Gilead shores up hope for NASH cock­tail with a glimpse at pos­i­tive proof-of-con­cept da­ta

When Gilead con­ced­ed fail­ure in its high-pro­file Phase III study for top late-stage NASH drug selon­sert­ib, CSO John McHutchi­son point­ed dis­ap­point­ed in­vestors to a com­bi­na­tion ap­proach be­ing test­ed in a mid-stage tri­al. Those da­ta are not ready just yet, but to­day the big biotech un­veiled some ear­ly num­bers to bol­ster their case for a cock­tail.

John McHutchi­son

On dis­play to­day at the In­ter­na­tion­al Liv­er Con­gress are topline re­sults from a proof-of-con­cept study test­ing cilofex­or (non­s­teroidal far­ne­soid X re­cep­tor or FXR ag­o­nist) and fir­so­co­stat (acetyl-CoA car­boxy­lase or ACC in­hibitor). Out of 20 pa­tients who were treat­ed with the oral reg­i­men once dai­ly for 12 weeks, 74% ex­pe­ri­enced “a sig­nif­i­cant de­cline of at least 30 per­cent in he­pat­ic fat” — a hall­mark of the dis­ease.

Re­searchers al­so doc­u­ment­ed im­prove­ments in oth­er bio­mark­ers, in­clud­ing “serum ALT (me­di­an rel­a­tive re­duc­tion, -37%; p<0.001) and GGT (-32%; p<0.001), along with mark­ers of re­duced bile acid syn­the­sis.”

Cilofex­or and fir­so­co­stat are al­so part of a triplet com­bo with the ASK1 in­hibitor selon­sert­ib, at the cen­ter of the Phase II AT­LAS study that McHutchi­son high­light­ed. In gen­er­al, FXR ac­ti­va­tion is thought to fight liv­er fi­bro­sis, ACC in­hibitors block fat­ty acid syn­the­sis, while ASK1 in­hibitor al­so helps re­duce in­flam­ma­tion.

“NASH is a com­plex dis­ease with mul­ti­ple bi­o­log­i­cal path­ways that in­flu­ence its pro­gres­sion. Com­bi­na­tion ther­a­peu­tic ap­proach­es which tar­get these path­ways, are like­ly to be need­ed to ef­fec­tive­ly treat pa­tients liv­ing with NASH, par­tic­u­lar­ly those with ad­vanced fi­bro­sis who have the great­est un­met need,” said McHutchi­son in a state­ment.

Gilead took a hit when selon­sert­ib flopped in its close­ly-watched STEL­LAR-4, out­per­formed by the place­bo at the low dose, though an­a­lysts ac­knowl­edged that fi­bro­sis was a tough tar­get to tack­le.

With a flock of small­er play­ers — in­clud­ing In­ter­cept, Gen­fit, Madri­gal and NGM Bio, which is part­nered with Mer­ck — con­tend­ing for the still va­cant NASH throne, Gilead has been pick­ing up ear­ly-stage as­sets in pur­suit of a sus­tain­ing fran­chise. In fact, cilofex­or came from the buy­out of Phenex Phar­ma and you might re­mem­ber fir­so­co­stat as GS-0976, which Gilead paid Nim­bus $600 mil­lion for.

It won’t be easy. But the pull is strong: NASH, which is typ­i­cal­ly as­so­ci­at­ed with obe­si­ty and di­a­betes, is set to eclipse he­pati­tis C as the lead­ing rea­son for liv­er trans­plants by 2020.

At the con­fer­ence, Gilead al­so pre­sent­ed screen­ing da­ta in sup­port of non-in­va­sive tests to iden­ti­fy NASH pa­tients with ad­vanced fi­bro­sis. Re­duc­ing the need for the cost­ly and risky liv­er biop­sies typ­i­cal­ly need­ed for the di­ag­no­sis can pave a smoother path for pa­tients to­ward treat­ment — ul­ti­mate­ly when they get ap­proved.


Im­age: Shut­ter­stock

Janet Woodcock (AP Images)

Janet Wood­cock to be act­ing FDA com­mis­sion­er while Biden team fi­nal­izes nom­i­nee — re­ports

Janet Woodcock is set to be the most powerful person at the FDA in less than a week.

The veteran regulator and longtime director of the Center for Drug Evaluation and Research has been tapped as acting commissioner of the FDA, according to reports by BioCentury’s Steve Usdin and Pink Sheet’s Sarah Karlin-Smith.

The appointment was requested by the incoming Biden team, Karlin-Smith added, as they sort out the nomination of a permanent successor to Stephen Hahn — whose one-year tenure has been defined by Covid-19.

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Janet Woodcock (AP Images)

Janet Wood­cock is in the run­ning for FDA com­mis­sion­er — what does that mean for the agen­cy's fu­ture?

Just a day after reports emerged that Janet Woodcock will serve as interim chief of the FDA, word has gotten out that she is also in the running for the permanent job.

The decision, as the initial wave of reactions suggest, could have dramatic implications for where the agency is headed in the next four years — if not beyond.

