Roche con­firms pa­tient death in ACE910 PhI­II he­mo­phil­ia tri­al, spurring new ques­tions about top block­buster hope­ful

Just a few months af­ter re­port­ing a slate of se­ri­ous ad­verse events for its piv­otal Phase III study of emi­cizum­ab (ACE910) for he­mo­phil­ia, Roche has raised fresh ques­tions about the safe­ty of the drug fol­low­ing the death of one of the pa­tients in the tri­al.

In a state­ment giv­en to the Eu­ro­pean Haemophil­ia As­so­ci­a­tion, Roche says that the pa­tient in their HAVEN-1 study died fol­low­ing two se­ri­ous ad­verse events.

It is our un­der­stand­ing that a pa­tient ex­pe­ri­enced a se­ri­ous rec­tal he­m­or­rhage (the first re­port­ed SAE) and re­ceived by­pass­ing agents, in­clud­ing re­peat­ed dos­es of ac­ti­vat­ed pro­throm­bin com­plex (aPCC), af­ter which the pa­tient de­vel­oped signs of Throm­bot­ic Mi­croan­giopa­thy (TMA, the sec­ond SAE). The pre­lim­i­nary as­sess­ment is that the clin­i­cal and lab­o­ra­to­ry char­ac­ter­is­tics of this case of TMA are con­sis­tent with what was ob­served in the two pre­vi­ous­ly re­port­ed cas­es; how­ev­er, our eval­u­a­tion of the avail­able in­for­ma­tion is on­go­ing.

The in­ves­ti­ga­tor con­clud­ed that the pa­tient died as a re­sult of the rec­tal he­m­or­rhage and that Roche’s drug was not re­spon­si­ble.

Daniel O’Day

The re­port, though, rais­es fresh ques­tions about the drug’s safe­ty af­ter in­ves­ti­ga­tors had to fend off per­sis­tent ques­tions about 4 spon­ta­neous­ly re­port­ed SAEs af­ter two pa­tients had throm­boem­bol­ic events and two pa­tients de­vel­oped throm­bot­ic mi­croan­giopa­thy, or TMA. That news helped briefly buoy Shire and No­vo Nordisk, which both see a big ri­val to their block­buster he­mo­phil­ia fran­chis­es in emi­cizum­ab.

Roche re­port­ed that “these events were seen with the con­comi­tant use of mul­ti­ple dos­es of a by­pass­ing agent with emi­cizum­ab while treat­ing a break­through bleed; in some cas­es the by­pass­ing agent at dos­es ex­ceed­ing the rec­om­mend­ed la­beled dos­es.”

Leerink’s Ja­son Ger­ber­ry, who’s been cheer­lead­ing for Shire’s he­mo­phil­ia fran­chise, sees this as a pos­i­tive for es­tab­lished drugs. And he trum­pet­ed grow­ing fears that ACE910 has been tied far too fre­quent­ly to se­ri­ous cas­es of TMA.

As we’ve pre­vi­ous­ly not­ed, MEDA­Corp he­mo­phil­ia spe­cial­ists gen­er­al­ly be­lieve TMA is oc­cur­ring at too high of a rate in HAVEN-1 vs. the non-ex­is­tence of TMA with stan­dard of care. While spe­cial­ists gen­er­al­ly be­lieve the TMA is an is­sue caused by the com­bi­na­tion of the two treat­ments, the root cause is not un­der­stood and thus it re­mains a pos­si­bil­i­ty that the TMA’s could be an ACE910 monother­a­py is­sue giv­en the Mab’s long half-life. In our view, ACE910 con­tin­ues to pose a risk to a por­tion of SH­PG’s FEI­BA fran­chise ($900m to­tal) giv­en the high un­met need in HA in­hibitor seg­ment, but we are of the view that ACE910 will get more mod­est trac­tion in the HA non-in­hibitor pop­u­la­tion where Shire de­rives $2.8bn (~18-19% of sales).

Long one of Roche’s top prospects, as laid out by phar­ma chief Daniel O’Day, Genen­tech re­searchers say that the drug hit the pri­ma­ry as well as all the sec­ondary end­points in their late-stage test. The big goal was a sta­tis­ti­cal­ly sig­nif­i­cant drop in the num­ber of bleeds among pa­tients with in­hibitors to fac­tor VI­II. And one of the sec­on­daries was a re­duc­tion in bleeds record­ed in an “in­tra-pa­tient com­par­i­son in peo­ple who had re­ceived pri­or by­pass­ing agent pro­phy­lax­is treat­ment.”

It’s fi­nal­ly over: Bio­gen, Ei­sai scrap big Alzheimer’s PhI­I­Is af­ter a pre­dictable BACE cat­a­stro­phe rais­es safe­ty fears

Months after analysts and investors called on Biogen and Eisai to scrap their BACE drug for Alzheimer’s and move on in the wake of a string of late-stage failures and rising safety fears, the partners have called it quits. And they said they were dropping the drug — elenbecestat — after the independent monitoring board raised concerns about…safety.

We don’t know exactly what researchers found in this latest catastrophe, but the companies noted in their release that investigators had determined that the drug was flunking the risk/benefit analysis.

