Eli Lil­ly has suf­fered through the biggest set­backs in late-stage drug de­vel­op­ment work for Alzheimer’s — pil­ing up high-pro­file fail­ures for sema­gace­s­tat, solanezum­ab and just months ago lan­abece­s­tat af­ter it be­came ap­par­ent that the BACE ap­proach was a non-starter in symp­to­matic pa­tients. To­day, it’s sig­nal­ing that the com­pa­ny is now ready to fold their hand ear­ly if it doesn’t look like they have a rea­son­able chance to go on to win the pot.

Out in the quar­ter­ly cleanup went a Phase II BACE com­bo in­clud­ing an an­ti­body for N3PG. And the com­pa­ny al­so axed what was termed an SEL BACE 1 Phase I study. N3PG will con­tin­ue on its own.

“There are many vari­abil­i­ties at play with the BACE class and re­cent find­ings from Lil­ly and oth­ers have chal­lenged the BACE hy­poth­e­sis,” notes a spokesper­son from Eli Lil­ly in an email fol­lowup with me. “As a field we are still eval­u­at­ing the class and will con­tin­ue to have ro­bust sci­en­tif­ic dis­cus­sions about its vi­a­bil­i­ty.”

Mer­ck dealt a de­ci­sive blow to BACE with back-to-back Phase III stud­ies in which the drug did what was ex­pect­ed in terms of turn­ing the tap off on amy­loid be­ta, the long­time cul­prit for a dis­ease that wipes out mem­o­ry. With clear ev­i­dence that the strat­e­gy is a non-starter, Lil­ly and its part­ners at As­traZeneca agreed to kill off their late-stage pro­gram for lan­abece­s­tat af­ter re­view­ing the re­sults to date.

But BACE isn’t quite fin­ished yet. 

Back in ear­ly June, Ei­sai and Bio­gen claimed a sig­nif­i­cant suc­cess for their BACE drug, elen­be­ce­s­tat. But while the bio­mark­er for amy­loid be­ta re­duc­tion was hit, the re­searchers failed to see a sta­tis­ti­cal­ly sig­nif­i­cant im­prove­ment in the de­cline of cog­ni­tion. That didn’t stop them from main­tain­ing that they had tracked a re­sponse “sug­gest­ing a de­lay of clin­i­cal symp­tom de­cline in ex­plorato­ry end­points.”

It wasn’t ex­act­ly a big win, rais­ing fresh doubts for two com­pa­nies that con­tin­ue to have a big stake in the amy­loid be­ta the­o­ry.

Ei­sai and Bio­gen have had their hands full de­fend­ing their da­ta on a dif­fer­ent drug, BAN2401, af­ter a change­up in the study de­sign drew a host of crit­ics sug­gest­ing that they had tilt­ed the tri­al to­ward a pos­i­tive out­come. And the crit­ics haven’t backed off af­ter a re­cent at­tempt to de­fend those re­sults.

The last four years have seen a sudden explosion in treatments for spinal muscular atrophy, a neurodegenerative condition that once led patients — often young ones — with a grim prognosis and no options. The prognosis still isn’t rosy, but now there are three FDA-approved options, enough to make the choice of one difficult.

Now a fourth potential option has entered the mix. Today, Scholar Rock announced the results from a proof-of-concept testing their SMA drug by itself and in combination with Ionis’ Spinraza, showing that all patient cohorts improved on standard scales used for measuring motor function in people with SMA.

A couple years after licensing Novimmune’s emapalumab and turning around a quick FDA OK, Stockholm-based Sobi is betting up to $1.2 billion for rights to another rare disease drug.

The company is shelling out $250 million upfront and adding up to $915 million in milestones for rights to develop and commercialize Apellis Pharmaceuticals’ drug pegcetacoplan outside the US. Together, the companies will see the systemic C3 therapy through five registrational trials in hematology, nephrology and neurology.

Three years ago, Catabasis CEO Jill Milne and the crew insisted they had found good reason for great cheer once they plumbed the data from their failed study for the Duchenne MD drug edasalonexent. Plunging into the extended open-label data, they said, you could find solid evidence of efficacy. And that justified a try in Phase III.

But they were wrong.

Monday, after the bell, the little biotech acknowledged that their pivotal attempt following the mid-stage flop was another failure. The primary, change in baseline on the North Star Ambulatory Assessment, and the secondary on timed function tests both came up short of statistical significance.