Neb­u­liz­er fails PhII COPD study, but Verona plans to march on

Billed as the first new class of bron­chodila­tor in more than four decades, Verona Phar­ma’s $VR­NA ex­per­i­men­tal neb­u­liz­er did not con­fer sta­tis­ti­cal­ly sig­nif­i­cant im­prove­ment on a mea­sure of lung func­tion in Phase II study in­volv­ing pa­tients with chron­ic ob­struc­tive pul­monary dis­ease (COPD) who were al­ready on in­haled long-act­ing bron­chodila­tors.

Verona has tout­ed the drug, known as en­sifen­trine or RPL554, as the first po­ten­tial ther­a­py for res­pi­ra­to­ry dis­eases that acts as both a bron­chodila­tor and an­ti-in­flam­ma­to­ry agent in a soli­tary com­pound. Two dos­es of the drug in a neb­u­lized for­mu­la­tion were be­ing test­ed in the three-day, place­bo-con­trolled tri­al as a main­te­nance treat­ment for 79 COPD pa­tients, who were al­ready on com­mon­ly used LAMA/LA­BA treat­ments.

Pa­tients re­ceived three days of treat­ment with each of two dose strengths (1.5 mg or 6 mg) of neb­u­lized en­sifen­trine or place­bo twice dai­ly. The pri­ma­ry end­point was im­prove­ment in lung func­tion with en­sifen­trine, as mea­sured by FEV1 (forced ex­pi­ra­to­ry vol­ume in one sec­ond), a stan­dard mea­sure of res­pi­ra­to­ry func­tion, four hours post-dose af­ter the morn­ing dose on day three.

Jan-An­ders Karls­son

The pri­ma­ry end­point of FEV1 was not found to be sta­tis­ti­cal­ly sig­nif­i­cant af­ter the morn­ing dose, al­though the small­er en­sifen­trine dose im­proved peak FEV1, the com­pa­ny said, adding that the im­prove­ment was main­tained through­out the 24-hour pe­ri­od on day 3. The com­pa­ny’s shares slumped about 36% in mid­day trad­ing.

How­ev­er, da­ta on sec­ondary end­points in­clud­ing peak FEV1 over time and re­duc­tions in resid­ual vol­ume were en­cour­ag­ing: Peak FEV1 af­ter evening dose on day 3 showed sta­tis­ti­cal­ly sig­nif­i­cant im­prove­ment with both dos­es, and sta­tis­ti­cal­ly sig­nif­i­cant re­duc­tions in mean resid­ual vol­ume were ob­served 15 min­utes fol­low­ing the evening dose on day 3, the Lon­don-based com­pa­ny said.

Over­all, the high­er dose did not re­sult in greater im­prove­ment in lung func­tion as com­pared with the 1.5 mg dose.

But Verona struck an up­beat tone. “Hav­ing demon­strat­ed in pre­vi­ous stud­ies the po­ten­tial of en­sifen­trine to de­liv­er ben­e­fits to pa­tients on no or sin­gle bron­chodila­tor ther­a­py, we be­lieve that this short study con­tin­ues to sup­port our view that en­sifen­trine may al­so be of ben­e­fit to more se­vere COPD pa­tients on dual and triple ther­a­py, for whom there are few oth­er treat­ment op­tions,” said Verona chief Jan-An­ders Karls­son in a state­ment.

“While we are dis­ap­point­ed that this ex­plorato­ry Phase 2 study did not achieve sta­tis­ti­cal sig­nif­i­cance for its pri­ma­ry end­point, these da­ta give us clar­i­ty on the de­sign…for fu­ture long-term stud­ies.”

Sun­Trust Robin­son Humphrey’s Ed­ward Nash ap­peared to agree with the com­pa­ny’s as­sess­ment, say­ing that the tri­al’s main goal was not met due to an un­ex­pect­ed­ly high­er place­bo ef­fect – oth­er­wise the drug did show im­proved FEV1 on top of dual/triple ther­a­py in a very chal­leng­ing COPD pa­tient pop­u­la­tion.

