J&J racks up a fresh set of pos­i­tive piv­otal da­ta for de­pres­sion drug es­ke­t­a­mine — but ques­tions linger on safe­ty

J&J has tak­en an­oth­er big step for­ward in its quest to bring home a block­buster ap­proval for its nasal spray for­mu­la­tion of ke­t­a­mine as a new rem­e­dy for ma­jor de­pres­sion.

Just weeks af­ter the phar­ma gi­ant re­port­ed that es­ke­t­a­mine had es­sen­tial­ly aced short-term piv­otal stud­ies, re­searchers are back with ev­i­dence of its long-term ef­fi­ca­cy. But they will like­ly face care­ful scruti­ny over the sub­stan­tial side ef­fects spurred by the ther­a­py, in­clud­ing a set of se­ri­ous ad­verse events re­port­ed in the lengthy safe­ty study.

The ef­fi­ca­cy study fo­cused on 705 treat­ment-re­sis­tant pa­tients re­cruit­ed out of its Phase III pro­gram who were sta­ble af­ter 16 weeks of ther­a­py with es­ke­t­a­mine and an oral an­ti-de­pres­sant. Fol­low­ing an­oth­er stretch of treat­ment, the es­ke­t­a­mine com­bo proved sig­nif­i­cant­ly more ef­fec­tive in pre­vent­ing a re­lapse than a place­bo spray plus oral de­pres­sion drug.

About one in four (26.7%) of the sta­ble re­mit­ters in the es­ke­t­a­mine arm ex­pe­ri­enced a re­lapse com­pared to 45.3% of the place­bo group (p=0.003) — a strong­ly pos­i­tive out­come. It’s par­tic­u­lar­ly sig­nif­i­cant that the re­searchers were able to track longterm re­spons­es for a drug known for its ephemer­al im­pact.

The safe­ty da­ta are a lit­tle more com­plex. As seen ear­li­er, and com­plete­ly ex­pect­ed, there was a high rate of dis­so­ci­a­tion — 22.4%. That un­der­scores why J&J plans to have the drug in­fused in a clin­ic, with an ob­ser­va­tion pe­ri­od to make sure pa­tients were be­hav­ing nor­mal­ly be­fore they leave.

Es­ke­t­a­mine is a low dose of ke­t­a­mine, a par­ty drug and horse tran­quil­iz­er that’s of­ten abused. J&J here is try­ing to nav­i­gate its way through Phase III with an ac­cept­able for­mu­la­tion for a tough pa­tient pop­u­la­tion in a field known for wide­spread fail­ure.

The safe­ty study was open la­bel, with pa­tients aware they were get­ting the drug. Re­searchers re­port­ed:

Fifty-five (6.9%) pa­tients ex­pe­ri­enced 68 se­ri­ous treat­ment-emer­gent ad­verse events. Of these, five se­ri­ous treat­ment-emer­gent ad­verse events from four sub­jects were as­sessed by the in­ves­ti­ga­tor as es­ke­t­a­mine nasal spray-re­lat­ed. There were two deaths which the in­ves­ti­ga­tor de­ter­mined to be un­re­lat­ed to es­ke­t­a­mine nasal spray or oral an­ti­de­pres­sant use. Lab­o­ra­to­ry tests, phys­i­cal ex­am­i­na­tion, and nasal tol­er­a­bil­i­ty re­vealed no trends of clin­i­cal con­cern in pa­tients treat­ed with es­ke­t­a­mine nasal spray for up to 52 weeks. No clin­i­cal­ly mean­ing­ful changes in cog­ni­tion were found. No cas­es of in­ter­sti­tial or ul­cer­a­tive cys­ti­tis were re­port­ed.

I asked a com­pa­ny rep what the five se­ri­ous ad­verse events were, as it could be rel­e­vant to a reg­u­la­to­ry re­view. Her re­sponse: de­pres­sion, delir­i­um, anx­i­ety and delu­sion, sui­ci­dal ideation and sui­cide at­tempt.

J&J has list­ed es­ke­t­a­mine as one of its top late-stage de­vel­op­ment pro­grams, prep­ping ap­pli­ca­tions for both sides of the At­lantic. They’re not home free yet, but in de­pres­sion uni­form safe­ty and ef­fi­ca­cy is un­heard of, with reg­u­la­tors will­ing to bal­ance the risks with the ben­e­fits for a tough group to treat.

On that score, J&J is well ahead of the game.

It’s fi­nal­ly over: Bio­gen, Ei­sai scrap big Alzheimer’s PhI­I­Is af­ter a pre­dictable BACE cat­a­stro­phe rais­es safe­ty fears

Months after analysts and investors called on Biogen and Eisai to scrap their BACE drug for Alzheimer’s and move on in the wake of a string of late-stage failures and rising safety fears, the partners have called it quits. And they said they were dropping the drug — elenbecestat — after the independent monitoring board raised concerns about…safety.

We don’t know exactly what researchers found in this latest catastrophe, but the companies noted in their release that investigators had determined that the drug was flunking the risk/benefit analysis.

