#ACC21: No­var­tis' En­tresto takes its 2nd fail­ure of the week­end at ACC, show­ing no ben­e­fit in most dire heart fail­ure pa­tients

No­var­tis’ En­tresto start­ed the ACC week­end off rough with a tri­al flop in heart at­tack pa­tients, slow­ing the drug’s push in­to ear­li­er pa­tients. Now, an NIH-spon­sored study is cast­ing doubt on En­tresto’s use in the most se­vere heart fail­ure pa­tients, an­oth­er black mark on the in­creas­ing­ly con­tro­ver­sial drug’s record.

En­tresto, a com­bi­na­tion of sacu­bi­tril and val­sar­tan, could not beat out val­sar­tan alone in an out­comes head-to-head for se­vere heart fail­ure pa­tients with a re­duced ejec­tion frac­tion (HFrEF), ac­cord­ing to da­ta pre­sent­ed Mon­day at the vir­tu­al Amer­i­can Col­lege of Car­di­ol­o­gy meet­ing.

The LIFE study, fund­ed by the NIH with par­tic­i­pa­tion from No­var­tis, found that in 355 pa­tients with Class IV HFrEF, En­tresto couldn’t top place­bo in terms of heart fail­ure sever­i­ty as mea­sured by the area un­der the curve for N-ter­mi­nal pro-B-type na­tri­uret­ic pep­tide (NT-proB­NP) lev­els af­ter six months of treat­ment. The Class IV des­ig­na­tion is re­served for pa­tients with an ejec­tion frac­tion mea­sured be­low 35% as well as oth­er phys­i­o­log­i­cal and func­tion­al mark­ers of se­vere heart fail­ure.

The da­ta showed no dif­fer­ence in terms of clin­i­cal out­comes, re­searchers said, but on some fol­low-on end­points val­sar­tan alone ac­tu­al­ly out­per­formed En­tresto, in­clud­ing on in­stances of hy­per­kalemia, or ex­cess potas­si­um lev­els.

“Al­though the tri­al did not have the sta­tis­ti­cal pow­er to eval­u­ate end­points such as car­dio­vas­cu­lar death and heart fail­ure hos­pi­tal­iza­tion, when you look at the to­tal­i­ty of the da­ta, every­thing was in fa­vor of val­sar­tan,” lead au­thor Dou­glas Mann said in a state­ment.

The study looked at the most se­vere heart fail­ure pa­tients as a fol­low-up on No­var­tis’ piv­otal PAR­A­DIGM-HF tri­al, which earned En­tresto its first FDA nod in HFrEF back in 2015. At the time, En­tresto was her­ald­ed as a break­through in heart fail­ure, but since then its record has been less than ster­ling de­spite one ma­jor ap­proval that came with con­tro­ver­sy of its own.

Ear­li­er this week­end, No­var­tis re­vealed full da­ta from its PAR­ADISE-MI study test­ing En­tresto af­ter a heart at­tack in pre­vent­ing a com­pos­ite end­point of death and heart fail­ure events. The drug missed bad­ly on that pri­ma­ry mark, but No­var­tis still tout­ed some pos­i­tive sec­ondary end­points, po­ten­tial­ly set­ting up an ar­gu­ment for the drug’s use in that set­ting.

Mean­while, En­tresto re­cent­ly earned a come-from-be­hind ap­proval in oth­er heart fail­ure pa­tients — those with a pre­served ejec­tion frac­tion (HF­pEF) — af­ter miss­ing the pri­ma­ry end­point on its piv­otal study in that pop­u­la­tion. De­spite the “nar­row miss” on p-val­ue, as No­var­tis called it, En­tresto earned the FDA’s back­ing to go ahead with a fil­ing, ar­gu­ing that pre­spec­i­fied analy­ses and sup­ple­men­tary da­ta cast doubt on the piv­otal study’s de­sign and didn’t cap­ture the full range of ben­e­fit for the drug.

With that ap­proval, En­tresto be­came the first drug ap­proved for HF­pEF, of­fer­ing some hope to a pa­tient pop­u­la­tion with poor out­comes and few op­tions.

In­side Track: Be­hind the Scenes of a Ma­jor Biotech SPAC

Dr. David Hung and Michelle Doig are no strangers to the SPAC phenomenon. As Founder and CEO of Nuvation Bio, a biotech company tackling some of the greatest unmet needs in oncology, Dr. Hung recently took the company public in one of this year’s biggest SPAC related deals. And as Partner at Omega Funds, Doig not only led and syndicated Nuvation Bio’s Series A, but is now also President of the newly formed, Omega-sponsored, Omega Alpha SPAC (Nasdaq: OMEG; oversubscribed $138m IPO priced January 6, 2021).

Barry Greene, Sage CEO

UP­DAT­ED: Sage's sec­ond chance at de­pres­sion hits the PhI­II pri­ma­ry, but ques­tions re­main over dura­bil­i­ty, side ef­fects

Looking to make a comeback after a big Phase III flop, Sage Therapeutics revealed data they believe could change the entire depression treatment landscape, given the vast array of failures in the field. But some results are spooking investors, sending Sage $SAGE shares down early Tuesday.