“We be­lieve the FDA would wel­come the low­er dose from a safe­ty stand­point and be­lieve to­tal­i­ty of da­ta which in­cludes ~104mL and 127mL im­prove­ment on top of monother­a­py (tiotropi­um) back­ground and 40mL to 50mL FEV1 im­prove­ments seen in dual/triple back­ground ther­a­py re­port­ed to­day pro­vides a pos­i­tive clin­i­cal and com­mer­cial pro­file for en­sifen­trine.”

Of the pa­tients treat­ed with dual bron­chodila­tor (LAMA/LA­BA) and triple ther­a­py (LAMA/LA­BA/ICS), re­search sug­gests that up to 40% (ap­prox­i­mate­ly 800,000 pa­tients in the US alone) are un­con­trolled, re­main­ing symp­to­matic and at an in­creased risk of ex­ac­er­ba­tions, ac­cord­ing to Verona.

Da­ta have sug­gest­ed that en­sifen­trine is an ef­fec­tive ad­di­tion to sin­gle bron­chodila­tors. The com­pa­ny is cur­rent­ly con­duct­ing a Phase II tri­al to eval­u­ate a dry pow­der in­haler for­mu­la­tion of en­sifen­trine for the same pa­tient pop­u­la­tion, and plans to test en­sifen­trine in a me­tered-dose in­haler for­mu­la­tion in pa­tients with COPD. In ad­di­tion, the drug is al­so be­ing test­ed for use in cys­tic fi­bro­sis and asth­ma.

Brian Kaspar. AveXis via Twitter

AveX­is sci­en­tif­ic founder fires back at No­var­tis CEO Vas Narasimhan, 'cat­e­gor­i­cal­ly de­nies any wrong­do­ing'

Brian Kaspar’s head was among the first to roll at Novartis after company execs became aware of the fact that manipulated data had been included in its application for Zolgensma, now the world’s most expensive therapy.

But in his first public response, the scientific founder at AveXis — acquired by Novartis for $8.7 billion — is firing back. And he says that not only was he not involved in any wrongdoing, he’s ready to defend his name as needed.

I reached out to Brian Kaspar after Novartis put out word that he and his brother Allen had been axed in mid-May, two months after the company became aware of the allegations related to manipulated data. His response came back through his attorneys.

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UP­DAT­ED: An em­bold­ened As­traZeneca splurges $95M on a pri­or­i­ty re­view vouch­er. Where do they need the FDA to hus­tle up?

AstraZeneca is in a hurry.

We learned this morning that the pharma giant — not known as a big spender, until recently — forked over $95 million to get its hands on a priority review voucher from Sobi, otherwise known as Swedish Orphan Biovitrum.

That marks another step down on price for a PRV, which allows the holder to slash 4 months off of any FDA review time.

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Martin Shkreli [via Getty]

Pris­on­er #87850-053 does not get to add drug de­vel­op­er to his list of cred­its

Just days after Retrophin shed its last ties to founder Martin Shkreli, the biotech is reporting that the lead drug he co-invented flopped in a pivotal trial. Fosmetpantotenate flunked both the primary and key secondary endpoints in a placebo-controlled trial for a rare disease called pantothenate kinase-associated neurodegeneration, or PKAN.

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We­bi­nar: Re­al World End­points — the brave new world com­ing in build­ing fran­chise ther­a­pies

Several biopharma companies have been working on expanding drug labels through the use of real world endpoints, combing through the data to find evidence of a drug’s efficacy for particular indications. But we’ve just begun. Real World Evidence is becoming an important part of every clinical development plan, in the soup-through-nuts approach used in building franchises.

I’ve recruited a panel of 3 top experts in the field — the first in a series of premium webinars — to look at the practical realities governing what can be done today, and where this is headed over the next few years, at the prodding of the FDA.

