Fol­low­ing EMA, FDA re­stricts use of high-dose Xel­janz, warn­ing of added risks for the block­buster JAK

The FDA has come out with new re­stric­tions on the use of Pfiz­er’s high-dose ver­sion of Xel­janz af­ter re­searchers drew a di­rect line be­tween the 10 mg dose and a high­er risk of blood clots and death.

In a new safe­ty warn­ing out to­day, the agency added a boxed warn­ing for the block­buster JAK in­hibitor, ad­vis­ing physi­cians of the risk and or­der­ing them to re­strict the ap­proved 10 mg dose for ul­cer­a­tive col­i­tis to “cer­tain pa­tients who are not treat­ed ef­fec­tive­ly or who ex­pe­ri­ence se­vere side ef­fects with cer­tain oth­er med­i­cines.”

Though it wasn’t ap­proved for rheuma­toid arthri­tis, re­searchers had been us­ing the 10 mg dose in a study for RA when they spot­ted the dan­ger­ous im­bal­ance in out­comes, which alarmed reg­u­la­tors on both sides of the At­lantic. In Eu­rope, the 10 mg dose is now banned among pa­tients with heart fail­ure, can­cer, as well as an iden­ti­fi­able risk of de­vel­op­ing blood clots.

The new re­stric­tions fol­low the 2018 OK on UC, its third in­di­ca­tion fol­low­ing the 2012 ap­proval for rheuma­toid arthri­tis and a 2017 OK for PsA.

Their no­tice to­day in­clud­ed this note:

The in­ter­im re­sults of the tri­al, as of Jan­u­ary 2019, have iden­ti­fied the fol­low­ing:

•19 cas­es of blood clots in the lung out of 3,884 pa­tient-years of fol­low-up in pa­tients who re­ceived to­fac­i­tinib 10 mg twice dai­ly, com­pared to 3 cas­es out of 3,982 pa­tient-years in pa­tients who re­ceived TNF block­ers

•45 cas­es of death from all caus­es out of 3,884 pa­tient-years of fol­low-up in pa­tients who re­ceived to­fac­i­tinib 10 mg twice dai­ly, com­pared to 25 cas­es out of 3,982 pa­tient-years in pa­tients who re­ceived TNF block­ers

The warn­ing on Xel­janz may well have a knock-on ef­fect at Eli Lil­ly, where agency con­cerns about Olu­mi­ant led them to steer clear of the high dose and stick with a low­er dose than the com­pa­ny felt would be ef­fec­tive. You can ex­pect the rest of the field to pay close at­ten­tion as they work on ri­val drugs — in­clud­ing some ther­a­pies they hope will have a bet­ter safe­ty pro­file.

So­cial im­age: Pfiz­er, AP Im­ages

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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Novartis CEO Vas Narasimhan [via Bloomberg/Getty]

I’m not per­fect: No­var­tis chief Vas Narasimhan al­most apol­o­gizes in the wake of a new cri­sis

Vas Narasimhan has warily stepped up with what might pass as something close to a borderline apology for the latest scandal to engulf Novartis.

But he couldn’t quite get there.

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FDA to Sarep­ta: Your wide­ly an­tic­i­pat­ed fol­lowup to Ex­ondys 51 is not get­ting an ac­cel­er­at­ed OK for Duchenne MD

In one of the least anticipated moves of the year, the FDA has rejected Sarepta’s application for an accelerated approval of its Duchenne MD drug golodirsen after fretting over safety issues.

In a statement that arrived after the bell on Monday, Sarepta explained the CRL, saying:

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Levi Garraway. Broad Institute via Youtube

Roche raids Eli Lil­ly for its next chief med­ical of­fi­cer as San­dra Horn­ing plans to step down

We found out Monday morning where Levi Garraway was headed after he left Eli Lilly as head of oncology R&D a few days ago. Roche named Garraway as their new chief medical officer, replacing Sandra Horning, who they say is retiring from the company.

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Af­ter a posse of Wall Street an­a­lysts pre­dict a like­ly new win for Sarep­ta, we're down to the wire on a crit­i­cal FDA de­ci­sion

As Bloomberg notes, most of the Wall Street analysts that cover Sarepta $SRPT are an upbeat bunch, ready to cheer on the team when it comes to their Duchenne MD drugs, or offer explanations when an odd setback occurs — as happened recently with a safety signal that was ‘erroneously’ reported last week.

Ritu Baral Cowen
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UP­DAT­ED: No­var­tis spin­off Nabri­va fi­nal­ly scores its first an­tibi­ot­ic ap­proval

In May, Nabriva Therapeutics suffered a setback after the FDA rejected its antibiotic for complicated urinary tract infections — the Novartis spinoff has now had some better luck with the US agency, which on Monday approved its other drug for community-acquired bacterial pneumonia.

The drug, lefamulin, has been developed as an intravenous and oral formulation and been tested in two late-stage clinical trials. The semi-synthetic compound, whose dosing can be switched between the two formulations, is engineered to inhibit the synthesis of bacterial protein by binding to a part of the bacterial ribosome.

Saqib Islam. CheckRare via YouTube

Spring­Works seeks $115M to push Pfiz­er drugs across fin­ish line while Sat­suma sells mi­graine play in $86M IPO

SpringWorks and Satsuma — both biotech spinouts that have closed B rounds in April — are loading up with IPO cash to boost their respective late-stage plans.
SpringWorks

Bain-backed SpringWorks is the better-known company of the two, and it’s gunning for a larger windfall of $115 million to add to $228 million from previous financings. In the process, the Stamford, CT-based team is also drawing the curtains on the partnerships it has in mind for the pair of assets it had initially licensed from Pfizer.

Mi­nor­i­ty racial groups con­tin­ue to be dis­mal­ly rep­re­sent­ed in can­cer tri­als — study

Data reveal that different racial and ethnic groups — by nature and/or nurture — can respond differently in terms of pharmacokinetics, efficacy, or safety to therapeutics, but this disparity is not necessarily accounted for in clinical trials. A fresh analysis of the last decade of US cancer drug approvals suggests the trend continues, cementing previous research that suggests oncology trials are woefully under-representative of the racial makeup of the real world.

Van­da shares slide af­ter FDA spurns their big end­point and re­jects a pitch on jet lag re­lief

Back in the spring of last year, Vanda Pharmaceuticals $VNDA served up a hot stew of mixed data for a slate of endpoints related to what they called clear evidence that their melatonin sleep drug Hetlioz (tasimelteon) could help millions of travelers suffering from jet lag.

Never mind that they couldn’t get a planned 90 people in the study, settling for 25 instead; Vanda CEO Mihael H. Polymeropoulos said they were building on a body of data to prove it would help jet-lagged patients looking for added sleep benefits. And that, they added, would be worth a major upgrade from the agency as they sought to tackle a big market.