J&J’s big block­buster hope­ful es­ke­t­a­mine scores high for ma­jor de­pres­sion — but side ef­fects haunt re­sults

Can a horse tran­quil­iz­er and no­to­ri­ous par­ty drug be rein­vent­ed as a safe and ef­fec­tive break­through ther­a­py to swift­ly treat ma­jor de­pres­sion and sui­ci­dal think­ing?

J&J $JNJ has been work­ing on that task for years and is now ham­mer­ing away at a piv­otal late-stage pro­gram. This week they’re rolling out some de­tailed Phase II re­sults that un­der­score the po­ten­tial, as well as the prob­lems, that seem in­ex­tri­ca­bly linked to this drug.

Hus­sei­ni Man­ji

J&J’s team took ke­t­a­mine — Spe­cial K as it’s called in cer­tain so­cial cir­cles — and cre­at­ed an in­tranasal ver­sion dubbed es­ke­t­a­mine. The phar­ma gi­ant picked up its first break­through des­ig­na­tion for this drug more than four years ago. And the phar­ma gi­ant be­lieves it’s a block­buster to be, one of the biggest po­ten­tial earn­ers in its late-stage pipeline.

Re­searchers took three dos­es of es­ke­t­a­mine in­to a Phase II study with 126 pa­tients, sep­a­rat­ing them in­to three dose groups. And the drug per­formed as they had ex­pect­ed, of­fer­ing a quick up­take over a two-week study with a dose-de­pen­dent re­ac­tion that of­fered fast re­lief for ma­jor de­pres­sive dis­or­der, as tracked in a com­mon­ly used tri­al as­sess­ment tool.

The good news: By day 8 there was a ma­jor im­prove­ment in the MADRS score for the high dose, more than twice what was reg­is­tered in the low-dose group — which was al­so still clin­i­cal­ly sig­nif­i­cant. Over a two-month fol­lowup, the re­sponse ap­peared to im­prove.

The bad news: Among the side ef­fects was “per­cep­tu­al changes/dis­so­cia­tive symp­toms,” which ran at more than twice the rate seen in the place­bo arm. One in four of the pa­tients tak­ing the drug ex­pe­ri­enced dis­so­cia­tive symp­toms. Se­da­tion was an­oth­er com­mon symp­tom. The dis­so­cia­tive symp­toms oc­curred short­ly af­ter dos­ing and gen­er­al­ly re­solved af­ter a cou­ple of hours. In oth­er words, the Phase II ver­sion of this drug still car­ries risks linked to Spe­cial K.

Aca­d­e­m­ic groups have been re­search­ing straight ke­t­a­mine in hu­mans for years, and their re­sults gen­er­al­ly match, with a rapid lift­ing of de­pres­sion, even among the pa­tients who ap­pear re­sis­tant to any­thing else avail­able. It is an amaz­ing­ly ef­fec­tive treat­ment, and would be an un­am­bigu­ous boon with­out the side ef­fects. It’s al­so tran­sient, with a dose ef­fect that wears off rel­a­tive­ly quick­ly, re­quir­ing re­peat­ed dos­ing to re­main ef­fec­tive.

That re­peat­ed dos­ing, and the longterm im­pact of a ver­sion of a drug that’s been used to in­duce schiz­o­phrenic symp­toms in healthy vol­un­teers, hasn’t been stud­ied so close­ly.

Cur­rent­ly, as any­one with de­pres­sion will tell you, the crop of de­pres­sion drugs avail­able is wild­ly in­con­sis­tent and of­ten tran­sient in na­ture. Ke­t­a­mine works on NM­DA re­cep­tors, and that in turn has led to a surge of new drug de­vel­op­ment pro­grams, in­clud­ing a late-stage ef­fort at Al­ler­gan af­ter that com­pa­ny ac­quired Nau­rex for $560 mil­lion up­front. Sage has al­so at­tract­ed wide­spread in­ter­est in its own ap­proach for de­pres­sion.

