He­mo­phil­ia groups warned of 5 deaths among pa­tients tak­ing Roche’s big new block­buster Hem­li­bra

The He­mo­phil­ia Fed­er­a­tion of Amer­i­ca has put out a state­ment not­ing that Roche alert­ed them of the deaths of 5 pa­tients who were tak­ing their new drug Hem­li­bra, cal­cu­lat­ed to be the biggest sin­gle drug launch of the year. And ac­cord­ing to Roche, the alert fol­lowed the death of two pa­tients ear­li­er this year, which they just learned about.

Ac­cord­ing to the state­ment, Roche’s Genen­tech in­formed them of the deaths Mon­day — adding 4 fa­tal­i­ties to the 1 death al­ready re­port­ed ear­ly last year.

The news trig­gered a 1.4% drop in Roche shares Wednes­day morn­ing.

Ac­cord­ing to the HFA:

Genen­tech has lit­tle in­for­ma­tion that they can present­ly share about the cir­cum­stances sur­round­ing the most re­cent pa­tient deaths; how­ev­er, Genen­tech could con­firm that the pa­tients had re­ceived Hem­li­bra as part of com­pas­sion­ate use and ex­pand­ed pa­tient ac­cess.

In a state­ment to End­points News late Tues­day, a spokesper­son for the com­pa­ny said that one of the pa­tients who died was in an ex­pand­ed ac­cess pro­to­col, three re­ceived it fol­low­ing com­pas­sion­ate use re­quests and one was in the HAVEN I tri­al. She added:

To date, five adults tak­ing Hem­li­bra have passed away. For all, the treat­ing physi­cian or in­ves­ti­ga­tor’s as­sess­ment was that the cause of death was un­re­lat­ed to Hem­li­bra (em­pha­sis pro­vid­ed by Roche). We pro­vid­ed the na­tion­al ad­vo­ca­cy groups with this up­date via phone yes­ter­day.

In a fol­lowup, Roche added a time­line:

  • In 2016, one adult tak­ing Hem­li­bra through a re­quest for com­pas­sion­ate use passed away.
  • In 2017, one adult par­tic­i­pat­ing in the Phase III HAVEN 1 clin­i­cal tri­al passed away and one adult tak­ing Hem­li­bra through a re­quest for com­pas­sion­ate use passed away.
  • In 2018, we just re­cent­ly learned that two adults tak­ing Hem­li­bra passed away. Again, the treat­ing physi­cian’s as­sess­ment for both pa­tients was that the cause of death was un­re­lat­ed to Hem­li­bra.

Roche $RHH­BY has had safe­ty is­sues to deal with be­fore on this drug.

The phar­ma gi­ant re­port­ed 2 cas­es of throm­boem­bol­ic events and 3 in­stances of throm­bot­ic mi­croan­giopa­thy from the Haven I Phase III tri­al. Roche rat­tled its most bull­ish fol­low­ers on this drug with the re­port that a pa­tient died on Feb­ru­ary 22, 2017 from a rec­tal he­m­or­rhage af­ter be­ing treat­ed with emi­cizum­ab and a by­pass­ing agent dur­ing a break­through bleed­ing episode. The in­ci­dents were at­trib­uted to the BPAs, which an­gered Shire and No­vo Nordisk, the two key ri­vals who are feel­ing the biggest im­pact from the ar­rival of Hem­li­bra.

Shire in par­tic­u­lar came out gun­ning against Hem­li­bra, which has a peak sales es­ti­mate of $4 bil­lion. Shire has claimed be­fore that Roche has is­sued “in­ac­cu­rate and mis­lead­ing” state­ments about the se­ri­ous ad­verse events tracked in its Phase III – events which con­spired to keep this would-be block­buster un­der a cloud.

Roche, though, nev­er blinked, bag­ging an ap­proval in the US No­vem­ber 17 for one of its biggest drugs in the pipeline, a key win that was bad­ly need­ed to ac­count for the loss of patent pro­tec­tion on 3 big fran­chise drugs. The EU fol­lowed with an OK Feb­ru­ary 18 and Japan fol­lowed suit March 18.

