Durable, safe and ef­fec­tive long-term kid­ney drug da­ta from Tri­ci­da fu­el block­buster po­ten­tial

Kid­ney drug de­vel­op­er Tri­ci­da’s shares shot up on Thurs­day, af­ter long-term da­ta high­light­ed its lead drug’s durable ef­fi­ca­cy and safe­ty pro­file as a treat­ment for meta­bol­ic aci­do­sis, in which faulty kid­neys are not able to ex­pel the acid caus­ing a buildup in the body.

The drug — TRC101 — is de­signed to bind to hy­drochlo­ric acid in the GI tract, trig­ger­ing the ejec­tion of acid via ex­cre­tion — there­by di­min­ish­ing acid lev­els and stim­u­lat­ing blood bi­car­bon­ate. The com­pa­ny ex­pects to sub­mit an ap­pli­ca­tion to mar­ket the drug by the sec­ond half of this year for the con­di­tion com­mon­ly caused by chron­ic kid­ney dis­ease (and be­lieved to ac­cel­er­ate the pro­gres­sion of CKD), in­crease the risk of mus­cle wast­ing and cause the loss of bone den­si­ty. If ap­proved, it will be the first drug to win the FDA nod specif­i­cal­ly for meta­bol­ic aci­do­sis.

Ger­rit Klaern­er

Da­ta post­ed last June showed the drug in­duced a sta­tis­ti­cal­ly sig­nif­i­cant in­crease in blood bi­car­bon­ate in 208 pa­tients af­ter 12 weeks in a Phase III study, hours af­ter the com­pa­ny ad­ver­tised plans to go pub­lic in a $150 mil­lion IPO. On Thurs­day, Tri­ci­da re­vealed da­ta from a 40-week ex­ten­sion to that study in the 185 pa­tients that com­plet­ed one year as part of the tri­al.

The drug met all the pri­ma­ry and sec­ondary goals of the ex­ten­sion por­tion of the tri­al. The main goal of the ex­ten­sion study was the as­sess­ment of the long-term safe­ty pro­file of TRC101 ver­sus place­bo — and da­ta showed 2.6% of the pa­tients on TRC101 ver­sus 9.8% on place­bo dis­con­tin­ued the 40-week treat­ment pe­ri­od pre­ma­ture­ly.

Sig­nif­i­cant­ly, da­ta on the drug’s dura­bil­i­ty were al­so pos­i­tive. Over 52 weeks, 63% of the 111 TRC101-treat­ed pa­tients ex­hib­it­ed an in­crease in blood bi­car­bon­ate lev­el of at least 4 mil­liequiv­a­lents per liter, or achieved a blood bi­car­bon­ate lev­el in the nor­mal range — com­pared to 38% of the 74 place­bo sub­jects (p=0.0015).

The sta­tis­ti­cal plan al­so called for the eval­u­a­tion of TRC101 ver­sus place­bo for the com­pos­ite end­point of: all-cause mor­tal­i­ty, dial­y­sis/kid­ney trans­plant or a ≥50% de­cline in es­ti­mat­ed glomeru­lar fil­tra­tion rate (a test used to check how well the kid­neys are work­ing) — DD50 when tak­en to­geth­er — over the 52 week pe­ri­od. Of the 124 sub­jects giv­en TRC101, 4% (5) had a DD50 event, in­clud­ing one pa­tient who ini­ti­at­ed dial­y­sis. In con­trast, of the 93 sub­jects ran­dom­ized to the place­bo group, 10.8% (10) sub­jects had a DD50 event, in­clud­ing four deaths and one who ini­ti­at­ed dial­y­sis.

While the tri­al was not pow­ered to as­sess all-cause mor­tal­i­ty and/or the pro­gres­sion of CKD out­comes, Tri­ci­da said it ob­served a 65% re­duc­tion in the an­nu­al­ized event rate of the com­pos­ite end­point of all-cause mor­tal­i­ty and/or the pro­gres­sion of CKD in TRC101-treat­ed sub­jects ver­sus the place­bo group.

“The 52-week…re­sults far ex­ceed­ed our ex­pec­ta­tions,” said com­pa­ny chief Ger­rit Klaern­er said in a state­ment. “We did not an­tic­i­pate that we would ob­serve ev­i­dence of clin­i­cal ben­e­fit be­yond the in­crease in blood bi­car­bon­ate in pa­tients treat­ed with TRC101 un­til the read out of the re­sults of our post­mar­ket­ing tri­al…in the 2022 to 2023 time­frame.”

Shares of the South San Fran­cis­co-based drug de­vel­op­er $TC­DA leapt more than 57% on Thurs­day, clos­ing at $37.80.

Cowen’s Phil Nadeau, who deemed the da­ta ‘im­pres­sive,’ ex­pects TRC101 will achieve $1 bil­lion in rev­enue by 2025.

