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.

Another big drug approval came through on Friday afternoon as the FDA OK’d AbbVie’s upadacitinib — an oral JAK1 inhibitor that is hitting the rheumatoid arthritis market with a black box warning of serious malignancies, infections and thrombosis reflecting fears associated with the class.

It will be sold as Rinvoq — at a wholesale price of $59,000 a year — and will likely soon face competition from a drug that AbbVie once controlled, and spurned. Reuters reports that a 4-week supply of Humira, by comparison, is $5,174, adding up to about $67,000 a year.

After a “hot” period of rapid growth between 2009 and 2012, and a relatively “cooler” period of slower growth from 2013 to 2015, China has once again become a top-of-mind priority for the CEOs of most large, multinational pharmaceutical companies.

At the International Pharma Forum, hosted in March in Beijing by the R&D Based Pharmaceutical Association Committee (RDPAC) and the Pharmaceutical Research and Manufacturers of America (PhRMA), no fewer than seven CEOs of major multinational pharmaceutical firms participated, including GSK, Eli Lilly, LEO Pharma, Merck KGaA, Pfizer, Sanofi and UCB. A few days earlier, the CEOs of several other large multinationals attended the China Development Forum, an annual business forum hosted by the research arm of China’s State Council. It’s hard to imagine any other country, except the US, having such drawing power at CEO level.

ICER has some strong words for PTC, Sarepta and the FDA as the US drug price watchdog concludes that as currently priced, their respective new treatments for Duchenne muscular dystrophy are decidedly not cost-effective.

The final report — which cements the conclusions of a draft issued in May — incorporates the opinion of a panel of 17 experts ICER convened in a public meeting last month. It also based its analysis of Emflaza (deflazacort) and Exondys 51 (eteplirsen) on updated annual costs of $81,400 and over $1 million, respectively, after citing “incorrect” lower numbers in the initial calculations.