The de­layed-re­lease for­mu­la­tion of Iron­wood and Al­ler­gan’s bow­el drug Linzess will not see the light of day.

The ex­per­i­men­tal drug, MD-7246, failed to help pa­tients with ab­dom­i­nal pain as­so­ci­at­ed with ir­ri­ta­ble bow­el syn­drome with di­ar­rhea (IBS-D) in a mid-stage study, prompt­ing the part­ners to aban­don the ther­a­py.

First ap­proved in 2012, Linzess (known chem­i­cal­ly as lina­clotide) en­hances the ac­tiv­i­ty of the in­testi­nal en­zyme guany­late cy­clase-C to in­crease the se­cre­tion of in­testi­nal flu­id and then tran­sit through the in­testi­nal tract, as well as re­duce vis­cer­al pain, to re­lieve pain and con­sti­pa­tion as­so­ci­at­ed with IBS.

MD-7246 was de­signed to sim­ply deal with the pain by tar­get­ing the de­liv­ery of lina­clotide to the colon, where the ma­jor­i­ty of the ab­dom­i­nal pain as­so­ci­at­ed with IBS is be­lieved to orig­i­nate, and to lim­it flu­id se­cre­tion in the small in­tes­tine for a min­i­mal im­pact on bow­el func­tion.

Ear­li­er this week, the part­ners said MD-7246 failed both the main and sec­ondary goals of the 388 pa­tient (IBS-D) Phase II study, but did not dis­close de­tails. Back in 2016, in a tri­al of 532 ir­ri­ta­ble bow­el pa­tients with con­sti­pa­tion (IBS-C), MD-7246 did help im­prove ab­dom­i­nal pain rel­a­tive to place­bo with no ef­fect on bow­el func­tion. In April, Cred­it Su­isse’s Mar­tin Auster had mod­eled ~$300 mil­lion sales op­por­tu­ni­ty for MD-7246 for Iron­wood, based on the com­pa­ny’s sales/re­im­burse­ment ap­por­tion­ment with part­ner Al­ler­gan (now a unit of Ab­b­Vie).

Mark Mal­lon

With MD-7246 in the scrap heap, Iron­wood is left with IW-3718 as the sole clin­i­cal-stage de­vel­op­ment pro­gram, which is cur­rent­ly in late-stage de­vel­op­ment for use in re­frac­to­ry gas­troe­sophageal re­flux dis­ease. An up­date on the pro­gram was ex­pect­ed in the sec­ond half of this year, but will like­ly slide in­to 2021 due to Covid-19-re­lat­ed de­lays.

“As Linzess faces a 2029 hori­zon for gener­ics based on ex­ist­ing set­tle­ments, we an­tic­i­pate the com­pa­ny will take steps to re­place the rev­enue from that fran­chise over the next sev­er­al years by in-li­cens­ing new as­sets. We be­lieve some val­ue-fo­cused share­hold­ers may dis­like this strat­e­gy,” Cowen’s Boris Peak­er wrote in a note on Wednes­day.

Linzess gen­er­at­ed about $803 mil­lion in sales in 2019.

Pe­ter Hecht Cy­cle­ri­on

Last year, Iron­wood shed its oth­er pipeline prospects to fo­cus on GI dis­or­ders, by spin­ning out a com­pa­ny called Cy­cle­ri­on fo­cused on the sol­u­ble guany­late cy­clase (GC) — a key en­zyme in the ni­tric ox­ide sig­nal­ing path­way — busi­ness. The Boston drug­mak­er’s chief Pe­ter Hecht left to head Cy­cle­ri­on, while Iron­wood brought As­traZeneca vet­er­an Mark Mal­lon to the helm.

With just days before President Joe Biden’s Covid-19 booster rollout is set to go into effect, an FDA advisory committee appeared on the verge of not recommending boosters for anyone in the US before a last-minute change of wording laid the groundwork for older adults to have access to a third dose.

The FDA’s adcomm on Vaccines and Related Biological Products (VRBPAC) roundly rejected Pfizer/BioNTech booster shots for all individuals older than 16 by a 16-2 vote Friday afternoon. Soon after, however, the agency posed committee members a new question limiting booster use to the 65-and-older population and individuals at high risk of disease due to occupational exposure or comorbidities.

AstraZeneca and Japanese drugmaker Daiichi Sankyo think they’ve struck gold with their next-gen ADC drug Enhertu, which has shown some striking data in late-stage breast cancer trials and early solid tumor tests. Getting into earlier patients is now the goal, starting with Enhertu’s complete walkover of a Roche drug in second-line breast cancer revealed Saturday.

Enhertu cut the risk of disease progression or death by a whopping 72% (p=<0.0001) compared with Roche’s ADC Kadcyla in second-line unresectable and/or metastatic HER2-positive breast cancer patients who had previously undergone treatment with a Herceptin-chemo combo, according to interim data from the Phase III DESTINY-Breast03 head-to-head study presented at this weekend’s #ESMO21.

In recent months, the battle for PD-(L)1 dominance has spilled over into early cancer with Merck’s Keytruda and Bristol Myers Squibb’s Opdivo all alone on the front lines. Keytruda now has another shell in its bandolier, and it could spell a quick approval.

Keytruda cut the risk of relapse or death by 35% over placebo (p=0.00658) in high-risk, stage 2 melanoma patients who had previously undergone surgery to remove their tumors, according to full data from the Phase III KEYNOTE-716 presented Saturday at #ESMO21.

Merck has worked hard to bring its I/O blockbuster Keytruda into earlier and earlier lines of therapy, and now the wonder drug appears poised to make a quick entry into early advanced cervical cancer.

A combination of Keytruda and chemotherapy with or without Roche’s Avastin cut the risk of death by 33% over chemo with or without Avastin (p=<0.001) in first-line patients with persistent, recurrent or metastatic cervical cancer, according to full data from the Phase III KEYNOTE-826 study presented Saturday at #ESMO21.

Facing the big dogs in the PD-(L)1 space, AstraZeneca has taken its own contender Imfinzi into blockbuster territory in its four years on the market but sees even bigger things for the drug. Combinations could be the key, and early results from a mid-stage test are adding some fuel to that strategy.

Imfinzi combined with one of two investigational immunotherapies — a CD73 antibody dubbed oleclumab or an Innate’s anti-NGK2a named monalizumab — topped Imfinzi alone in terms of overall response and progression-free survival in patients with stage III non-small cell lung cancer whose tumors had not worsened during concurrent chemoradiation, according to interim data from the Phase II COAST trial set to be presented at #ESMO21.