Ac­er Ther­a­peu­tics’ bid to re­pur­pose celipro­lol — a be­ta-block­er on the mar­ket for hy­per­ten­sion — as a treat­ment for a rare, in­her­it­ed con­nec­tive tis­sue dis­or­der has hit a se­vere set­back. The New­ton, Mass­a­chu­setts-based com­pa­ny on Tues­day said the FDA re­ject­ed the drug and has asked for an­oth­er clin­i­cal tri­al.

The com­pa­ny’s shares $AC­ER cratered near­ly 77% to $4.47 in Tues­day morn­ing trad­ing.

Chris Schelling LinkedIn

The drug, brand­ed as Ed­si­vo, is un­der de­vel­op­ment for vas­cu­lar Ehlers-Dan­los syn­drome (vEDS) — a rare dis­or­der caused by mu­ta­tions large­ly in the COL3A1 gene, which caus­es ar­te­r­i­al dis­sec­tions and rup­tures that can lead to an ear­ly death. It is es­ti­mat­ed to af­fect be­tween 1 in 50,000 and 1 in 200,000 peo­ple, and there are no treat­ments ap­proved to treat it.

The com­pa­ny sub­mit­ted an ap­pli­ca­tion to mar­ket the drug based on a small, 54-pa­tient study — the Be­ta-Block­ers in Ehlers-Dan­los Syn­drome Treat­ment (BBEST) —  which was de­signed to show the drug could pre­vent ar­te­r­i­al dis­sec­tions and rup­tures in vEDS pa­tients. The tri­al test­ed the drug against a place­bo and was stopped ear­ly as celipro­lol was work­ing well; pa­tients giv­en the drug, com­pared with no treat­ment, saw a re­duc­tion in ar­te­r­i­al events, such as rup­ture or dis­sec­tion, by three­fold. How­ev­er, the study was un­der­pow­ered. Re­searchers ac­knowl­edged that they did not “reach our tar­get num­ber of pa­tients”.

In April, Paris vEDS Pa­tient Reg­istry Da­ta was pub­lished in the Jour­nal of the Amer­i­can Col­lege of Car­di­ol­o­gy. It “de­scribed the long-term out­come of 144 COL3A1+ vEDS pa­tients, most of whom (~90%) were treat­ed with celipro­lol and mon­i­tored for up to 20 yrs (me­di­an 5.3 yrs). Key da­ta high­lights in­clude low­er rates of mor­tal­i­ty and ar­te­r­i­al com­pli­ca­tions in this pa­tient group than that ex­pect­ed from the nat­ur­al his­to­ry of the dis­ease. Celipro­lol-treat­ed pa­tients had an 80.7% sur­vival rate at ~11 yrs vs 48.5% for those not treat­ed,” Need­ham’s Serge Be­langer wrote in a note.

Be­langer was op­ti­mistic the drug would win ap­proval, and es­ti­mat­ed a tar­get mar­ket op­por­tu­ni­ty be­tween $200 mil­lion and $400 mil­lion, based on ex­pect­ed Ed­si­vo an­nu­al pric­ing of $100,000-$200,00 per pa­tient.

On Tues­day, Ac­er chief Chris Schelling said the com­pa­ny is ex­pect­ed to re­spond to the FDA in the third quar­ter.

Hepatitis delta, also known as hepatitis D, is a liver infection caused by the hepatitis delta virus (HDV) that results in the most severe form of human viral hepatitis for which there is no approved therapy.

HDV is a single-stranded, circular RNA virus that requires the envelope protein (HBsAg) of the hepatitis B virus (HBV) for its own assembly. As a result, hepatitis delta virus (HDV) infection occurs only as a co-infection in individuals infected with HBV. However, HDV/HBV co-infections lead to more serious liver disease than HBV infection alone. HDV is associated with faster progression to liver fibrosis (progressing to cirrhosis in about 80% of individuals in 5-10 years), increased risk of liver cancer, and early decompensated cirrhosis and liver failure.
HDV is the most severe form of viral hepatitis with no approved treatment.
Approved nucleos(t)ide treatments for HBV only suppress HBV DNA, do not appreciably impact HBsAg and have no impact on HDV. Investigational agents in development for HBV target multiple new mechanisms. Aspirations are high, but a functional cure for HBV has not been achieved nor is one anticipated in the forseeable future. Without clearance of HBsAg, anti-HBV investigational treatments are not expected to impact the deadly course of HDV infection anytime soon.

