The FDA’s an­timi­cro­bial drugs ad­vi­so­ry com­mit­tee on Thurs­day vot­ed unan­i­mous­ly in fa­vor of FDA ap­prov­ing Take­da’s an­tivi­ral for post-trans­plant cy­tomegalovirus.

The ad­comm vot­ed 17-0 on the ques­tion of whether the over­all ben­e­fit-risk pro­file is fa­vor­able for the use of Take­da’s marib­avir for the treat­ment of trans­plant re­cip­i­ents with CMV in­fec­tion and dis­ease re­frac­to­ry to treat­ment and with geno­typ­ic re­sis­tance to four oth­er an­tivi­rals — gan­ci­clovir, val­gan­ci­clovir, fos­car­net or cid­o­fovir.

On whether the drug, which took about two decades to de­vel­op, should be ap­proved for the same pop­u­la­tion but those with­out geno­typ­ic re­sis­tance to the four an­tivi­rals, the com­mit­tee vot­ed 17-0.

FDA’s brief­ing doc­u­ments re­leased ahead of the meet­ing showed how marib­avir proved safe across mul­ti­ple stud­ies and sta­tis­ti­cal­ly su­pe­ri­or to in­ves­ti­ga­tor-as­signed treat­ment (IAT) in a Phase III tri­al, which Take­da an­nounced ear­li­er this year.

While sev­er­al mem­bers of the ad­comm said dur­ing the dis­cus­sion that they don’t want to let per­fect be the en­e­my of the good in terms of the da­ta around marib­avir, sev­er­al oth­ers ques­tioned the end­point used in that tri­al, and why the tri­al didn’t in­clude a more di­verse pop­u­la­tion.

Ad­comm chair Lind­sey Baden of the Dana-Far­ber Can­cer In­sti­tute, who vot­ed in fa­vor of the ap­proval, al­so called the da­ta “messy,” but said the to­tal­i­ty of da­ta is per­sua­sive. He al­so not­ed the ad­van­tages of an oral drug in this in­di­ca­tion.

Com­mit­tee mem­ber Nan­cy Bridges, chief of the trans­plan­ta­tion branch at the NIH’s Na­tion­al In­sti­tute of Al­ler­gy and In­fec­tious Dis­eases, who vot­ed in fa­vor of ap­proval al­so said that over­all, “the da­ta are very per­sua­sive.”

But she not­ed that the par­tic­i­pants in the Phase III tri­al “were over­whelm­ing­ly white,” even though this con­di­tion has a high­er preva­lence among African Amer­i­cans. “I’d like to see some da­ta from the com­pa­ny on ef­fi­ca­cy in African Amer­i­cans, which we don’t have,” Bridges said.

George Siber­ry, a med­ical of­fi­cer at the US Agency for In­ter­na­tion­al De­vel­op­ment, al­so said it was dis­ap­point­ing that no ado­les­cents were in­clud­ed in the piv­otal tri­al.

Pe­ter Weina, di­rec­tor of the De­fense Health Agency, said that even if the drug is ap­proved for a nar­row pop­u­la­tion, it’ll be used for all dif­fer­ent in­di­ca­tions off-la­bel.

“I’m torn that the dif­fer­ence be­tween geno­typ­ic re­sis­tance and no geno­typ­ic re­sis­tance is tru­ly a moot point here,” Weina said.

An ap­proval from FDA would cap a long and rocky his­to­ry for the drug, which has changed hands sev­er­al times over the last two decades fol­low­ing both pos­i­tive and neg­a­tive tri­als.

Glax­o­SmithK­line first syn­the­sized the drug about 20 years ago and did some ear­ly clin­i­cal work be­fore li­cens­ing it to the rare dis­ease and in­fec­tious dis­ease-fo­cused biotech Vi­roPhar­ma.

Vi­roPhar­ma then missed a pri­ma­ry end­point in a Phase III study in 2009. Marib­avir failed to pre­vent CMV in­fec­tions bet­ter than place­bo in pa­tients re­ceiv­ing bone mar­row trans­plants. Vi­roPhar­ma sug­gest­ed a high­er dose might lead to a bet­ter re­sponse, but end­ed up pass­ing the can­di­date to Shire as part of a $4.2 bil­lion buy­out in 2013.

Shire upped the dose in var­i­ous phar­ma­co­ki­net­ic and ef­fi­ca­cy stud­ies, and in 2016, a Phase II study showed that the drug helped clear in­fec­tions. The FDA com­mend­ed the re­sults with a break­through des­ig­na­tion in 2018. And the fol­low­ing year, Take­da com­plet­ed its ac­qui­si­tion of Shire for $62 bil­lion.

The FDA is still wary about a trial testing a microbiome therapy in patients with steroid-resistant acute graft-versus-host disease (aGVHD).

A year after MaaT Pharma’s IND application in the US was first met with a clinical hold, the French biotech said the agency is maintaining the hold. The crux of the matter, MaaT suggested, has to do with the way it puts together its drug candidate, which is administered as an enema (i.e. an injection of fluid into the bowel).

Over the past three years, Endpoints News has spotlighted 60 women who have blazed trails and supercharged R&D across the biopharma world. And judging from the response we’ve received, to both our special reports and live events, telling their stories — including any obstacles they may have had to overcome — has inspired our readers in many different ways.

But change takes time, and the fact remains that women are still underrepresented at the upper ranks of the drug-making world.

Pfizer is launching its second-ever rebate program, this time for Panzyga, its treatment for a rare neurological disease of the peripheral nerves.

The program began last month, according to STAT which first reported the news, and offers a refund of out-of-pocket costs for patients who must discontinue their course before the fifth treatment for “clinical reasons.”

Panzyga was approved back in 2018 to treat primary immunodeficiency (PI) in patients two years and older and chronic immune thrombocytopenia (cITP) in adults. It has since picked up an indication in chronic inflammatory demyelinating polyneuropathy (CIDP), a condition that’s characterized by weakness of the arms or legs, tingling or numbness, and a loss of deep tendon reflexes, according to the NIH.

Endo International will likely be the next pharma company to file for bankruptcy under a mountain of opioid lawsuits.

The Dublin, Ireland-based company revealed in its Q2 results on Tuesday that it’s in talks with first lien creditors, and that “these negotiations will likely result in a pre-arranged filing under Chapter 11 of the U.S. Bankruptcy Code by Endo International plc and substantially all of its subsidiaries, which could occur imminently.”