FDA Ad­Com backs Gilead­'s move to ex­pand De­scovy la­bel — but stops short of en­dors­ing broad PrEP use

Gilead is one step clos­er to un­lock­ing a po­ten­tial­ly block­buster new use of its two-drug HIV reg­i­men De­scovy — though prob­a­bly not all of it.

In a meet­ing late Wednes­day, the FDA’s An­timi­cro­bial Drugs Ad­vi­so­ry Com­mit­tee vot­ed 16 to 2 en­dors­ing De­scovy as a pre-ex­po­sure pro­phy­lax­is, or PrEP, in men and trans­gen­der women who have sex with men. On the ques­tion of ex­pand­ing the in­di­ca­tion to in­clude cis­gen­der women, though, a slight ma­jor­i­ty of ex­perts (10 ver­sus 8) vot­ed against it, cit­ing a lack of da­ta.

Di­ana Brainard

The rec­om­men­da­tions were large­ly in line with the agency’s in-house re­view, which point­ed out that an ap­proval cov­er­ing cis­gen­der women would re­quire a ques­tion­able ex­trap­o­la­tion of PK da­ta. While Gilead did pro­vide proof of sys­temic drug con­cen­tra­tions, the mea­sure­ments were large­ly un­help­ful in quan­tifi­able and in­ter­pret­ing whether there are ad­e­quate drug con­cen­tra­tions in cer­vi­co­v­agi­nal tis­sues.

In a state­ment, Di­ana Brainard — SVP of HIV and emerg­ing virus­es — praised the Ad­Com for a “thought­ful re­view and dis­cus­sion of the da­ta.” Though the com­pa­ny did not com­ment di­rect­ly on ex­pand­ing De­scovy’s use to cis­gen­der women, it had this to add:

Gilead rec­og­nizes the val­ue that De­scovy could bring to HIV pre­ven­tion ef­forts for the broad­est pos­si­ble at-risk pop­u­la­tion in the Unit­ed States and will con­tin­ue to work with FDA as the agency com­pletes its re­view of the ap­pli­ca­tion.

In terms of seiz­ing a big piece of the mar­ket, though, miss­ing out on the cis­gen­der women la­bel might not be that big of a deal af­ter all. Cis­gen­der women form less than 7% of PrEP use, ac­cord­ing to Jef­feries an­a­lyst Michael Yee.

SVB Leerink’s Ge­of­frey Porges not­ed just a few days ago that MSMs form the most im­por­tant pop­u­la­tion for De­scovy’s add-on OK, though “for Gilead’s pur­pos­es it is use­ful to have a broad la­bel with all rel­e­vant at-risk pop­u­la­tions in­clud­ed, and get­ting such an en­dorse­ment from the Ad­Com would give their De­scovy launch ad­di­tion­al mo­men­tum.”

His peak sales es­ti­mate for De­scovy stands at $3.8 bil­lion.

Ad­di­tion­al mo­men­tum mat­ters here be­cause De­scovy will like­ly be go­ing up against gener­ics of Gilead’s own Tru­va­da, with launch­es sched­uled for next Sep­tem­ber. De­scovy’s ad­van­tages over Tru­va­da — sub­sti­tut­ing TAF, or teno­fovir alafe­namide, for TDF (teno­fovir diso­prox­il fu­marate) in com­bi­na­tion with emtric­itabine — could ap­pear slight un­der the best of cir­cum­stances. It re­mains to be seen whether pay­ers will be will­ing to cov­er a new brand­ed drug over a gener­ic for safe­ty is­sues such as bone min­er­al den­si­ty.

Brian Kaspar. AveXis via Twitter

AveX­is sci­en­tif­ic founder fires back at No­var­tis CEO Vas Narasimhan, 'cat­e­gor­i­cal­ly de­nies any wrong­do­ing'

Brian Kaspar’s head was among the first to roll at Novartis after company execs became aware of the fact that manipulated data had been included in its application for Zolgensma, now the world’s most expensive therapy.

But in his first public response, the scientific founder at AveXis — acquired by Novartis for $8.7 billion — is firing back. And he says that not only was he not involved in any wrongdoing, he’s ready to defend his name as needed.

I reached out to Brian Kaspar after Novartis put out word that he and his brother Allen had been axed in mid-May, two months after the company became aware of the allegations related to manipulated data. His response came back through his attorneys.

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We­bi­nar: Re­al World End­points — the brave new world com­ing in build­ing fran­chise ther­a­pies

Several biopharma companies have been working on expanding drug labels through the use of real world endpoints, combing through the data to find evidence of a drug’s efficacy for particular indications. But we’ve just begun. Real World Evidence is becoming an important part of every clinical development plan, in the soup-through-nuts approach used in building franchises.

I’ve recruited a panel of 3 top experts in the field — the first in a series of premium webinars — to look at the practical realities governing what can be done today, and where this is headed over the next few years, at the prodding of the FDA.

