ly's an­ti­body cock­tail cleared for pre­ven­tion

The FDA re­leased brief­ing doc­u­ments this week from the agency and Pfiz­er each out­lin­ing their ar­gu­ments for to­day’s Covid-19 boost­er shot ad­comm, but one thing con­spic­u­ous­ly miss­ing was the ques­tion on which pan­el mem­bers would be vot­ing. But late Thurs­day night, reg­u­la­tors pub­lished that ques­tion.

Ad­comm mem­bers will be asked whether or not the safe­ty and ef­fi­ca­cy da­ta from Pfiz­er/BioN­Tech’s orig­i­nal Phase III study “sup­port ap­proval” of a boost­er shot at least six months af­ter the sec­ond dose in in­di­vid­u­als old­er than 16. The ques­tion no­tably ex­cludes the re­al-world da­ta from Is­rael and oth­er analy­ses that Pfiz­er and the Biden ad­min­is­tra­tion had said would be a cen­ter­piece of their ar­gu­ments for boost­ers.

It’s not im­me­di­ate­ly clear whether this ques­tion would be the on­ly one asked at the ad­comm, but the FDA had yet to up­date its web­site as of ear­ly Fri­day morn­ing.

Here’s the ex­act word­ing:

Do the safe­ty and ef­fec­tive­ness da­ta from clin­i­cal tri­al C4591001 sup­port ap­proval of a COMIR­NATY boost­er dose ad­min­is­tered at least 6 months af­ter com­ple­tion of the pri­ma­ry se­ries for use in in­di­vid­u­als 16 years of age and old­er? Please vote Yes or No.

Pfiz­er spent much of its 53-page brief­ing doc­u­ment on the var­i­ous ob­ser­va­tion­al stud­ies that have popped up dur­ing the Delta surge, show­ing the vac­cine’s pro­tec­tion against mild dis­ease wan­ing over time but re­main­ing very strong against se­vere Covid-19 and hos­pi­tal­iza­tion. The FDA’s brief­ing doc­u­ments, how­ev­er, spent on­ly two para­graphs ad­dress­ing those stud­ies, say­ing there is a lot that present “con­flict­ing con­clu­sions.”

The word­ing of the ques­tion dif­fers con­sid­er­ably from those asked in the orig­i­nal vac­cine ad­comms last year, be­fore any vac­cine had been au­tho­rized or ap­proved. Fri­day’s ques­tion fo­cus­es specif­i­cal­ly on sup­port­ing ap­proval, where­as the old­er ques­tions asked whether or not the ben­e­fits of the vac­cine out­weighed the risks.

It’s a phras­ing some out­side ob­servers strug­gled to in­ter­pret. Walid Gel­lad, di­rec­tor of the Uni­ver­si­ty of Pitts­burgh Cen­ter for Phar­ma­ceu­ti­cal Pol­i­cy and Pre­scrib­ing, not­ed in a Twit­ter thread Thurs­day night the con­trast be­tween the ques­tion and the “nar­row” fo­cus on the Phase III study.

— Max Gel­man

FDA ex­pands EUA for Eli Lil­ly’s an­ti­body cock­tail to cov­er pre­ven­tion

Eli Lil­ly and Ab­Cellera are square­ly back in ac­tion.

Just days af­ter the US re­sumed dis­tri­b­u­tion of their an­ti­body cock­tail na­tion­wide to fight against a surge in cas­es — dom­i­nat­ed by the Delta vari­ant — the com­pa­nies said the com­bo of bam­lanivimab and ete­se­vimab has been cleared for emer­gency use to pre­vent Covid-19 in peo­ple who have been ex­posed to some­one in­fect­ed with SARS-CoV-2 or at high risk of ex­po­sure, such as in the prison or nurs­ing home set­ting.

It marks the sec­ond EUA the FDA has is­sued for post-ex­po­sure pro­phy­lax­is, af­ter grant­i­ng the same ex­pan­sion for Re­gen­eron’s an­ti­bod­ies.

On top of pro­tect­ing peo­ple who have not been ful­ly vac­ci­nat­ed, Lil­ly notes that in­di­vid­u­als who can’t mount an ad­e­quate im­mune re­sponse to com­plete vac­ci­na­tion may ben­e­fit from the drugs. It’s sanc­tioned for high-risk in­di­vid­u­als 12 or old­er.