Who­ev­er wins this race, if it is won, will have ac­cess to an enor­mous mar­ket, even if its side ef­fects lim­it the drug to a group of the most se­vere­ly af­flict­ed pa­tients.

“If ap­proved by the FDA,” says J&J’s Hus­sei­ni Man­ji, “es­ke­t­a­mine would be one of the first new ap­proach­es to treat re­frac­to­ry ma­jor de­pres­sive dis­or­der avail­able to pa­tients in the last 50 years.”

But the very size of the mar­ket al­so rais­es the bar on safe­ty and ef­fi­ca­cy. And that ju­ry will re­main out un­til Phase III da­ta are com­plete.

Nick Leschly via Getty

UP­DAT­ED: Blue­bird shares sink as an­a­lysts puz­zle out $1.8M stick­er shock and an un­ex­pect­ed de­lay

Blue­bird bio $BLUE has un­veiled its price for the new­ly ap­proved gene ther­a­py Zyn­te­glo (Lenti­Glo­bin), which came as a big sur­prise. And it wasn’t the on­ly un­ex­pect­ed twist in to­day’s sto­ry.

With some an­a­lysts bet­ting on a $900,000 price for the β-tha­lassemia treat­ment in Eu­rope, where reg­u­la­tors pro­vid­ed a con­di­tion­al ear­ly OK, blue­bird CEO Nick Leschly said Fri­day morn­ing that the pa­tients who are suc­cess­ful­ly treat­ed with their drug over 5 years will be charged twice that — $1.8 mil­lion — on the con­ti­nent. That makes this drug the sec­ond most ex­pen­sive ther­a­py on the plan­et, just be­hind No­var­tis’ new­ly ap­proved Zol­gens­ma at $2.1 mil­lion, with an­a­lysts still wait­ing to see what kind of pre­mi­um can be had in the US.

Ted Love. HAVERFORD COLLEGE

Glob­al Blood Ther­a­peu­tics poised to sub­mit ap­pli­ca­tion for ac­cel­er­at­ed ap­proval, with new piv­otal da­ta on its sick­le cell dis­ease drug

Global Blood Therapeutics is set to submit an application for accelerated approval in the second-half of this year, after unveiling fresh data from a late-stage trial that showed just over half the patients given the highest dose of its experimental sickle cell disease drug experienced a statistically significant improvement in oxygen-wielding hemoglobin, meeting the study's main goal.

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News­mak­ers at #EHA19: Re­gen­eron, Ar­Qule track progress on re­sponse rates

Re­gen­eron’s close­ly-watched bis­pe­cif­ic con­tin­ues to ring up high re­sponse rates

Re­gen­eron’s high-pro­file bis­pe­cif­ic REGN1979 is back in the spot­light at the Eu­ro­pean Hema­tol­ogy As­so­ci­a­tion sci­en­tif­ic con­fab. And while the stel­lar num­bers we saw at ASH have erod­ed some­what as more blood can­cer pa­tients are eval­u­at­ed, the re­sponse rates for this CD3/CD20 drug re­main high.

A to­tal of 13 out of 14 fol­lic­u­lar lym­phomas re­spond­ed to the drug, a 93% ORR, down from 100% at the last read­out. In 10 out of 14, there was a com­plete re­sponse. In dif­fuse large B-cell lym­phoma the re­sponse rate was 57% among pa­tients treat­ed at the 80 mg to 160 mg dose range. They were all com­plete re­spons­es. And 2 of these Cars were for pa­tients who had failed CAR-T ther­a­py.

Search­ing for the next block­buster to fol­low Darza­lex, J&J finds a $150M an­ti-CD38 drug from part­ner Gen­mab

Now that J&J and Genmab have thrust Darzalex onto the regulatory orbit for first-line use in multiple myeloma, the partners are lining up a deal for a next-gen follow-on to the leading CD38 drug.


Janssen — J&J’s biotech unit — has its eyes on HexaBody-CD38, a preclinical compound generated on Genmab’s tech platform designed to make drugs more potent via hexamerization.