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Lisa M. DeAngelis, MSKCC

MSK picks brain can­cer ex­pert Lisa DeAn­ge­lis as its next CMO — fol­low­ing José Basel­ga’s con­tro­ver­sial ex­it

It’s official. Memorial Sloan Kettering has picked a brain cancer expert as its new physician-in-chief and CMO, replacing José Baselga, who left under a cloud after being singled out by The New York Times and ProPublica for failing to properly air his lucrative industry ties.

His replacement, who now will be in charge of MSK’s cutting-edge research work as well as the cancer care delivered by hundreds of practitioners, is Lisa M. DeAngelis. DeAngelis had been chair of the neurology department and co-founder of MSK’s brain tumor center and was moved in to the acting CMO role in the wake of Baselga’s departure.

Penn team adapts CAR-T tech, reengi­neer­ing mouse cells to treat car­diac fi­bro­sis

After establishing itself as one of the pioneer research centers in the world for CAR-T cancer therapies, creating new attack vehicles to eradicate cancer cells, a team at Penn Medicine has begun the tricky transition of using the basic technology for heart repair work.

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Tal Zaks. Moderna

The mR­NA uni­corn Mod­er­na has more ear­ly-stage hu­man da­ta it wants to show off — reach­ing new peaks in prov­ing the po­ten­tial

The whole messenger RNA field has attracted billions of dollars in public and private investor cash gambled on the prospect of getting in on the ground floor. And this morning Boston-based Moderna, one of the leaders in the field, wants to show off a few more of the cards it has to play to prove to you that they’re really in the game.

The whole hand, of course, has yet to be dealt. And there’s no telling who gets to walk with a share of the pot. But any cards on display at this point — especially after being accused of keeping its deck under lock and key — will attract plenty of attention from some very wary, and wired, observers.

“In terms of the complexity and unmet need,” says Tal Zaks, the chief medical officer, “this is peak for what we’ve accomplished.”

Moderna has two Phase I studies it wants to talk about now.

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It's not per­fect, but it's a good start: FDA pan­elists large­ly en­dorse Aim­mune's peanut al­ler­gy ther­a­py

Two days after a fairly benign review from FDA staff, an independent panel of experts largely endorsed the efficacy and safety of Aimmune’s peanut allergy therapy, laying the groundwork for approval with a risk evaluation and mitigation strategy (REMS).

Traditionally, peanut allergies are managed by avoidance, but the threat of accidental exposure cannot be nullified. Some allergists have devised a way to dose patients off-label with peanut protein derived from supermarket products to wean them off their allergies. But the idea behind Aimmune’s product was to standardize the peanut protein, and track the process of desensitization — so when accidental exposure in the real world invariably occurs, patients are less likely to experience a life-threatening allergic reaction.

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Rit­ter bombs fi­nal PhI­II for sole lac­tose in­tol­er­ance drug — shares plum­met

More than two years ago Ritter Pharmaceuticals managed to find enough silver lining in its Phase IIb/III study — after missing the top-line mark — to propel its lactose intolerance toward a confirmatory trial. But as it turned out, the enthusiasm only set the biotech and its investors up to be sorely disappointed.

This time around there’s little left to salvage. Not only did RP-G28 fail to beat placebo in reducing lactose intolerance symptoms, patients in the treatment group actually averaged a smaller improvement. On a composite score measuring symptoms like abdominal pain, cramping, bloating and gas, patients given the drug had a mean reduction of 3.159 while the placebo cohort saw a 3.420 drop on average (one-sided p-value = 0.0106).

Ear­ly snap­shot of Ad­verum's eye gene ther­a­py sparks con­cern about vi­sion loss

An early-stage update on Adverum Biotechnologies’ intravitreal gene therapy has triggered investor concern, after patients with wet age-related macular degeneration (AMD) saw their vision deteriorate, despite signs that the treatment is improving retinal anatomy.

Adverum, on Wednesday, unveiled 24-week data from the OPTIC trial of its experimental therapy, ADVM-022, in six patients who have been administered with one dose of the therapy. On average, patients in the trial had severe disease with an average of 6.2 anti-VEGF injections in the eight months prior to screening and an average annualized injection frequency of 9.3 injections.

Alex Ar­faei trades his an­a­lyst's post for a new role as biotech VC; Sanofi vet heads to Vi­for

Too often, Alex Arfaei arrived too late. 

An analyst at BMO Capital Markets, he’d meet with biotech or pharmaceutical heads for their IPO or secondary funding and his brain, trained on a biology degree and six years at Merck and Endo, would spring with questions: Why this biomarker? Why this design? Why not this endpoint? Not that he could do anything about it. These execs were coming for clinical money; their decisions had been made and finalized long ago.

Arde­lyx bags its first FDA OK for IBS, set­ting up a show­down with Al­ler­gan, Iron­wood

In the first of what it hopes will be a couple of major regulatory milestones for its new drug, Ardelyx has bagged an FDA approval to market Ibsrela (tenapanor) for irritable bowel syndrome.

The drug’s first application will be for IBS with constipation (IBS-C), inhibiting sodium-hydrogen exchanger NHE3 in the GI tract in such a way as to increase bowel movements and decrease abdominal pain. This comes on the heels of two successful Phase III trials.