Prob­lems, prob­lems, prob­lems: But Alk­er­mes will fight it out this week over the FDA’s ob­jec­tions to its big de­pres­sion drug ALKS 5461

Alk­er­mes tried sev­er­al new things when their re­searchers test­ed ALKS 5461 for ma­jor de­pres­sion in clin­i­cal tri­als. Now they have to see if they can con­vince the FDA and a group of out­side ex­perts that the drug is ac­tu­al­ly as ef­fec­tive — and as safe — as they in­sist it is.

Alk­er­mes $ALKS is at­tempt­ing to gain an ap­proval for this drug — which is seen as a lynch pin to its fu­ture rev­enue — de­spite key tri­al fail­ures and an ar­guably thin lay­er of con­tro­ver­sial da­ta back­ing the drug.

In the agency’s in­ter­nal re­view of the drug, ini­tial­ly re­ject­ed by the FDA and then tak­en in for a re­view af­ter a sud­den about-face on its de­mand for new tri­als ahead of a mar­ket­ing de­ci­sion, reg­u­la­tors make it clear that Alk­er­mes pushed ahead with a study de­sign they clear­ly in­sist­ed was in­ad­e­quate to pro­vide the in­sight on ef­fi­ca­cy they need to ap­prove a drug for ma­jor de­pres­sion.

Those ob­jec­tions helped dri­ve down the stock price to­day, which slid 6.5% on the frosty — though not for­bid­ding — re­cep­tion.

Most im­por­tant­ly, the reg­u­la­tors high­light Alk­er­mes’ move to use an ab­bre­vi­at­ed scor­ing sys­tem, cut­ting out es­sen­tial points that have scut­tled oth­er de­pres­sion drugs — in­clud­ing track­ing sui­ci­dal think­ing on the part of pa­tients.

From the re­view:

The Mont­gomery Ås­berg De­pres­sion Rat­ing Scale is a 10-item di­ag­nos­tic ques­tion­naire used to mea­sure the sever­i­ty of de­pres­sive episodes in pa­tients with mood dis­or­ders (MADRS-10). The Ap­pli­cant used an abridged 6-item ver­sion of the MADRS-10 for the pri­ma­ry end­point of one of the prin­ci­pal stud­ies (Study 207). The Di­vi­sion had ren­dered ad­vice ex­plic­it­ly against this plan, based on analy­ses of the MADRS-10 and MADRS-6 by both the Di­vi­sion and the Agency’s Clin­i­cal Out­comes As­sess­ment (COA) Staff. The COA Staff had con­clud­ed that the MADRS-6 could not re­place the MADRS-10 for use as a pri­ma­ry end­point be­cause the abridged ques­tion­naire ex­cludes con­cepts that are rel­e­vant and im­por­tant in MDD, specif­i­cal­ly “re­duced sleep,” “re­duced ap­petite,” “con­cen­tra­tion dif­fi­cul­ties,” and “sui­ci­dal thoughts.”

Not on­ly that, but the agency takes ex­cep­tion to Alk­er­mes’ view that the drug is a non-opi­oid.

(B)up­renor­phine is an opi­oid. Al­though the Ap­pli­cant has made sev­er­al ar­gu­ments that the oth­er com­po­nent of their drug, sami­dor­phan, negates the μ-opi­oid prop­er­ties of buprenor­phine, this has not been con­clu­sive­ly proven. Al­though we agree with the Ap­pli­cant that there are few­er opi­oid prop­er­ties for this com­bi­na­tion prod­uct than there like­ly would have been from the opi­oid alone, there re­mains some ev­i­dence of a mild opi­ate ef­fect (in­clud­ing mild with­draw­al ef­fects) from the tri­als.

In sev­er­al cas­es, the FDA spot­lights messy da­ta that they clear­ly have tak­en is­sue with. That in­cludes drop­ping the clas­sic ap­proach of as­sess­ing pa­tients at par­tic­u­lar time points in a study and in­stead shoot­ing for av­er­age scores over a pe­ri­od of time. That may not fly with the FDA, but the reg­u­la­tors do want to hear the ex­perts’ opin­ions on that sub­ject.