In the US, the FDA added a boxed warn­ing about safe­ty haz­ards. When the drug was ap­proved last fall, the agency not­ed:

Cas­es of throm­bot­ic mi­croan­giopa­thy and throm­bot­ic events were re­port­ed when on av­er­age a cu­mu­la­tive amount of >100 U/kg/24 hours of ac­ti­vat­ed pro­throm­bin com­plex con­cen­trate (aPCC) was ad­min­is­tered for 24 hours or more to pa­tients re­ceiv­ing emi­cizum­ab-kxwh pro­phy­lax­is. The pre­scrib­ing in­for­ma­tion con­tains a boxed warn­ing to mon­i­tor for throm­bot­ic mi­croan­giopa­thy and throm­bot­ic events when aPCC is ad­min­is­tered. If symp­toms oc­cur, aPCC should be dis­con­tin­ued and emi­cizum­ab-kxwh should be sus­pend­ed.

The HFA added:

Genen­tech has a Med­ical Com­mu­ni­ca­tions line at 1(800)-821-8590 for pa­tients, con­cerned com­mu­ni­ty mem­bers, and health­care providers who seek fur­ther in­for­ma­tion. HFA en­cour­ages you to reach out to Genen­tech and/or to your treat­ing physi­cian if you have ques­tions or con­cerns.

UP­DAT­ED: Clay Sie­gall’s $614M wa­ger on tu­ca­tinib pays off with solid­ly pos­i­tive piv­otal da­ta and a date with the FDA

Back at the beginning of 2018, Clay Siegall snagged a cancer drug called tucatinib with a $614 million cash deal to buy Cascadian. It paid off today with a solid set of mid-stage data for HER2 positive breast cancer that will in turn serve as the pivotal win Siegall needs to seek an accelerated approval in the push for a new triplet therapy.

And if all the cards keep falling in its favor, they’ll move from 1 drug on the market to 3 in 2020, which is shaping up as a landmark year as Seattle Genetics prepares for its 23rd anniversary on July 15.

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UP­DAT­ED: The FDA sets a reg­u­la­to­ry speed record, pro­vid­ing a snap OK for Ver­tex's break­through triplet for cys­tic fi­bro­sis

The FDA has approved Vertex’s new triplet for cystic fibrosis at a record-setting speed.

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IM­brave150: Roche’s reg­u­la­to­ry crew plans a glob­al roll­out of Tecen­triq com­bo for liv­er can­cer as PhI­II scores a hit

Just weeks after Bristol-Myers Squibb defended its failed pivotal study pitting Opdivo against Nexavar in liver cancer, Roche says it’s beat the frontline challenge with a combination of their PD-L1 Tecentriq with Avastin. And now they’re rolling their regulatory teams in the US, Europe and China in search of a new approval — badly needed to boost a trailing franchise effort.
Given their breakthrough and Big Pharma status as well as the use of two approved drugs, FDA approval may well prove to be something of a formality. And the Chinese have been clear that they want new drugs for liver cancer, where lethal disease rates are particularly high.
Researchers at their big biotech sub, Genentech, say that the combo beat Bayer’s Nexavar on both progression-free survival as well as overall survival — the first advance in this field in more than a decade. We won’t get the breakdown in months of life gained, but it’s a big win for Roche, which has lagged far, far behind Keytruda and Opdivo, the dominant PD-1s that have captured the bulk of the checkpoint market so far.
Researchers recruited hepatocellular carcinoma — the most common form of liver cancer — patients for the IMbrave150 study who weren’t eligible for surgery ahead of any systemic treatment of the disease.
Roche has a fairly low bar to beat, with modest survival benefit for Nexavar, approved for this indication 12 years ago. But they also plan to offer a combo therapy that could have significantly less toxicity, offering patients a much easier treatment regimen.
Cowen’s Steven Scala recently sized up the importance of IMbrave150, noting:

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That $335M JV Bay­er set up on CRISPR/Cas9? They’re let­ting the biotech part­ner car­ry on

Bayer committed $300 million to set up a joint venture on CRISPR/Cas9 tech with CRISPR Therapeutics $CRSP. But they’re handing off control now to the smaller biotech while retaining a couple of opt-ins for programs nearing an IND.

Bayer $BAY made much of the fact that they were going all-in on gene editing when they did their deal 3 years ago with CRISPR Therapeutics, which pitched $35 million in on their end. This was the cornerstone of their plan to set up new JVs that could make some serious leap forwards in hot new R&D spaces. Now CRISPR will have full management control of Casebia as they pursue programs in hemophilia, ophthalmology and autoimmune diseases.
Samarth Kulkarni, the CEO at CRISPR, made it sound like a natural progression.

