Durec­t's non-opi­oid painkiller brush­es aside check­ered past, gain­ing FDA ap­proval in shoul­der surg­eries

Af­ter a long and of­ten bumpy ride, Durect’s non-opi­oid painkiller has re­ceived the FDA’s en­dorse­ment.

US reg­u­la­tors ap­proved the sus­tained-re­lease bupi­va­caine so­lu­tion for use up to 72 hours af­ter cer­tain shoul­der surg­eries, Durect an­nounced Tues­day morn­ing. The drug is called Posimir, and its ap­proval breathes life in­to a com­pa­ny that once teetered on pen­ny stock ter­ri­to­ry af­ter the pro­gram racked up two tri­al fail­ures and a CRL.

Durect’s $DR­RX shares shot up about 24% in ear­ly Tues­day trad­ing. The com­pa­ny will be re­quired to con­duct two post­mar­ket­ing, non-clin­i­cal stud­ies.

Doc­tors will be able to use the drug in what’s called sub­acro­mi­al de­com­pres­sion surg­eries that treat shoul­der im­pinge­ments. The in­juries stem from too much repet­i­tive use and cause pain when in­di­vid­u­als raise their arms over their heads.

Nor­mal­ly, such surg­eries are per­formed arthro­scop­i­cal­ly in an out­pa­tient set­ting, in­sert­ing sur­gi­cal in­stru­ments in­to small in­ci­sions made in the shoul­der with the aid of a small cam­era. The idea be­hind the drug is to de­liv­er it di­rect­ly in­to the shoul­der space be­tween the col­lar­bone and ball-and-sock­et joint once the surgery it­self is com­plet­ed.

Posimir then func­tions as a lo­cal anal­gesic and an al­ter­na­tive to oral opi­oid painkillers typ­i­cal­ly ad­min­is­tered in re­cov­ery. The first three days af­ter the surgery are usu­al­ly the most painful, Durect says, and Posimir con­tin­u­ous­ly re­leas­es bupi­va­caine in the shoul­der for 72 hours or more to com­bat that pain.

The com­pa­ny added that the 660 mg of bupi­va­caine con­tained in the drug is more than any oth­er ap­proved sin­gle-dose, sus­tained-re­lease bupi­va­caine prod­uct. Durect is aim­ing at a mar­ket that sees about 600,000 such shoul­der surg­eries per year where full re­cov­ery time can last from weeks to months.

For now, Posimir will be lim­it­ed to this type of pro­ce­dure, as the drug is not in­di­cat­ed for soft tis­sue sur­gi­cal pro­ce­dures or oth­er or­tho­pe­dic pro­ce­dures, such as ad­min­is­tra­tion in­to a joint or bone.

Posimir’s rocky his­to­ry be­gan sev­er­al years ago. Durect re­port­ed a tri­al fail­ure back in 2012, and in 2014 the FDA re­ject­ed its pitch over safe­ty con­cerns. Af­ter reg­u­la­tors re­quest­ed a change to the tri­al in 2016, Durect con­duct­ed an­oth­er study di­vid­ed in­to two parts: a place­bo arm and com­para­tor arm.

That study al­so flopped in 2017, demon­strat­ing no sta­tis­ti­cal dif­fer­ence in pa­tient re­sponse be­tween the arms in pain re­duc­tion for the first 48 hours af­ter surgery. The news sent Durect shares crash­ing in­to pen­ny stock ter­ri­to­ry at the time and al­so dinged its part­ner No­var­tis, where the San­doz unit had paid $20 mil­lion up­front in a $293 mil­lion deal.

Posimir re­turned to the FDA in an ad­comm in Jan­u­ary 2020, and the pan­el could not de­cide whether to rec­om­mend ap­proval. It split down the mid­dle with a 6-6 vote, not­ing neu­ro­log­i­cal safe­ty con­cerns and sug­gest­ing the ther­a­py’s du­ra­tion of ac­tion was lim­it­ed to 12 to 24 hours. Those in fa­vor of ap­proval not­ed pa­tients could see ben­e­fits sim­ply be­cause the drug is not an opi­oid.

Has the mo­ment fi­nal­ly ar­rived for val­ue-based health­care?

RBC Capital Markets’ Healthcare Technology Analyst, Sean Dodge, spotlights a new breed of tech-enabled providers who are rapidly transforming the way clinicians deliver healthcare, and explores the key question: can this accelerating revolution overturn the US healthcare system?

Key points

Tech-enabled healthcare providers are poised to help the US transition to value, not volume, as the basis for reward.
The move to value-based care has policy momentum, but is risky and complex for clinicians.
Outsourced tech specialists are emerging to provide the required expertise, while healthcare and tech are also converging through M&A.
Value-based care remains in its early stages, but the transition is accelerating and represents a huge addressable market.

