Megablock­buster day for Roche too as MS game-chang­er Ocre­vus gets a green light at the FDA

Sev­erin Schwan, Roche CEO

Tues­day turned out to be the day for a game of megablock­busters. Re­gen­eron and Sanofi snagged an FDA OK for Dupix­ent, a land­mark new eczema ther­a­py, and now Roche came through with a thumbs up for ocre­lizum­ab, which promis­es to remap the land­scape for the mul­ti­ple scle­ro­sis drug mar­ket.

Ocre­lizum­ab — which will now be sold as Ocre­vus — could be used to treat most MS pa­tients, a com­bi­na­tion of re­laps­ing/re­mit­ting and pri­ma­ry pro­gres­sive pa­tients. That’s a unique dis­tinc­tion that is like­ly to make this a key fo­cus among doc­tors who spe­cial­ize in treat­ing MS. And that could be a game change for every­one in the field.

Roche priced this drug for mar­ket pen­e­tra­tion at $65,000 a year, a 25% dis­count to Rebif.

“Ac­cord­ing to the NMSS, MS med­i­cines on av­er­age cost al­most 4 times more to­day than they did 12 years ago,” notes a spokesper­son for Roche. “In fact, Rebif – the 14 year-old stan­dard of care that OCRE­VUS was shown to be clin­i­cal­ly su­pe­ri­or in two RMS tri­als – now costs about $86,000. We feel that the in­dus­try needs to start to re­verse this trend, and be­lieve that pric­ing Ocre­vus 25% less than the com­para­tor in our tri­als is an im­por­tant first step.”

Eval­u­atePhar­ma has pegged con­sen­sus fore­casts of rev­enue for 2022 at $4 bil­lion for this ther­a­py, about a bil­lion dol­lars be­hind where Dupix­ent is ex­pect­ed to land. Its pres­ence in the pipeline, com­bined with a re­cent ap­proval of its check­point Tecen­triq and a few oth­er top prospects, has al­lowed Roche CEO Sev­erin Schwan to large­ly stay out of an M&A mar­ket he has long viewed as over­priced and way too risky.

In­ves­ti­ga­tors say they were able to de­ter­mine the drug in­creased the pro­por­tion of re­laps­ing/re­mit­ting MS pa­tients see­ing the elim­i­na­tion of dis­ease ac­tiv­i­ty by 75% over 96 weeks com­pared to Rebif. Most achieved that sta­tus at the end of 24 weeks of treat­ment with the ther­a­py. And the com­pa­ny al­so out­lined new pos­i­tive da­ta on the elim­i­na­tion of dis­ease pro­gres­sion among pri­ma­ry pro­gres­sive MS pa­tients com­pared to a place­bo.

Bri­an Sko­r­ney, Baird an­a­lyst

The da­ta paves the way for a new con­tender that is en­ter­ing a fast-chang­ing and fu­ri­ous­ly com­pet­i­tive mar­ket. A 40mg gener­ic ver­sion of Te­va’s Co­pax­one may be on the way soon as Bio­gen’s flag­ship drug Tec­fidera con­tin­ues to see its mar­ket de­te­ri­o­rate. That ero­sion has left Bio­gen in­cred­i­bly vul­ner­a­ble to grow­ing crit­i­cism of its busi­ness mod­el.

“Re­call, we’ve ad­vo­cat­ed that Tysabri should be an ob­vi­ous tar­get for Ocre­vus in RMS giv­en the as­so­ci­at­ed safe­ty risks, sim­i­lar­i­ties in ad­min­is­tra­tion, etc,” not­ed Baird’s Bri­an Sko­r­ney. “Docs in­di­cat­ed that about 50% of Ocre­vus pa­tients would like­ly be PPMS pa­tients, with 11% com­ing from Tysabri and an­oth­er 11% switch­es from Tec­fidera. This im­plies an al­most 20% hit to over­all Tysabri de­mand. How­ev­er, when asked about long-term trends, gener­ic 40mg Co­pax­one, and oth­er com­pet­i­tive threats, docs still be­lieve Tec­fidera could see a 20%+ de­cline in scripts by YE18.”