Woodcock, the longtime CDER director, is being vetted alongside former FDA principal deputy commissioner Joshua Sharfstein, Bloomberg reported. Already tapped as acting head of the agency, she’s set to take over from Stephen Hahn right after Biden’s inauguration next week.

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CEO Brett Monia (Ionis)

Can Brett Mo­nia push Io­n­is be­yond Spin­raza?

For 30 years, Brett Monia struggled as one of Ionis’ top scientists to get their antisense technology to work. Now, as CEO, he’s trying to use it to turn Ionis into one of the industry’s biggest biotechs.

Monia, one of the handful of young scientists who in 1989 followed Stanley Crooke across the country from SmithKline (now GSK) in Philadelphia to found Ionis in Northern California, replaced Crooke as CEO last January. By then, they had proven antisense, an RNA-based method for manipulating gene expression, could work dramatically well in at least some instances, transforming spinal muscular atrophy with the Biogen-partnered blockbuster Spinraza.

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Steve Harr (L) and Hans Bishop

Paint­ing by the num­bers, Sana founders carve up a gi­ant uni­corn-sized IPO — for a biotech that has­n't quite made it to the clin­ic

Sana Biotechnology is one of those startups that was sketched in on the chalkboard day one in the shape of a unicorn.

A giant unicorn.

And from the numbers the cell therapy 2.0 play spelled out in their S-1 $SANA, it’s clear that the company founders — led by a pair of major VCs aligned with some high-profile industry figures — are hunting a big chunk of that value for themselves.

The raise they penciled in — $150 million — isn’t likely what they actually have in mind, and it doesn’t do justice to the size of their ambitions.

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Terry Rosen, Arcus CEO

Gilead part­ner Ar­cus earns an­a­lyst­s' plau­dits for ear­ly pan­cre­at­ic can­cer da­ta that 'ex­ceed­ed ex­pec­ta­tion­s'

Arcus’ small molecule CD73 inhibitor for pancreatic cancer got a standing ovation from analysts who said preliminary data “exceeded expectations”— making waves in a field that’s seen little progress in several years and proving the candidate could be worth the hundreds of millions Gilead provided upfront in a deal that included more than a billion dollars for opt-in rights and milestones.

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David Kessler in April 2009 (Eric Risberg/AP Images)

Covid-19 roundup: Hack­ers start re­leas­ing 'ma­nip­u­lat­ed' Covid-19 vac­cine docs; Ex-FDA com­mish David Kessler to re­place Mon­cef Slaoui as Op­er­a­tion Warp Speed chief — re­port

There’s a new twist on the EMA Covid-19 hacking story.

Friday the European agency put out the 5th in a series of statements about the hackers who broke into their system, noting that some of the information on vaccines that was gleaned in the attack is showing up online — altered to raise questions about the Covid-19 vaccines now in use.

This included internal/confidential email correspondence dating from November, relating to evaluation processes for COVID-19 vaccines. Some of the correspondence has been manipulated by the perpetrators prior to publication in a way which could undermine trust in vaccines.

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With KRAS break­through on the hori­zon, Am­gen's David Reese re­flects on so­tora­si­b's loom­ing re­view date and murky fu­ture

After decades of failures laid waste to R&D outfits looking to solve the KRAS G12C puzzle, Amgen is as close as anyone ever has been to an approval with sotorasib. For Amgen R&D head David Reese, the drug’s looming review date is a point of reflection for his own career and a big milestone for Amgen’s blooming — if controversial — next-gen oncology pipeline.

Amgen filed its FDA application for sotorasib in December to treat metastatic non-small cell lung cancer with the KRAS mutation — once thought to be “undruggable” — months after the agency offered its breakthrough designation based on pivotal Phase I data showing previously unheard of response rates.

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News brief­ing: Five Prime fi­nal­izes PhI­II plans for gas­tric can­cer; AI di­ag­nos­tics-fo­cused Paige ex­pands staff

Five Prime Therapeutics has finalized a plan to take their comeback gastric cancer drug into late-stage studies.

The South San Francisco-based biotech released full Phase II data for bemarituzumab on Friday, which Five Prime said in November met all of its pre-specified efficacy endpoints in a topline readout. Now, the company is announcing it plans to launch a Phase III trial for the program in 2021. Following November’s readout, the future of bemarituzumab had not yet been finalized.

Peter Thiel, Getty (Photographer: Kiyoshi Ota/Bloomberg)

Pe­ter Thiel's psy­che­delics-fo­cused ATAI ac­quires ma­jor­i­ty stake in Recog­ni­fy and its lead schiz­o­phre­nia can­di­date

Billionaire Peter Thiel has made significant and sometimes controversial pushes into life sciences over the past few years, and one of his startups out of Berlin has made a new acquisition less than two months after achieving unicorn status.

ATAI Life Sciences purchased a majority stake Tuesday in Recognify Life Sciences, a company focused on developing treatments for cognitive impairment associated with schizophrenia. The financial terms of the deal weren’t disclosed, but the acquisition follows up a $125 million Series C in November co-led by Thiel, leading to a post-money valuation of about $1 billion for ATAI.