FDA ex­perts gun down Alk­er­mes’ pitch for ALKS-5461, slam­ming the com­pa­ny on mul­ti­ple fronts

A large group of out­side ex­perts at the FDA has slapped down Alk­er­mes’ cam­paign to gain an ap­proval for their de­pres­sion drug ALKS-5461, ob­ject­ing to a messy set of da­ta and the way the biotech man­aged the study and re­port­ed the da­ta.

The key ques­tion: Did Alk­er­mes present sub­stan­tial ev­i­dence of the drug’s ef­fi­ca­cy? Twen­ty pan­el mem­bers vot­ed no, with on­ly 3 yes votes, which makes it ex­treme­ly un­like­ly that the FDA’s for­mal de­ci­sion would be any dif­fer­ent. 

A slight ma­jor­i­ty, 13 to 10, vot­ed that the re­searchers had ad­e­quate­ly char­ac­ter­ized the safe­ty of the drug. But that won’t save this drug. By 21 to 2 the com­mit­tee con­clud­ed that Alk­er­mes had failed to sup­port a fa­vor­able ben­e­fit/risk pro­file.

Alk­er­mes’ stock dropped about 9% in af­ter-mar­ket trad­ing Thurs­day.

The FDA’s harsh re­view drew some at­ten­tion from an­a­lysts, in­clud­ing Stifel’s Paul Mat­teis, who not­ed:

It was al­most as if the FDA was so blunt­ly neg­a­tive in its re­marks so as to fos­ter a pan­el vote that cor­rob­o­rat­ed its skep­ti­cal view­point. ALKS is con­duct­ing an­oth­er tri­al for ‘5461 (but re­sults are a ways away) ahead of a 1/31/19 PDU­FA; the fo­cus for the stock is like­ly to shift to ALKS3831.

The set­back like­ly leaves Alk­er­mes back where it was at the be­gin­ning of the reg­u­la­to­ry process, when the FDA ini­tial­ly re­fused to file the ap­pli­ca­tion and then did an about face and opened the door to a re­view. The com­pa­ny has an­oth­er tri­al un­der­way, but now may well be look­ing at a re­quire­ment to mount new, ex­pen­sive and lengthy clin­i­cal tri­als that would like­ly take at least 3 years to com­plete.

Ever­core ISI’s Umer Raf­fat just shook his head at the time­line.

Tech­ni­cal­ly, ALKS has an­oth­er 450 pt Ph 3 on­go­ing on this drug … which re­ports in 2021 as per clin­i­cal­tri­als.gov.  (I sin­cere­ly hope that ALKS is us­ing MADRS-10 at fi­nal time­point in this tri­al … un­like the last Ph 3).  So sure, there’s a chance … but the con­ver­sa­tion has to move past this drug now.

In its pre­sen­ta­tions to­day, agency rep­re­sen­ta­tives high­light­ed the role of a sin­gle “su­per re­spon­der” in in­flu­enc­ing the out­come of one of the tri­als. Late tri­al de­sign changes al­so drew flak. And Alk­er­mes’ in­sis­tence on craft­ing its own ef­fi­ca­cy mea­sures, leav­ing out key points like sui­ci­dal think­ing, was a dis­as­ter.

Here are some of the blunt ex­pert com­ments from to­day:

“I don’t think there’s ev­i­dence this drug works.”

“I’m very con­cerned about the last minute changes.”

“A sin­gle sub­ject dri­ves the re­sults so strong­ly.”

I’m con­cerned about the “lack of trans­paren­cy about in­di­vid­ual sub­ject lev­el da­ta.”

One pan­elist ob­ject­ed to Alk­er­mes’ “cher­ry pick­ing” study da­ta.

“I think there were too many changes along the way.”

“We pay the ul­ti­mate price be­cause we’re the guinea pigs.”

“A lot more needs to be done.”

Alk­er­mes CEO Richard Pops has been tout­ing this drug for years, build­ing its pro­file as a ma­jor new en­try in the field. But Alk­er­mes comes out of this now with its cred­i­bil­i­ty and rep­u­ta­tion for com­pe­tence tar­nished and its pro­jec­tions on fu­ture growth in ques­tion.

Im­age: Richard Pops at an End­points News break­fast event in San Fran­cis­co Jan­u­ary 2017 End­points News

A New Fron­tier: The In­ner Ear

What happens when a successful biotech venture capitalist is unexpectedly diagnosed with a chronic, life-disrupting vertigo disorder? Innovation in neurotology.

That venture capitalist was Jay Lichter, Ph.D., and after learning there was no FDA-approved drug treatment for his condition, Ménière’s disease, he decided to create a company to bring drug development to neurotology. Otonomy was founded in 2008 and is dedicated to finding new drug treatments for the hugely underserved community living with balance and hearing disorders. Helping patients like Jay has been the driving force behind Otonomy, a company heading into a transformative 2020 with three clinical trial readouts: Phase 3 in Ménière’s disease, Phase 2 in tinnitus, and Phase 1/2 in hearing loss. These catalysts, together with others in the field, highlight the emerging opportunity in neurotology.
Otonomy is leading the way in neurotology
Neurotology, or the treatment of inner ear neurological disorders, is a large and untapped market for drug developers: one in eight individuals in the U.S. have moderate-to-severe hearing loss, tinnitus or vertigo disorders such as Ménière’s disease.1 With no FDA-approved drug treatments available for these conditions, the burden on patients—including social anxiety, lower quality of life, reduced work productivity, and higher rates of depression—can be significant.2, 3, 4

Joe Jimenez, Getty

Ex-No­var­tis CEO Joe Jimenez is tak­ing an­oth­er crack at open­ing a new chap­ter in his ca­reer — and that in­cludes a new board seat and a $250M start­up

Joe Jimenez is back.