Alk­er­mes al­so used a nov­el tri­al de­sign to se­lect pa­tients for the study, and now reg­u­la­tors want the out­side ex­perts to dis­cuss their opin­ions on how this worked. Ex­plain­ing the move, reg­u­la­tors not­ed:

In Stage 1, pa­tients who meet study en­trance cri­te­ria are ran­dom­ized to drug vs. place­bo, with a skewed ran­dom­iza­tion ra­tio that places far more pa­tients in the place­bo group. Stage 2 in­cludes on­ly non-re­spon­ders from the Stage 1 place­bo group, and these pa­tients are re-ran­dom­ized to drug vs. place­bo. Re­sults from the two stages are merged to pro­vide a sin­gle over­all test of hy­poth­e­sis. There are a num­ber of un­re­solved sta­tis­ti­cal ques­tions re­gard­ing the most ap­pro­pri­ate method for an­a­lyz­ing the re­sults of an SPCD study.

The ex­pert pan­el will gath­er on Thurs­day to hash it all out and of­fer their opin­ion to the FDA over­lords. In the mean­time, Paul Mat­teis at Stifel says Alk­er­mes is fac­ing some se­vere head­winds go­ing in­to the pan­el re­view Thurs­day.

Over­all, the docs are def­i­nite­ly neg­a­tive and sug­gest that FDA is lean­ing to­wards a CRL, but they al­so don’t seem to com­plete­ly close the door on ap­proval (for ex­am­ple they dis­cuss, hy­po­thet­i­cal­ly, what a REMS would look like – on­ly rel­e­vant if the drug were ap­proved). We con­tin­ue to be­lieve that the prob­a­bil­i­ty of ap­proval is well be­low 50%, and we don’t think the docs to­day are like­ly to ma­jor­ly change in­vestors’ views on the is­sue.

Part club, part guide, part land­lord: Arie Bellde­grun is blue­print­ing a string of be­spoke biotech com­plex­es in glob­al boom­towns — start­ing with Boston

The biotech industry is getting a landlord, unlike anything it’s ever known before.

Inspired by his recent experiences scrounging for space in Boston and the Bay Area, master biotech builder, investor, and global dealmaker Arie Belldegrun has organized a new venture to build a new, 250,000 square foot biopharma building in Boston’s Seaport district — home to Vertex and a number of up-and-coming biotech players.

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Novotech CRO Ex­pands Chi­na Team as Biotech De­mand for Clin­i­cal Tri­als In­creas­es up to 79%

An increase in demand of up to 79% for clinical trials in China has prompted Novotech the Asia-Pacific CRO to rapidly expand the China team, appointing expert local clinical executives to their Shanghai and Hong Kong offices. The company is planning to expand their team by 30% over the next quarter.

Novotech China has seen considerable demand recently which is borne out by research from GlobalData:
A global migration of clinical research is occurring from high-income countries to low and middle-income countries with emerging economies. Over the period 2017 to 2018, for example, the number of clinical trial sites opened by biotech companies in Asia-Pacific increased by 35% compared to 8% in the rest of the world, with growth as high as 79% in China.
Novotech CEO Dr John Moller said China offers the largest population in the world, rapid economic growth, and an increasing willingness by government to invest in research and development.
Novotech’s 23 years of experience working in the region means we are the ideal CRO partner for USA biotechs wanting to tap the research expertise and opportunities that China offers.
There are over 22,000 active investigators in Greater China, with about 5,000 investigators with experience on at least 3 studies (source GlobalData).

UP­DAT­ED: With loom­ing ‘apoc­a­lypse of drug re­sis­tance,’ Mer­ck’s com­bi­na­tion an­tibi­ot­ic scores FDA ap­proval on two fronts

Merck — one of the last large biopharmaceuticals companies in the beleaguered field of antibiotic drug development — on Wednesday said the FDA had sanctioned the approval of its combination antibacterial for the treatment of complicated urinary tract and intra-abdominal infections.

To curb the rise of drug-resistant bacteria and maintain the efficacy of the therapy, Recarbrio (and other antibacterials) — the drug must be used to treat or prevent infections that are proven or strongly suspected to be caused by susceptible gram-negative bacteria, Merck $MRK said.

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John McHutchison in 2012. Getty Images

The $1.1M good­bye: Gilead CSO John McHutchi­son is out as Daniel O’Day shakes up the se­nior team

Just a little more than a year after John McHutchison grabbed a promotion to become CSO at Gilead in the wake of Norbert Bischofberger’s exit, he’s out amid a shakeup of the senior team that is also triggering the departure of two other top execs.

Gilead stated that McHutchison “has decided to step down” from the job as of August 2nd. And their SEC filing notes that he’ll be getting a $1.1 million check to settle up on his contract.