Lat­est on ul­tra-rare dis­ease ap­proval; Pos­i­tive, if mixed, signs for Bio­gen's ALS drug; Clay Sie­gall finds a new job; and more

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Over the last four years, we’ve honored 80 women whose extraordinary accomplishments have changed the game in biopharma R&D. You can now nominate someone to be highlighted in this year’s special report. Details are here.

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FDA spells out how can­cer drug de­vel­op­ers can use one tri­al for both ac­cel­er­at­ed and full ap­provals

The FDA’s Oncology Center of Excellence has been a bright spot within the agency in terms of speeding new treatments to patients. That flexibility was on full display this morning as FDA released new draft guidance spelling out exactly how oncology drug developers can fulfill both the accelerated and full approval’s requirements with just a single randomized controlled trial.

While Congress recently passed legislation that will allow FDA to require confirmatory trials to be recruiting and ongoing prior to granting an accelerated approval, the agency is now making clear that the initial trial used to win the AA, if designed appropriately, can also serve as the trial for converting the accelerated approval into a full approval.

FDA ad­vi­sors unan­i­mous­ly rec­om­mend ac­cel­er­at­ed ap­proval for Bio­gen's ALS drug

A panel of outside advisors to the FDA unanimously recommended that the agency grant accelerated approval to Biogen’s ALS drug tofersen despite the drug failing the primary goal of its Phase III study, an endorsement that could pave a path forward for the treatment.

By a 9-0 vote, members of the Peripheral and Central Nervous System Drugs Advisory Committee said there was sufficient evidence that tofersen’s effect on a certain protein associated with ALS is reasonably likely to predict a benefit for patients. But panelists stopped short of advocating for a full approval, voting 3-5 against (with one abstention) and largely citing the failed pivotal study.

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Clay Siegall, Morphimmune CEO

Up­dat­ed: Ex-Seagen chief Clay Sie­gall emerges as CEO of pri­vate biotech

Clay Siegall will be back in the CEO seat, taking the helm of a private startup working on targeted cancer therapies.

It’s been almost a year since Siegall resigned from Seagen, the biotech he co-founded and led for more than 20 years, in the wake of domestic violence allegations by his then-wife. His eventual successor, David Epstein, sold the company to Pfizer in a $43 billion deal unveiled last week.

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Sijmen de Vries, Pharming CEO

FDA ap­proves Pharm­ing drug for ul­tra-rare im­mun­od­e­fi­cien­cy dis­ease

US regulators cleared an ultra-rare drug from Pharming Group, by way of Novartis, on Friday afternoon.

The Dutch biotech said the FDA greenlit leniolisib for an immunodeficiency disease known as activated phosphoinositide 3-kinase delta (PI3Kδ) syndrome, or APDS. People 12 years and older can receive the oral drug, to be marketed as Joenja, beginning early next month, Pharming said, five days ahead of the decision deadline set by the FDA as part of a priority review.

No­vo Nordisk oral semaglu­tide tri­al shows re­duc­tion in blood sug­ar, plus weight loss

Novo Nordisk is testing higher levels of its oral version of its GLP-1, semaglutide, and its type 2 diabetes trial results released today show reductions in blood sugar as well as weight loss.

In the Phase IIIb trial, Novo compared its oral semaglutide in 25 mg and 50 mg doses with the 14 mg version that’s currently the maximum approved dose. The trial looked at how the doses compared when added to a stable dose of one to three oral antidiabetic medicines in people with type 2 diabetes who were in need of an intensified treatment.

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Ly­me vac­cine test com­ple­tion is pushed back by a year as Pfiz­er, Val­ne­va say they'll ad­just tri­al

Valneva and Pfizer have adjusted the end date for the Phase III study of their investigational Lyme disease vaccine, pushing it back by a year after issues at a contract researcher led to thousands of US patients being dropped from the test.

In a March 20 update to clinicaltrials.gov, Valneva and Pfizer moved the primary completion date on the trial, called VALOR, from the end of 2024 to the end of 2025.

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Stuart Peltz, former PTC Therapeutics CEO

Stu­art Peltz re­signs as PTC Ther­a­peu­tics CEO af­ter 25 years

Stuart Peltz, the longtime CEO of PTC Therapeutics who’s led the rare disease drug developer since its founding 25 years ago, is stepping down.

Succeeding him in the top job is Matthew Klein, who joined PTC in 2019 and was promoted to chief operating officer in 2022. In a call with analysts, he said the CEO transition has been planned for “quite some time” — in fact, as part of it, he gave the company’s presentation at the JP Morgan healthcare conference earlier this year.

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