(T)here is a ma­jor need to con­trol meta­bol­ic aci­do­sis and slow the pro­gres­sion of CKD. Though sodi­um bi­car­bon­ate is ef­fec­tive, its high sodi­um con­cen­tra­tion makes most CKD pa­tients in­el­i­gi­ble for it…With 25 mil­lion peo­ple in the U.S. hav­ing stage 3, 4, or 5 CKD, TRC101 al­so ad­dress­es a large pa­tient pop­u­la­tion, and even mod­est pen­e­tra­tion could yield bil­lions in sales.

(T)he com­pos­ite end­point da­ta com­bined with the phys­i­cal func­tion­ing scores show clear, clin­i­cal­ly mean­ing­ful ben­e­fits to pa­tients. In fact, the dra­mat­ic re­duc­tion in the com­pos­ite end­point im­plies that physi­cians need to treat at most 3 pa­tients in or­der for 1 to de­rive a clin­i­cal­ly mean­ing­ful re­duc­tion in CKD pro­gres­sion.

Sep­a­rate­ly, Tri­ci­da on Thurs­day said it had amend­ed its debt fa­cil­i­ty with Her­cules Cap­i­tal, rais­ing the to­tal amount avail­able to up to $200 mil­lion from the $100 mil­lion agreed in Feb­ru­ary 2018.

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.

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 is 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 is 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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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.

David Lockhart, ReCode Therapeutics CEO

Pfiz­er throws its weight be­hind LNP play­er eye­ing mR­NA treat­ments for CF, PCD

David Lockhart did not see the meteoric rise of messenger RNA and lipid nanoparticles coming.

Thanks to the worldwide fight against Covid-19, mRNA — the genetic code that can be engineered to turn the body into a mini protein factory — and LNPs, those tiny bubbles of fat carrying those instructions, have found their way into hundreds of millions of people. Within the biotech world, pioneers like Alnylam and Intellia have demonstrated just how versatile LNPs can be as a delivery vehicle for anything from siRNA to CRISPR/Cas9.

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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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Leen Kawas (L) has resigned as CEO of Athira and will be replaced by COO Mark Litton

Ex­clu­sive: Athi­ra CEO Leen Kawas re­signs af­ter in­ves­ti­ga­tion finds she ma­nip­u­lat­ed da­ta

Leen Kawas, CEO and founder of the Alzheimer’s upstart Athira Pharma, has resigned after an internal investigation found she altered images in her doctoral thesis and four other papers that were foundational to establishing the company.

Mark Litton, the company’s COO since June 2019 and a longtime biotech executive, has been named full-time CEO. Kawas, meanwhile, will no longer have ties to the company except for owning a few hundred thousand shares.

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Pascal Soriot, AstraZeneca CEO (via Getty images)

UP­DAT­ED: FDA slaps As­traZeneca's MCL-1 can­cer drug with a hold af­ter safe­ty is­sue — 2 years af­ter Am­gen axed a trou­bled ri­val

There are new questions being posed about a class of cancer drugs in the wake of the second FDA-enforced clinical hold in the field.

Two years after the FDA hit Amgen with a clinical hold on its MCL-1 inhibitor AMG 397 following signs of cardiac toxicity, AstraZeneca says that regulators hit them with a hold on their rival therapy of the same class.

The pharma giant noted on clinicaltrials.gov that its Phase I/II study for the MCL-1 drug AZD5991 “has been put on hold to allow further evaluation of safety related information.”

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Sur­geons suc­cess­ful­ly at­tach pig kid­ney to a hu­man for the first time, us­ing tech from Unit­ed's Re­vivi­cor

In a first, researchers reportedly successfully transplanted a pig kidney into a human without triggering an immediate immune response this week. And the technology came from the biotech United Therapeutics.

Surgeons spent three days attaching the kidney to the patient’s blood vessels, but when all was said and done, the kidney appeared to be functioning normally in early testing, Reuters and the New York Times were among those to report. The kidney came from a genetically altered pig developed through United’s Revivicor unit.

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Sen. Richard Durbin (D-IL, foreground) and Sen. Richard Blumenthal (D-CT) (Patrick Semansky/AP Images)

Sen­a­tors back FDA's plan to re­quire manda­to­ry pre­scriber ed­u­ca­tion for opi­oids

Three Senate Democrats are backing an FDA plan to require mandatory prescriber education for opioids as overdose deaths have risen sharply over the past decade, with almost 97,000 American opioid-related overdose deaths in the past year alone.

While acknowledging a decline in overall opioid analgesic dispensing in recent years, the FDA said it’s reconsidering the need for mandatory prescriber training through a REMS given the current situation with overdoses, and is seeking input on the aspects of the opioid crisis that mandatory training could potentially mitigate.