The com­bi­na­tion of a low vac­ci­na­tion rate and a rise in break­through Covid-19 cas­es has trans­lat­ed to sky­rock­et­ing de­mand for mon­o­clon­al an­ti­bod­ies. Just days ago, Re­gen­eron re­vealed the gov­ern­ment has placed a new, $2.9 bil­lion or­der for 1.4 mil­lion ad­di­tion­al dos­es of its an­ti­bod­ies.

Lil­ly had li­censed bam­lanivimab from Ab­Cellera and ete­se­vimab from Shang­hai’s Jun­shi to put to­geth­er the com­bo.

“The ex­pand­ed use au­tho­riza­tion for bam­lanivimab to­geth­er with ete­se­vimab pro­vides a way to pro­tect the sig­nif­i­cant num­ber of peo­ple who, be­cause of their sit­u­a­tion­al ex­po­sure risk or med­ical con­di­tion, re­main vul­ner­a­ble to COVID-19,” Ab­Cellera CEO Carl Hansen said in a state­ment. “More than 535,000 pa­tients have been treat­ed with bam­lanivimab alone or to­geth­er with ete­se­vimab, po­ten­tial­ly keep­ing more than 25,000 pa­tients out of the hos­pi­tal and sav­ing more than 10,000 lives.”

— Am­ber Tong

Re­searchers peg As­traZeneca/Ox­ford, Pfiz­er/BioN­Tech vac­cine im­mu­ni­ty about 1 year

A group of Ox­ford sci­en­tists says the Covid-19 vac­cine that their col­leagues have de­vel­oped with As­traZeneca ap­pears to kick up an­ti­bod­ies that last equal­ly as long as the ones elicit­ed by Pfiz­er and BioN­Tech’s ri­val shot.

An­a­lyz­ing an­ti-spike IGG an­ti­body re­spons­es among 186,527 vac­ci­nat­ed peo­ple in the UK to fig­ure out the du­ra­tion of pro­tec­tion of­fered by the two vac­cines, the re­searchers con­clud­ed:

Pro­tec­tion based on cur­rent pos­i­tiv­i­ty thresh­olds can last for at least 0.5-1 year for ChA­dOx1 and over a year for BNT162b2; how­ev­er, giv­en the re­duced ef­fec­tive­ness against vari­ants of con­cern, the du­ra­tion of pro­tec­tion may be sig­nif­i­cant­ly re­duced. These re­sults may in­form vac­ci­na­tion strate­gies; a third boost­ing dose may be need­ed, and could be pri­ori­tised to the more vul­ner­a­ble pop­u­la­tion groups.

They al­so found that no mat­ter when it’s giv­en af­ter the first dose, a sec­ond dose of ChA­dOx1 and BNT162b2 in­duced “sig­nif­i­cant boost­ing” of an­ti-spike an­ti­bod­ies tar­get­ing SARS-CoV-2.

There was, how­ev­er, a key dif­fer­ence: An­ti­body lev­els de­clined faster for younger in­di­vid­u­als af­ter a sec­ond dose of the Ox­ford/As­traZeneca vac­cine, while old­er peo­ple get­ting BNT162b2 saw their lev­els de­cline faster — al­though it was off­set by high­er peak lev­els.

“In the most vul­ner­a­ble groups, the net ef­fect was a sim­i­lar du­ra­tion of time above dif­fer­ent thresh­olds from the two vac­cines, but with longer du­ra­tions with BNT162b2 in younger groups,” they added.

No­tably, they al­so of­fered a coun­ter­point to re­cent stud­ies that sug­gest­ed longer dos­ing in­ter­vals may gen­er­ate more im­mu­ni­ty, sug­gest­ing that the dif­fer­ences in an­ti­body lev­els may be re­lat­ed to how and when those stud­ies mea­sured an­ti­body lev­els.

— Am­ber Tong

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.

Covid-19 vac­cine boost­ers earn big thumbs up, but Mod­er­na draws ire over world sup­ply; What's next for Mer­ck’s Covid pill?; The C-suite view on biotech; 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.

You may remember that at the beginning of this year, Endpoints News set a goal to go broader and deeper. We are still working towards that, and are excited to share that Beth Snyder Bulik will be joining us on Monday to cover all things pharma marketing. You can sign up for her weekly Endpoints MarketingRx newsletter in your reader profile.

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No­var­tis de­vel­op­ment chief John Tsai: 'We go deep in the new plat­form­s'

During our recent European Biopharma Summit, I talked with Novartis development chief John Tsai about his experiences over the 3-plus years he’s been at the pharma giant. You can read the transcript below or listen to the exchange in the link above.