J&J's block­buster Ste­lara wins US ap­proval for ul­cer­a­tive col­i­tis

J&J’s Stelara, which is set to be in the top ten list of blockbusters come 2025, is now cleared by the FDA for use in ulcerative colitis (UC), an inflammatory disease of the large intestine.

The biologic targets interleukin (IL)-12 and IL-23 cytokines, which are known to play a key role in inflammatory and immune responses. Stelara, which generated about $4.7 billion in the first nine months of 2019, is a key player in the crowded marketplace of drugs to treat autoimmune disorders such as psoriasis, rheumatoid arthritis and Crohn’s disease. AbbVie’s star therapy, Humira, continues to dominate, despite its looming patent cliff in the United States, while others including J&J’s $JNJ own anti-IL23 Tremfya, Lilly’s $LLY anti-IL-17 Taltz and AbbVie’s $ABBV recently approved anti-IL-23 antibody Skyrizi carve out a slice of market share.

Drug com­pa­nies reach $260M set­tle­ment just ahead of opi­oid tri­al; Oys­ter Point set terms for $85M IPO

→ Hours before the first federal opioid trial was set to begin, three drug distributors and an opioid manufacturer agreed to a $260 million agreement settlement, the Wall Street Journal was the first to report. The deal — which will see McKesson, Cardinal Health and AmerisourceBergen pay $215 million to Summit and Cuyahoga counties, and Teva deal out $35 million in cash and addiction treatments — does not resolve the pending, nationwide litigation that may result in a settlement worth upwards of $40 billion. Negotiators in that case, brought by 2,300 tribes, counties and cities nationwide and led by several states’ attorneys general, worked through much of Friday without success. Josh Stein, the attorney general for North Carolina, said they were trying to put together a $48 billion deal.

GSK of­floads two vac­cines in $1.1B deal as it works to re­vive the pipeline

GlaxoSmithKline is leaving the deep dark woods and its viruses behind.

GSK has agreed to divest its vaccines for rabies, RabAvert, and tick-born encephalitis vaccine, Encepur, to Bavarian Nordic, part of the company’s broader efforts to narrow its pipeline and focus on oncology and immunology.

The deal is worth up to nearly $1.1 billion, with a $336 million upfront payment. GSK acquired the vaccines from Novartis as part of an exchange for their late-stage oncology programs in 2015 under former chief Sir Andrew Witty.

Pfiz­er gets some en­cour­ag­ing PhI­II news on a fran­chise sav­ior, but is a dos­ing ad­van­tage worth the $295M up­front?

Close to 3 years after Opko tried to defend itself as shares tumbled on the news that its long-acting growth hormone had failed to outperform a placebo, the Pfizer partner $PFE is back. And this time they’re pitching Phase III data that demonstrate their drug is non-inferior — or maybe a tad better — than their well-known but fading standard in the field.
The comparator drug here is Genotropin, which earned a marginal $142 million for Pfizer last year — down 9% from the year before. Approved 24 years ago, biosimilars are now in development that Pfizer would like to stay out in front of. The market leader here is Norditropin, a growth hormone from Novo Nordisk that uses the same basic ingredient as Genotropin, which the Danish company sells with a kid-friendly self-injectable pen. That would also present some big competition if the new therapy from Opko/Pfizer makes it to the market.
The new data, says researchers, underscore that a weekly injection of somatrogon performed as well or slightly better than Genotropin (somatropin) in young children with growth hormone deficiency. Investigators tracked height velocity at 10.12 cm/year, edging out the older drug’s 9.78 cm/year. That 0.33 difference may not prove compelling to payers, though, who have been known to overlook dosing advantages in favor of lower costs.
That message may have weighed on the stock reaction this morning, with a 30%-plus hike $OPK giving way to more marginal gains.
Back in late 2016, Opko had to defend itself against a devastating Phase III setback as their initial late-stage trial failed against a sugar pill. Opko later blamed that setback on outliers in the study, though it wasn’t able to expunge the failure.

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As­traZeneca's Farx­i­ga scores FDA nod to cut risk of hos­pi­tal­iza­tion for heart fail­ure in di­a­bet­ics

While the FDA recently spurned an application to allow AstraZeneca’s blockbuster drug Farxiga for type 1 diabetes that cannot be controlled by insulin, citing safety concerns — the US regulator has endorsed the use of the SGLT2 treatment to reduce the risk of hospitalisation for heart failure in patients with type-2 diabetes and established cardiovascular disease or multiple CV risk factors.