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Lisa M. DeAngelis, MSKCC

MSK picks brain can­cer ex­pert Lisa DeAn­ge­lis as its next CMO — fol­low­ing José Basel­ga’s con­tro­ver­sial ex­it

It’s official. Memorial Sloan Kettering has picked a brain cancer expert as its new physician-in-chief and CMO, replacing José Baselga, who left under a cloud after being singled out by The New York Times and ProPublica for failing to properly air his lucrative industry ties.

His replacement, who now will be in charge of MSK’s cutting-edge research work as well as the cancer care delivered by hundreds of practitioners, is Lisa M. DeAngelis. DeAngelis had been chair of the neurology department and co-founder of MSK’s brain tumor center and was moved in to the acting CMO role in the wake of Baselga’s departure.

Penn team adapts CAR-T tech, reengi­neer­ing mouse cells to treat car­diac fi­bro­sis

After establishing itself as one of the pioneer research centers in the world for CAR-T cancer therapies, creating new attack vehicles to eradicate cancer cells, a team at Penn Medicine has begun the tricky transition of using the basic technology for heart repair work.

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Tal Zaks. Moderna

The mR­NA uni­corn Mod­er­na has more ear­ly-stage hu­man da­ta it wants to show off — reach­ing new peaks in prov­ing the po­ten­tial

The whole messenger RNA field has attracted billions of dollars in public and private investor cash gambled on the prospect of getting in on the ground floor. And this morning Boston-based Moderna, one of the leaders in the field, wants to show off a few more of the cards it has to play to prove to you that they’re really in the game.

The whole hand, of course, has yet to be dealt. And there’s no telling who gets to walk with a share of the pot. But any cards on display at this point — especially after being accused of keeping its deck under lock and key — will attract plenty of attention from some very wary, and wired, observers.

“In terms of the complexity and unmet need,” says Tal Zaks, the chief medical officer, “this is peak for what we’ve accomplished.”

Moderna has two Phase I studies it wants to talk about now.

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It's not per­fect, but it's a good start: FDA pan­elists large­ly en­dorse Aim­mune's peanut al­ler­gy ther­a­py

Two days after a fairly benign review from FDA staff, an independent panel of experts largely endorsed the efficacy and safety of Aimmune’s peanut allergy therapy, laying the groundwork for approval with a risk evaluation and mitigation strategy (REMS).

Traditionally, peanut allergies are managed by avoidance, but the threat of accidental exposure cannot be nullified. Some allergists have devised a way to dose patients off-label with peanut protein derived from supermarket products to wean them off their allergies. But the idea behind Aimmune’s product was to standardize the peanut protein, and track the process of desensitization — so when accidental exposure in the real world invariably occurs, patients are less likely to experience a life-threatening allergic reaction.

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Rit­ter bombs fi­nal PhI­II for sole lac­tose in­tol­er­ance drug — shares plum­met

More than two years ago Ritter Pharmaceuticals managed to find enough silver lining in its Phase IIb/III study — after missing the top-line mark — to propel its lactose intolerance toward a confirmatory trial. But as it turned out, the enthusiasm only set the biotech and its investors up to be sorely disappointed.

This time around there’s little left to salvage. Not only did RP-G28 fail to beat placebo in reducing lactose intolerance symptoms, patients in the treatment group actually averaged a smaller improvement. On a composite score measuring symptoms like abdominal pain, cramping, bloating and gas, patients given the drug had a mean reduction of 3.159 while the placebo cohort saw a 3.420 drop on average (one-sided p-value = 0.0106).

Ear­ly snap­shot of Ad­verum's eye gene ther­a­py sparks con­cern about vi­sion loss

An early-stage update on Adverum Biotechnologies’ intravitreal gene therapy has triggered investor concern, after patients with wet age-related macular degeneration (AMD) saw their vision deteriorate, despite signs that the treatment is improving retinal anatomy.

Adverum, on Wednesday, unveiled 24-week data from the OPTIC trial of its experimental therapy, ADVM-022, in six patients who have been administered with one dose of the therapy. On average, patients in the trial had severe disease with an average of 6.2 anti-VEGF injections in the eight months prior to screening and an average annualized injection frequency of 9.3 injections.

Alex Ar­faei trades his an­a­lyst's post for a new role as biotech VC; Sanofi vet heads to Vi­for

Too often, Alex Arfaei arrived too late. 

An analyst at BMO Capital Markets, he’d meet with biotech or pharmaceutical heads for their IPO or secondary funding and his brain, trained on a biology degree and six years at Merck and Endo, would spring with questions: Why this biomarker? Why this design? Why not this endpoint? Not that he could do anything about it. These execs were coming for clinical money; their decisions had been made and finalized long ago.

Arde­lyx bags its first FDA OK for IBS, set­ting up a show­down with Al­ler­gan, Iron­wood

In the first of what it hopes will be a couple of major regulatory milestones for its new drug, Ardelyx has bagged an FDA approval to market Ibsrela (tenapanor) for irritable bowel syndrome.

The drug’s first application will be for IBS with constipation (IBS-C), inhibiting sodium-hydrogen exchanger NHE3 in the GI tract in such a way as to increase bowel movements and decrease abdominal pain. This comes on the heels of two successful Phase III trials.