San­dra Horn­ing

“The FDA’s ap­proval of OCRE­VUS is the be­gin­ning of a new era for the MS com­mu­ni­ty and rep­re­sents a sig­nif­i­cant sci­en­tif­ic ad­vance with this first-in-class B cell tar­get­ed ther­a­py,” said San­dra Horn­ing, chief med­ical of­fi­cer and head of Glob­al Prod­uct De­vel­op­ment. “Un­til now, no FDA-ap­proved treat­ment has been avail­able to the pri­ma­ry pro­gres­sive MS com­mu­ni­ty, and some peo­ple with re­laps­ing forms of MS con­tin­ue to ex­pe­ri­ence dis­ease ac­tiv­i­ty and dis­abil­i­ty pro­gres­sion de­spite avail­able ther­a­pies. We be­lieve OCRE­VUS, giv­en every six months, has the po­ten­tial to change the dis­ease course for peo­ple with MS, and we are com­mit­ted to help­ing those who can ben­e­fit gain ac­cess to our med­i­cine.”

ZS Per­spec­tive: 3 Pre­dic­tions on the Fu­ture of Cell & Gene Ther­a­pies

The field of cell and gene therapies (C&GTs) has seen a renaissance, with first generation commercial therapies such as Kymriah, Yescarta, and Luxturna laying the groundwork for an incoming wave of potentially transformative C&GTs that aim to address diverse disease areas. With this renaissance comes several potential opportunities, of which we discuss three predictions below.

Allogenic Natural Killer (NK) Cells have the potential to displace current Cell Therapies in oncology if proven durable.

Despite being early in development, Allogenic NKs are proving to be an attractive new treatment paradigm in oncology. The question of durability of response with allogenic therapies is still an unknown. Fate Therapeutics’ recent phase 1 data for FT516 showed relatively quicker relapses vs already approved autologous CAR-Ts. However, other manufacturers, like Allogene for their allogenic CAR-T therapy ALLO-501A, are exploring novel lymphodepletion approaches to improve persistence of allogenic cells. Nevertheless, allogenic NKs demonstrate a strong value proposition relative to their T cell counterparts due to comparable response rates (so far) combined with the added advantage of a significantly safer AE profile. Specifically, little to no risk of graft versus host disease (GvHD), cytotoxic release syndrome (CRS), and neurotoxicity (NT) have been seen so far with allogenic NK cells (Fig. 1). In addition, being able to harness an allogenic cell source gives way to operational advantages as “off-the-shelf” products provide improved turnaround time (TAT), scalability, and potentially reduced cost. NKs are currently in development for a variety of overlapping hematological indications with chimeric antigen receptor T cells (CAR-Ts) today, and the question remains to what extent they will disrupt the current cell therapy landscape. Click for more details.

A $3B+ peak sales win? Pfiz­er thinks so, as FDA of­fers a tardy green light to its JAK1 drug abroc­i­tinib

Back in the fall of 2020, newly crowned Pfizer chief Albert Bourla confidently put their JAK1 inhibitor abrocitinib at the top of the list of blockbuster drugs in the late-stage pipeline with a $3 billion-plus peak sales estimate.

Since then it’s been subjected to serious criticism for the safety warnings associated with the class, held back by a cautious FDA and questioned when researchers rolled out a top-line boast that their heavyweight contender had beaten the champ in the field of atopic dermatitis — Dupixent — in a head-to-head study.

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Michel Vounatsos, Biogen CEO (World Economic Forum/Ciaran McCrickard)

Bio­gen vows to fight CM­S' draft cov­er­age de­ci­sion for Aduhelm be­fore April fi­nal­iza­tion

Biogen executives made clear in an investor call Thursday they are not preparing to run a new CMS-approved clinical trial for their controversial Alzheimer’s drug anytime soon.

As requested in a draft national coverage decision from CMS earlier this week, Biogen and other anti-amyloid drugs will need to show “a meaningful improvement in health outcomes” for Alzheimer’s patients in a randomized, placebo-controlled trial to get paid for their drugs, rather than just the reduction in amyloid plaques that won Aduhelm its accelerated approval in June.