John Carroll: I followed your career for quite some time. You’ve had more than 20 years in big pharma R&D and you’ve obviously seen quite a lot. I really was curious about what it was like for you three and a half years ago when you took over as R&D chief at Novartis. Obviously a big move, a lot of changes. You went to work for the former R&D chief of Novartis, Vas Narasimhan, who had his own track record there. So what was the biggest adjustment when you went into this position?

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Tillman Gerngross, Adagio CEO

Q&A: Till­man Gern­gross ex­plains why his Covid mAb will have an edge over an al­ready crowd­ed field

If anyone knows about monoclonal antibodies, it’s serial entrepreneur, Adimab CEO, and Dartmouth professor of bioengineering Tillman Gerngross.

Even the name of Gerngross’ new antibody startup Adagio Therapeutics is meant to reflect his vision behind the development of his Covid-19 mAb: slowly, he said, explaining that “everyone else, whether it’s Regeneron, Lilly, or AstraZeneca, Vir, they all valued speed over everything.”

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Amit Etkin, Alto Neuroscience CEO (Alto via Vimeo)

A star Stan­ford pro­fes­sor leaves his lab for a start­up out to re­make psy­chi­a­try

About five years ago, Amit Etkin had a breakthrough.

The Stanford neurologist, a soft-spoken demi-prodigy who became a professor while still a resident, had been obsessed for a decade with how to better define psychiatric disorders. Drugs for depression or bipolar disorder didn’t work for many patients with the conditions, and he suspected the reason was how traditional diagnoses didn’t actually get at the heart of what was going on in a patient’s brain.

Susan Galbraith, Executive VP, Oncology R&D, AstraZeneca

As­traZeneca on­col­o­gy R&D chief Su­san Gal­braith: 'Y­ou're go­ing to need or­thog­o­nal com­bi­na­tion­s'


Earlier in the week we broadcast our 4th annual European Biopharma Summit with a great lineup of top execs. One of the one-on-one conversations I set up was with Susan Galbraith, the oncology research chief at AstraZeneca. In a wide-ranging discussion, Galbraith reviewed the cancer drug pipeline and key trends influencing development work at the pharma giant. You can watch the video, above, or stick with the script below. — JC

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Roche's Tecen­triq cross­es the fin­ish line first in ad­ju­vant lung can­cer, po­ten­tial­ly kick­ing off gold rush

While falling behind the biggest PD-(L)1 drugs in terms of sales, Roche has looked to carve out a space for its Tecentriq with a growing expertise in lung cancer. The drug will now take an early lead in the sought-after adjuvant setting — but competitors are on the way.

The FDA on Friday approved Tecentriq as an adjuvant therapy for patients with Stage II-IIIA non small cell lung cancer with PD-(L)1 scores greater than or equal to 1, making it the first drug of its kind approved in an early setting that covers around 40% of all NSCLC patients.

FDA's vac­cine ad­comm unan­i­mous­ly sup­ports Mod­er­na's boost­er in same pop­u­la­tions as Pfiz­er's boost­er

The FDA’s vaccine advisory committee on Thursday voted 19-0 in support of expanding Moderna’s Covid-19 vaccine EUA for booster doses for certain high-risk individuals. FDA is expected to authorize the Moderna booster shortly.

Similarly to the Pfizer booster shot, Moderna’s will likely be authorized for those older than 65, adults at high risk of severe Covid-19, and adults whose frequent institutional or occupational exposure to SARS-CoV-2 puts them at high risk of serious complications of Covid-19. But unlike the Pfizer adcomm, where FDA had to scramble to get the committee to vote in favor of a booster, this committee was unanimous with the Moderna shot.

David Kessler testifies during a Senate hearing in May (Jim Lo Scalzo/Pool via AP Images)

Biden's fight with Mod­er­na over pro­vid­ing vac­cines for the poor­est coun­tries in­ten­si­fies

With about $10 billion in taxpayer funds invested in Moderna so far, it would seem that the company would be more understanding of pleas from President Joe Biden and the federal government to provide more vaccine doses to low- and middle-income countries.

But the Biden-Moderna feud over supplying the world with doses of mRNA vaccines is now spilling into the public, with Biden’s chief science officer of the government’s Covid-19 response David Kessler explaining the details in an online panel discussion moderated by Yale law professor Amy Kapczynski on Wednesday.

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