ZHEN SU — Merck Serono’s Senior Vice President and Global Head of Oncology
ELLIOTT LEVY — Amgen’s Senior Vice President of Global Development
CHRIS BOSHOFF — Pfizer Oncology’s Chief Development Officer

A premium subscription to Endpoints News is required to attend this webinar. Please upgrade to either an Insider or Enterprise plan for access. Already have Endpoints Premium? Please sign-in below. You can contact our Subscriptions team at help@endpointsnews.com with any issues.

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Am­gen, Al­ler­gan biosim­i­lar of Roche's block­buster Rit­ux­an clears an­oth­er US piv­otal study 

Novartis $NVS may have given up, but Amgen $AMGN and Allergan $AGN are plowing ahead with their knockoff of Roche’s blockbuster biologic Rituxan in the United States.

Their copycat, ABP 798, was found to have a clinically equivalent impact as Rituxan — meeting the main goal of the study involving CD20-positive B-cell non-Hodgkin’s lymphoma patients. This is the second trial supporting the profile of the biosimilar. In January, it came through with positive PK results in patients with rheumatoid arthritis.

BeiGene and Mus­tang nail down spe­cial FDA sta­tus for top drugs; Roche bags added cov­er­age for Hem­li­bra

→ BeiGene $BGNE is getting a boost in its drive to field a rival to Imbruvica. The FDA has offered an accelerated review to zanubrutinib, a BTK inhibitor that has posted positive results for mantle cell lymphoma. The PDUFA date lands on February 27, 2020. The drug scored breakthrough status at the beginning of the year.

→ BeiGene isn’t the only biopharma company to gain special regulatory status today. Mustang Bio $MBIO and St. Jude Children’s Research Hospital announced that MB-107, a lentiviral gene therapy for the treatment of X-linked severe combined immunodeficiency, also known as bubble boy disease, has been granted Regenerative Medicine Advanced Therapy status.

Trump ad­min­is­tra­tion re­vives bid to get drug list prices on TV ads

The Trump administration is not giving up just yet. On Wednesday, the HHS filed an appeal against a judge’s decision in July to overturn a ruling obligating drug manufacturers to disclose the list price of their therapies in television adverts — hours before it was stipulated to go into effect.

In May, the HHS published a final ruling requiring drugmakers to divulge the wholesale acquisition cost— of a 30-day supply of the drug — in tv ads in a bid to enhance price transparency in the United States. The pharmaceutical industry has vehemently opposed the rule, asserting that list prices are not what a typical patient in the United States pays for treatment — that number is typically determined by the type of (or lack thereof) insurance coverage, deductibles and out-of-pocket costs. Although there is truth to that claim, the move was considered symbolic in the Trump administration’s healthcare agenda to hold drugmakers accountable in a climate where skyrocketing drug prices have incensed Americans on both sides of the aisle.

Ver­sant-backed Chi­nook gets a $65M launch round for its dis­cov­ery quest in a resur­gent kid­ney field

Versant is once again stepping off the beaten track in biotech to see if they can blaze a trail of their own in a field that has looked too thorny to many investors for years.

The venture group and their partners at Apple Tree are bringing their latest creation out of stealth mode today. Born in Versant’s Inception Sciences’ Chinook Therapeutics is betting that its preclinical take on kidney disease can get an early lead among the companies starting up in the field.

Sir An­drew Dil­lon, NICE's first — and on­ly — chief ex­ec­u­tive to step down next year

Using a laptop borrowed from his former employer, South London’s St George’s Hospital, Sir Andrew Dillon set about establishing NICE — launched by the then health secretary Frank Dobson — in 1999.  On Thursday, the UK cost-effectiveness watchdog said its first and only chief executive — Dillon — is stepping down in March 2020.

Back in the day, decisions about which drugs and interventions were funded by the National Health Service (NHS) were made at the local level, but this ‘postcode prescribing’ system was fraught with skewed healthcare deployment making the structure unsustainable. A national system was deemed necessary — and NICE was formed to bridge that gap.