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Lat­est news on Pfiz­er's $3B+ JAK1 win; Pacts over M&A at #JPM22; 2021 by the num­bers; Bio­gen's Aduhelm reck­on­ing; The sto­ry of sotro­vimab; and more

Welcome back to Endpoints Weekly, your review of the week’s top biopharma headlines. Want this in your inbox every Saturday morning? Current Endpoints readers can visit their reader profile to add Endpoints Weekly. New to Endpoints? Sign up here.

For those of you who attended #JPM22 in any shape or form, we hope you had a fruitful time. Regardless of how you spent the past hectic week, may your weekend be just what you need it to be.

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‘Skin­ny la­bels’ on gener­ics can save pa­tients mon­ey, re­search shows, but re­cent court de­ci­sions cloud fu­ture

New research shows how generic drug companies can successfully market a limited number of approved indications for a brand name drug, prior to coming to market for all of the indications. But several recent court decisions have created a layer of uncertainty around these so-called “skinny” labels.

While courts have generally allowed generic manufacturers to use their statutorily permitted skinny-label approvals, last summer, a federal circuit court found that Teva Pharmaceuticals was liable for inducing prescribers and patients to infringe GlaxoSmithKline’s patents through advertising and marketing practices that suggested Teva’s generic, with its skinny label, could be employed for the patented uses.

Robert Califf, FDA commissioner nominee (Graeme Sloan/Sipa USA/Sipa via AP Images)

Rob Califf ad­vances as Biden's FDA nom­i­nee, with a close com­mit­tee vote

Rob Califf’s second confirmation process as FDA commissioner is already much more difficult than his near unanimous confirmation under the Obama administration.

The Senate Health Committee on Thursday voted 13-8 in favor of advancing Califf’s nomination to a full Senate vote. Several Democrats voted against Califf, including Sen. Bernie Sanders and Sen. Maggie Hassan. Several other Democrats who aren’t on the committee, like West Virginia’s Joe Manchin and Ed Markey of Massachusetts, also said Thursday that they would not vote for Califf. Markey, Hassan and Manchin all previously expressed reservations about the prospect of Janet Woodcock as an FDA commissioner nominee too.

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UP­DAT­ED: CMS to re­strict cov­er­age of Bio­gen's con­tro­ver­sial Alzheimer's drug to on­ly clin­i­cal tri­als

The Centers for Medicare and Medicaid Services on Tuesday said it will only pay for Biogen’s Aduhelm and other FDA-approved anti-amyloid monoclonal antibodies for Alzheimer’s disease under CMS-approved randomized controlled trials.

The draft national coverage decision, which insurers nationwide are likely to follow, makes clear that CMS will be looking for randomized controlled trials that “demonstrate a clinically meaningful benefit in cognition and function.” That will be a tough task for Biogen, which previously showed conflicting benefits from past Aduhelm trials that were initially cut short due to futility and then resurrected for the accelerated approval.

CRO own­er pleads guilty to ob­struct­ing FDA in­ves­ti­ga­tion in­to fal­si­fied clin­i­cal tri­al da­ta

The co-owner of a Florida-based clinical research site pleaded guilty to lying to an FDA investigator during a 2017 inspection, revealing that she falsely portrayed part of a GlaxoSmithKline pediatric asthma study as legitimate, when in fact she knew that certain data had been falsified, the Department of Justice said Wednesday.

Three other employees — Yvelice Villaman Bencosme, Lisett Raventos and Maytee Lledo — previously pleaded guilty and were sentenced in connection with falsifying data associated with the trial at the CRO Unlimited Medical Research.

Susan Galbraith, AstraZeneca EVP, Oncology R&D

Can­cer pow­er­house As­traZeneca rolls the dice on a $75M cash bet on a buzzy up­start in the on­col­o­gy field

After establishing itself in the front ranks of cancer drug developers and marketers, AstraZeneca is putting its scientific shoulder — and a significant amount of cash — behind the wheel of a brash new upstart in the biotech world.

The pharma giant trumpeted news this morning that it is handing over $75 million upfront to ally itself with Scorpion Therapeutics, one of those biotechs that was newly birthed by some top scientific, venture and executive talent and bequeathed with a fortune by way of a bankroll to advance an only hazily explained drug platform. And they are still very much in the discovery and preclinical phase.

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