The ex-CEO of Novartis has taken a board seat on Century Therapeutics, the Versant and Bayer-backed startup focused on coming up with a brand new twist on cell therapies for cancer — a field where Jimenez made his mark backing the first personalized CAR-T approved for use.

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Can we make the an­tibi­ot­ic mar­ket great again?

The standard for-profit model in drug development is straightforward. Spend millions, even billions, to develop a medicine from scratch. The return on investment (and ideally a tidy profit) comes via volume and/or price, depending on the disease. But the string of big pharma exits and slew of biotech bankruptcies indicate that the model is sorely flawed when it comes to antibiotics.

The industry players contributing to the arsenal of antimicrobials are fast dwindling, and the pipeline for new antibiotics is embarrassingly sparse, the WHO has warned. Drugmakers are enticed by greener pastures, compared to the long, arduous and expensive path to antibiotic approval that offers little financial gain as treatments are typically priced cheaply, and often lose potency over time as microbes grow resistant to them.

Top Har­vard chemist caught up in FBI’s 'T­hou­sand Tal­ents' drag­net, ac­cused of ly­ing about Chi­nese con­nec­tions, pay

The FBI’s probe into the alleged theft of R&D secrets by Chinese authorities has drawn Harvard’s top chemist into its net.

The agency accused Charles M. Lieber, who chairs the university’s chemistry and chemical biology department, with lying about his involvement in China’s Thousand Talents campaign, which was established as a way of drawing in innovators from around the world. And the scientist, 60, was charged with making false statements about his ties to China.

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Eye­ing a trio of tri­al ini­ti­a­tions, Jim Wilson's gene ther­a­py start­up woos Bruce Gold­smith from Deer­field as CEO

Passage Bio — Jim Wilson’s self-described “legacy company” — has wooed a seasoned biotech executive to steer the clinical entry of its first three gene therapy programs.

Bruce Goldsmith jumps to the helm of Passage after a brief CEO stint at Civetta, a cancer-focused startup he helped launch while a venture partner at Deerfield. He takes over from OrbiMed partner and interim chief Stephen Squinto, who will now lead the R&D team.

The FTC and New York state ac­cuse Mar­tin Shkre­li of run­ning a drug mo­nop­oly. They plan to squash it — and per­ma­nent­ly ex­ile him

Pharma bro Martin Shkreli was jailed, publicly pilloried and forced to confront some lawmakers in Washington riled by his move to take an old generic and move the price from $17.50 per pill to $750. But through 4 years of controversy and public revulsion, his company never backed away from the price — left uncontrolled by a laissez faire federal policy on a drug’s cost.

Now the FTC and the state of New York plan to pry his fingers off the drug once and for all and open it up to some cheap competition. And their lawsuit is asking that Shkreli — with several years left on his prison sentence — be banned permanently from the pharma industry.

UP­DAT­ED: Ac­celeron res­ur­rects block­buster hopes for so­tater­cept with pos­i­tive PhII — and shares rock­et up

Acceleron $XLRN says that its first major trial readout of 2020 is a success.

In a Phase II study of 106 patients with pulmonary arterial hypertension (PAH), Acceleron’s experimental drug sotatercept hit its primary endpoint: a significant reduction in pulmonary vascular resistance. The drug also met three different secondary endpoints, including the 6-minute walking test.

“We’re thrilled to report such positive topline results from the PULSAR trial,” Acceleron CEO Habib Dable said in a statement. The company said in a conference call they plan on discussing a Phase III trial design with regulators.

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Short at­tack­er Sahm Ad­ran­gi draws crosshairs over a fa­vorite of Sanofi’s new CEO — with PhII da­ta loom­ing

Sahm Adrang Kerrisdale

Kerrisdale chief Sahm Adrangi took a lengthy break from his series of biotech short attacks after his chief analyst in the field pulled up stakes and went solo. But he’s making a return to drug development this morning, drawing crosshairs over a company that’s one of new Sanofi CEO Paul Hudson’s favorite collaborators.

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Amber Saltzman (Ohana)

Flag­ship's first ven­ture of 2020 is out, and it's all about sperm

A couple years ago, Amber Salzman got a call as she was returning East full-time after a two-year stint running a gene therapy company in California.

It was from someone at Flagship Pioneering, the deep-pocketed biotech venture firm. They had a new company with a new way of thinking about sperm. It had been incubating for over a year, and now they wanted her to run it.

“It exactly fit,” Salzman told Endpoints News. “I just thought I had to do something.”