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Thomas Gajewski, David Steinberg. (CRI, Pyxis)

Bay­er, Long­wood back star re­searcher's deep dive in­to the tu­mor mi­croen­vi­ron­ment for new I/O tar­gets

From PD-1 targeting to the RAS pathway to the STING complex, Thomas Gajewski has spent the past two decades of his career decoding the various ways the immune system can be unleashed to defend against cancer. So when the University of Chicago professor comes around to putting all his findings into a new platform for finding new targets, VCs and pharma groups alike pay attention.

“He’s been studying T cells for 20 years, plus he’s one of the world’s leaders if not the world leader in the space,” David Steinberg, partner at Longwood Fund, said. “Furthermore, let me add he did a lot of the foundational research and also some of the seminal clinical trials in the existing set of I/O agents. He understands the space really well, he understands the current strengths, and I think he understood really well what was missing, so he knew where to look.”

Kamala Harris speaking yesterday at the Des Moines Register Iowa Presidential Candidate Forum [via Getty]

Who’s the tough­est on drug prices? A game of po­lit­i­cal one-up­man­ship is dri­ving the pol­i­cy de­bate in Wash­ing­ton

Earlier this week we got a look at Senator Kamala Harris’ position on drug prices. She’s proposing that HHS take an average price from single-payer systems like the UK, Germany and Canada — which leverage market access for lower prices — and use that to set the US price. Anything drug companies collect above that would be taxed at a rate of 100%.

And the rhetoric is scathing:
While families struggle to make it to the end of the month, pharmaceutical companies are turning record profits. They’re spending nearly as much on advertising as R&D. They’re manipulating their market power to hike prices on lifesaving generic drugs. They’re making twice the profit of the average industry in America and still increased drug prices by 10.5% over the past six months alone. Meanwhile, they are charging dramatically higher prices to American consumers.
That’s an escalation on Joe Biden’s plan, which includes drug importation from those cheaper markets as well as allowing Medicare to negotiate prices — something that virtually all Dems agree on now.

SJ Lee [File photo]

Go­ing in­side cells, Sung Joo Lee has sketched some big goals for his small — but glob­al — team of drug hunters

For a small biotech based in South Korea with a research arm in Cambridge, MA, Orum Therapeutics has sketched out some big goals aimed at developing antibodies for intracellular targets. And now they have a new $30 million round to push the work forward, aiming at a slate of currently undruggable quests.

Orum has been working on a platform tech out of Ajou University that relies on endocytosis to smuggle antibodies and their cargo inside a cell. They’ve published work in Nature that illustrates its preclinical potential in RAS mutations, and KRAS is on their list of targets. 

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Astel­las buys in­to Fre­quen­cy's re­gen­er­a­tive med strat­e­gy with a $625M al­liance on hear­ing loss

The executive team at Frequency Therapeutics never oversold the results of their maiden Phase I/II study for a new drug to rectify hearing loss. It was, they said back in April, primarily about safety and tolerability, where their drug FX-322 performed as they had hoped. 

That early glimpse of efficacy everyone searches for in their first try on humans? 

(I)mprovements in hearing function, including audiometry and word scores, were observed in multiple FX-322 treated patients.

We don’t know exactly what that means. But whatever the details, Astellas found enough in the data to jump in with a sizable collaboration deal.

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H1 analy­sis: The high-stakes ta­ble in the biotech deals casi­no is pay­ing out some record-set­ting win­nings

For years the big trend among dealmakers at the major players has been centered on ratcheting down upfront payments in favor of bigger milestones. Better known as biobucks for some. But with the top 15 companies competing for the kind of “transformative” pacts that can whip up some excitement on Wall Street, with some big biotechs like Regeneron now weighing in as well, cash is king at the high stakes table.

We asked Chris Dokomajilar, the head of DealForma, to crunch the numbers for us, looking over the top 20 deals for the past decade and breaking it all down into the top alliances already created in 2019. Gilead has clearly tipped the scales in terms of the coin of the bio-realm, with its record-setting $5 billion upfront to tie up to Galapagos’ entire pipeline.

Dokomajilar notes:

We’re going to need a ‘three comma club’ for the deals with over $1 billion in total upfront cash and equity. The $100 million-plus club is getting crowded at 164 deals in the last decade with new deals being added towards the top of the chart. 2019 already has 14 deals with at least $100 million in upfront cash and equity for a total year-to-date of over $9 billion. That beats last year’s $8 billion and sets a record.

Add upfronts and equity payments and you get $11.5 billion for the year, just shy of last year’s record-setting $11.8 billion.

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