ZHEN SU — Mer­ck Serono’s Se­nior Vice Pres­i­dent and Glob­al Head of On­col­o­gy
EL­LIOTT LEVY — Am­gen’s Se­nior Vice Pres­i­dent of Glob­al De­vel­op­ment
CHRIS BOSHOFF — Pfiz­er On­col­o­gy’s Chief De­vel­op­ment Of­fi­cer

A premium subscription to Endpoints News is required to attend this webinar. Please upgrade to either an Insider or Enterprise plan for access. Already have Endpoints Premium? Please sign-in below. You can contact our Subscriptions team at help@endpointsnews.com with any issues.

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UP­DAT­ED: An em­bold­ened As­traZeneca splurges $95M on a pri­or­i­ty re­view vouch­er. Where do they need the FDA to hus­tle up?

AstraZeneca is in a hurry.

We learned this morning that the pharma giant — not known as a big spender, until recently — forked over $95 million to get its hands on a priority review voucher from Sobi, otherwise known as Swedish Orphan Biovitrum.

That marks another step down on price for a PRV, which allows the holder to slash 4 months off of any FDA review time.

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Martin Shkreli [via Getty]

Pris­on­er #87850-053 does not get to add drug de­vel­op­er to his list of cred­its

Just days after Retrophin shed its last ties to founder Martin Shkreli, the biotech is reporting that the lead drug he co-invented flopped in a pivotal trial. Fosmetpantotenate flunked both the primary and key secondary endpoints in a placebo-controlled trial for a rare disease called pantothenate kinase-associated neurodegeneration, or PKAN.

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Am­gen, Al­ler­gan biosim­i­lar of Roche's block­buster Rit­ux­an clears an­oth­er US piv­otal study 

Novartis $NVS may have given up, but Amgen $AMGN and Allergan $AGN are plowing ahead with their knockoff of Roche’s blockbuster biologic Rituxan in the United States.

Their copycat, ABP 798, was found to have a clinically equivalent impact as Rituxan — meeting the main goal of the study involving CD20-positive B-cell non-Hodgkin’s lymphoma patients. This is the second trial supporting the profile of the biosimilar. In January, it came through with positive PK results in patients with rheumatoid arthritis.

BeiGene and Mus­tang nail down spe­cial FDA sta­tus for top drugs; Roche bags added cov­er­age for Hem­li­bra

→ BeiGene $BGNE is getting a boost in its drive to field a rival to Imbruvica. The FDA has offered an accelerated review to zanubrutinib, a BTK inhibitor that has posted positive results for mantle cell lymphoma. The PDUFA date lands on February 27, 2020. The drug scored breakthrough status at the beginning of the year.

→ BeiGene isn’t the only biopharma company to gain special regulatory status today. Mustang Bio $MBIO and St. Jude Children’s Research Hospital announced that MB-107, a lentiviral gene therapy for the treatment of X-linked severe combined immunodeficiency, also known as bubble boy disease, has been granted Regenerative Medicine Advanced Therapy status.

Trump ad­min­is­tra­tion re­vives bid to get drug list prices on TV ads

The Trump administration is not giving up just yet. On Wednesday, the HHS filed an appeal against a judge’s decision in July to overturn a ruling obligating drug manufacturers to disclose the list price of their therapies in television adverts — hours before it was stipulated to go into effect.

In May, the HHS published a final ruling requiring drugmakers to divulge the wholesale acquisition cost— of a 30-day supply of the drug — in tv ads in a bid to enhance price transparency in the United States. The pharmaceutical industry has vehemently opposed the rule, asserting that list prices are not what a typical patient in the United States pays for treatment — that number is typically determined by the type of (or lack thereof) insurance coverage, deductibles and out-of-pocket costs. Although there is truth to that claim, the move was considered symbolic in the Trump administration’s healthcare agenda to hold drugmakers accountable in a climate where skyrocketing drug prices have incensed Americans on both sides of the aisle.

Ver­sant-backed Chi­nook gets a $65M launch round for its dis­cov­ery quest in a resur­gent kid­ney field

Versant is once again stepping off the beaten track in biotech to see if they can blaze a trail of their own in a field that has looked too thorny to many investors for years.

The venture group and their partners at Apple Tree are bringing their latest creation out of stealth mode today. Born in Versant’s Inception Sciences’ Chinook Therapeutics is betting that its preclinical take on kidney disease can get an early lead among the companies starting up in the field.

Sir An­drew Dil­lon, NICE's first — and on­ly — chief ex­ec­u­tive to step down next year

Using a laptop borrowed from his former employer, South London’s St George’s Hospital, Sir Andrew Dillon set about establishing NICE — launched by the then health secretary Frank Dobson — in 1999.  On Thursday, the UK cost-effectiveness watchdog said its first and only chief executive — Dillon — is stepping down in March 2020.

Back in the day, decisions about which drugs and interventions were funded by the National Health Service (NHS) were made at the local level, but this ‘postcode prescribing’ system was fraught with skewed healthcare deployment making the structure unsustainable. A national system was deemed necessary — and NICE was formed to bridge that gap.