First, the primary: Sage and Biogen reported Phase III data for once-daily zuranolone Tuesday morning, saying the experimental drug hit its primary endpoint by spurring a statistically significant change from baseline in the 17-item Hamilton Rating Scale for Depression total score. After 15 days, patients in the drug arm saw an average change of -14.1 points, compared to -12.3 on placebo.

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Bio­gen sig­nals a big PhI­II fail­ure as the lead gene ther­a­py in their $800M Night­star buy­out goes down in flames

That $800 million buyout of Nightstar has turned into a bust for Biogen as the lead therapy in the deal failed a pivotal study, signaling a severe setback for the biotech’s ambitions in gene therapies.

The big biotech put out the word after the market closed on Monday that the gene therapy they picked up in the deal for a degenerative blindness called choroideremia failed the Phase III study, just a month after their #2 drug in the deal also flopped in a mid-stage study.

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CEO Harith Rajagopalan (Fractyl)

Af­ter a decade in the type 2 di­a­betes game, Fractyl Lab­o­ra­to­ries recharges with a fresh $100M and a new name

Harith Rajagopalan compared the way type 2 diabetes is managed to sticking your fingers in a dam that’s leaking from a number of places.

You can take drugs to lower your blood sugar, cholesterol, or blood pressure, but you’re not addressing what he says is the core issue — the metabolic abnormality that causes the disease.

“We’re so busy plugging the holes in the dam, we don’t have time to see that the whole infrastructure is at risk,” he said. “That infrastructure is a full-body systemic metabolic abnormality called metabolic syndrome, that we’re ignoring while we’re so busy trying to treat all of the individual symptoms of the condition.”

Hal Barron, GSK R&D chief (Endpoints News)

Hal Bar­ron gam­bles $625M cash on high-wire TIG­IT act, throw­ing Glax­o­SmithK­line in­to heat­ed race and com­plet­ing next-gen I/O trin­i­ty

Count Hal Barron and GlaxoSmithKline in for the TIGIT fight.

The stakes are as high as the risks: While a growing pack of Big Pharma rivals is lending credence to the hypothesis that TIGIT will be the next big immune checkpoint and cancer drug target, the first clinical trials have shown response rates that can be described as modest at best. But Barron’s bet is on the whole “axis” that the receptor sits on, with an eye on testing its new anti-TIGIT antibody not just in combo with PD-1 but also in triplets.

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Lynn Fitch, Mississippi Attorney General (Rogelio V. Solis/AP Images)

Mis­sis­sip­pi sues Eli Lil­ly, Sanofi and No­vo over in­sulin prices as in­ter­change­able biosim­i­lars may ar­rive soon

Mississippi Attorney General Lynn Fitch last week sued the top three insulin manufacturers, which collectively cover almost the entire US insulin market, alleging that they’ve colluded to raise their prices in lockstep, and in some cases by more than 1,000% for drugs that are decades old.

“Because of Manufacturer Defendants’ collusive price increases, nearly a century after the discovery of insulin, diabetes medications have become unaffordable for many diabetics,” the lawsuit says.

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Michel Sade­lain puts his name and new cell en­gi­neer­ing tech be­hind 'ag­nos­tic' CAR-T start­up chas­ing epi­ge­net­ic anti­gens

It felt natural for Alain Maiore and Sebastian Amigorena to bring in Michel Sadelain as a co-founder of Mnemo Therapeutics. A CAR-T pioneer, Sadelain had been involved as an advisor since the early days — enthusiastic about Amigorena’s work in a genetic knockout that could enhance T cell memory and a new class of potential targets he’s discovered — and could introduce some well-known technologies to the toolbox. So they got the initial cash from Sofinnova Partners to plant roots in Paris and New York in early 2019; within a few months, they began to see more clearly just what the antigen discovery platform might unlock.

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Geoffrey Porges, SVB Leerink

Top an­a­lyst maps a rocky road for Ver­tex — un­less they adopt a $10B M&A cam­paign to save the pipeline

After repeatedly poking Vertex $VRTX execs with pointed criticism of their R&D strategy, top SVB Leerink analyst Geoffrey Porges is now turning up the heat to a full-scale roasting.

In a note out early Monday morning, Porges spotlights the impact of Vertex’s recent follow-up failure on AATD — their treatment hit the endpoint but missed on commercial prospects — rewriting his recommended scenario for CEO Reshma Kewalramani as she grapples with the setback.

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Andrew Hopkins, Exscientia CEO

Ex­sci­en­tia spends Soft­Bank's cash in bid to edge out AI ri­vals

Exscientia is sprinting to win the great AI biotech race.

The UK company, having long labored on small discovery deals with large pharmas, raised up to $525 million in a Series D led by the infamous Japanese conglomerate SoftBank in April and followed it up less than a month later with a Bristol Myers Squibb deal that paid $50 million cash and $1.2 billion in milestones.

Now, the Oxford spinout is splurging on a shiny new tool. On Monday they announced they purchased the three-year-old molecule-screening biotech Allcyte, a longtime collaborator, for $60.6 million in cash and stock.

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