Genmab is footing the bill on studies in multiple myeloma and diffuse large B-cell lymphoma; once it completes clinical proof of concept, Janssen has the option to license the drug for a $150 million exercise fee. There’s also $125 million worth of milestones in play.

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Gene ther­a­pies seize the top of the list of the most ex­pen­sive drugs on the plan­et — and that trend has just be­gun

Anyone looking for a few simple reasons why the gene therapy field has caught fire with the pharma giants need only look at the new list of the 10 most expensive therapies from GoodRx.

Two recently approved gene therapies sit atop this list, with Novartis’ Zolgensma crowned the king of the priciest drugs at $2.1 million. Right below is Luxturna, the $850,000 pioneer from Spark, which Roche is pushing hard to acquire as it adds a gene therapy group to the global mix.

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Savara shares are crushed as PhI­II tri­al flunks pri­ma­ry, key sec­on­daries — but they can’t stop be­liev­ing

In­vestors are in no mood to hear biotechs tout the suc­cess of a “key” sec­ondary end­point when the piv­otal Phase III flunks the pri­ma­ry goal. Just ask Savara. 

The Texas biotech $SVRA went look­ing for a sil­ver lin­ing as com­pa­ny ex­ecs blunt­ly con­ced­ed that Mol­gradex, an in­haled for­mu­la­tion of re­com­bi­nant hu­man gran­u­lo­cyte-macrophage colony-stim­u­lat­ing fac­tor (GM-CSF), failed to spur sig­nif­i­cant­ly im­proved treat­ment out­comes for pa­tients with a rare res­pi­ra­to­ry dis­ease called au­toim­mune pul­monary alve­o­lar pro­teinosis, or aPAP.

As an­oth­er an­tibi­otics biotech sinks in­to a cri­sis, warn­ings of a sec­tor ‘col­lapse’

Another antibiotics company is scrambling to survive today, forcing the company’s founding CEO to exit in a reorganization that eliminates its research capabilities as the survivors look to improve on minuscule sales of their newly approved treatment. And the news — on top of an alarming series of failures — spurred at least one figure in the field to warn of a looming collapse of the antimicrobial resistance research field.

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'We kept at it': Jef­frey Blue­stone plots late-stage come­back af­ter teplizum­ab shown to de­lay type 1 di­a­betes

Late-stage da­ta pre­sent­ed at the Amer­i­can Di­a­betes As­so­ci­a­tion an­nu­al meet­ing in 2010 pushed Eli Lil­ly to put a crimp on teplizum­ab as the phar­ma gi­ant found it un­able to re­set the clock on new­ly di­ag­nosed type 1 di­a­betes. At the same con­fer­ence but in dif­fer­ent hands nine years lat­er, the drug is mak­ing a crit­i­cal come­back by scor­ing suc­cess in an­oth­er niche: de­lay­ing the on­set of the dis­ease.

In a Phase II tri­al with 76 high-risk in­di­vid­u­als — rel­a­tives of pa­tients with type 1 di­a­betes who have di­a­betes-re­lat­ed au­toan­ti­bod­ies in their bod­ies — teplizum­ab al­most dou­bled the me­di­an time of di­ag­no­sis com­pared to place­bo (48.4 months ver­sus 24.4 months). The haz­ard ra­tio for di­ag­no­sis was 0.41 (p=0.006).

Bain’s biotech team has cre­at­ed a $1B-plus fund — with an eye to more Big Phar­ma spin­outs

One of the biggest investors to burst onto the biotech scene in recent years has re-upped with more than a billion dollars flowing into its second fund. And this next wave of bets will likely include more of the Big Pharma spinouts that highlighted their first 3 years in action.

Adam Koppel and Jeff Schwartz got the new life sciences fund at Bain Capital into gear in the spring of 2016, as they were putting together a $720 million fund with $600 million flowing in from external investors and the rest drawn from the Bain side of the equation. This time the external investors chipped in $900 million, with Bain coming in for roughly $180 million more.

They’re not done with Fund I, with plans to add a couple more deals to the 15 they’ve already posted. And once again, they’re estimating another 15 to 20 investments over a 3- to 5-year time horizon for Fund II.

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