More than 3 years after Merck stepped up and paid $1 billion in cold, hard cash to gain the US commercial rights to Bayer’s high-risk heart drug vericiguat in a broad-ranging cardio alliance, the partners say their Phase III study has come through with promising data and a date with regulators.
We don’t have the data, and won’t until they put it out at an upcoming scientific session, but Merck touted the results, saying that their big Phase III VICTORIA study hit the primary endpoint  — with vericiguat combined with available therapies reducing “the risk of the composite endpoint of heart failure hospitalization or cardiovascular death in patients with worsening chronic heart failure with reduced ejection fraction (HFrEF) compared to placebo when given in combination with available heart failure therapies.”
Depending on the hard data, and how it breaks out with the combinations used, this drug could pose a threat to Novartis’ blockbuster drug Entresto, currently at $1.6 billion while analysts expect peak sales to hit $4 billion.
The drug is a soluble guanylate cyclase (sGC) stimulator, which Bayer and Merck have had high hopes for. Evidently, so did cardiologists. Cowen’s last analysis set potential sales at $400 million in 2024, but that number could go up significantly now.
Cowen’s Steve Scala noted this morning:
Vericiguat could be a lucrative product for Merck, and one with potentially under-appreciated value. At Cowen’s Therapeutics Conference in September 2019, 80% of specialists anticipated a positive result from VICTORIA whereas only 51% of investors shared this optimism.
Investigators recruited more than 5,000 patients at more than 600 centers in 42 countries for this study — one of the most expensive propositions in R&D. Millions of people in the US suffer from heart failure with reduced ejection fraction when the failing heart fails to contract properly to eject blood into the system. Bayer holds ex-US rights to the drug and also stands to earn cash from the $1.1 billion in milestones Merck agreed on for their collaboration.
Remarkably, the drug was pushed into Phase III despite failing the mid-stage trial — though investigators flagged a success at the high dose of 10 mg. In VICTORIA, researchers started patients at 2.5 mg and then titrated up to 5 and then 10 mg.

Thirteen of the top biotech venture capitalists in the country wrote a letter last week warning lawmakers that if Congress passes a drug pricing bill House Speaker Nancy Pelosi has put before lawmakers, they won’t be able to invest in biomedical research at their current rate, and patients will suffer.

“If policies such as those included within H.R. 3, the Lower Drug Costs Now Act, are passed, our ability to continue to invest in future biomedical innovation will be severely constrained, thus crushing the hopes of millions of patient waiting for the next breakthroughs to treat or cure their cancers, rare genetic diseases, Alzheimer’s, or other serious and life-threatening conditions,” they wrote in a letter addressed to the highest-ranking Democrats and Republicans in the House and Senate and acquired by Endpoints News. 

Turns out Dicerna wasn’t done with deals yet after locking in $200 million upfront from Roche for a hepatitis B cocktail two weeks ago.

Novo Nordisk has signed on as the latest partner to its GalXC RNAi platform, handing over $175 million in cash to claim any and all targets of interest in liver-related cardio-metabolic diseases that are not already reserved in previous pacts. The Danish drugmaker — which has signaled its interest to expand considerably beyond its core diabetes franchise into areas like NASH — is also purchasing $50 million worth of Dicerna’s equity at a 25% premium of $21.93 per share. More research payments and milestones extending to the billions are on the line.

→ Gene therapy maker Orchard Therapeutics has been granted an accelerated assessment for OTL-200 by the EMA’s Committee for Medicinal Products for Human Use (CHMP). The gene therapy — in development in partnership with the San Raffaele-Telethon Institute for Gene Therapy (SR-Tiget) in Milan, Italy — being used towards the treatment of metachromatic leukodystrophy.

→ Pharmaceutical Product Development has announced that its parent company, PPD, Inc has submitted a draft to the SEC relating to the proposal of an IPO of the parent company’s common stock. Number of shares and price range have not yet been determined.