The FDA on Wednes­day re­ject­ed Ake­bia Ther­a­peu­tics’ vadadu­s­tat, once a fron­trun­ner to treat ane­mia due to chron­ic kid­ney dis­ease, due to safe­ty con­cerns.

In is­su­ing a CRL, the com­pa­ny, which saw its stock price fall by more than 65% this af­ter­noon, said in a state­ment that the FDA has re­quest­ed an ad­di­tion­al tri­al and that the safe­ty ques­tions cen­tered on the drug’s “fail­ure to meet non-in­fe­ri­or­i­ty in MACE in the non-dial­y­sis pa­tient pop­u­la­tion, the in­creased risk of throm­boem­bol­ic events, dri­ven by vas­cu­lar ac­cess throm­bo­sis in dial­y­sis pa­tients, and the risk of drug-in­duced liv­er in­jury.”

Ake­bia CEO John But­ler, who used a pri­or­i­ty re­view vouch­er to speed up the FDA’s re­view, said the com­pa­ny is “ex­treme­ly dis­ap­point­ed to re­ceive a CRL for vadadu­s­tat,” even as But­ler had pre­vi­ous­ly sig­naled con­cerns about the drug’s ap­prov­abil­i­ty in the non-dial­y­sis pop­u­la­tion.

“The CRL stat­ed that Ake­bia could ex­plore ways to po­ten­tial­ly demon­strate a fa­vor­able ben­e­fit-risk as­sess­ment through new clin­i­cal tri­als. Ake­bia will dis­cuss the de­tails of the CRL with its col­lab­o­ra­tion part­ners and re­quest a meet­ing with the FDA,” the com­pa­ny said.

The re­jec­tion comes as a sur­prise as an­a­lysts at four Wall Street biotech re­search out­fits pre­vi­ous­ly ex­pect­ed an ap­proval for va­da in the pop­u­la­tion on dial­y­sis, and as Ake­bia re­cent­ly re­vised its com­mer­cial­iza­tion deal with Vi­for, in­ject­ing a quick $85 mil­lion in­to the biotech to help with a launch that now won’t hap­pen.

The re­jec­tion for vadadu­s­tat comes as the FDA al­so re­cent­ly re­ject­ed As­traZeneca and Fi­bro­Gen’s rox­adu­s­tat for the same in­di­ca­tion, and al­so due to safe­ty con­cerns. But in Eu­rope, the drug won ap­proval in Au­gust.

Ake­bia and its part­ner Ot­su­ka Phar­ma­ceu­ti­cal are still await­ing an on­go­ing re­view in Eu­rope. In Japan, vadadu­s­tat is ap­proved as a treat­ment for ane­mia due to CKD in both dial­y­sis-de­pen­dent and non-dial­y­sis-de­pen­dent adult pa­tients.

The FDA’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) voted unanimously in favor of “harmonizing” Covid vaccine compositions, meaning all current vaccine recipients would receive a bivalent vaccine, regardless of whether they’ve gotten their primary series.

The vote marks an effort to clear up confusion around varying formulations and dosing schedules for current primary series and booster vaccines, as well as “get closer to the strains that are circulating,” according to committee member Paul Offit, professor of pediatrics at the Children’s Hospital of Philadelphia.

Eli Lilly has succeeded in its attempt to get the first non-covalent version of Bruton’s tyrosine kinase, or BTK, inhibitors to market, pushing it past rival Merck.

The FDA gave an accelerated nod to Lilly’s daily oral med, to be sold as Jaypirca, for patients with relapsed or refractory mantle cell lymphoma.

The agency’s green light, disclosed by the Indianapolis Big Pharma on Friday afternoon, catapults Lilly into a field dominated by covalent BTK inhibitors, which includes AbbVie and Johnson & Johnson’s Imbruvica, AstraZeneca’s Calquence and BeiGene’s Brukinsa.

Merck’s blockbuster cancer treatment Keytruda has been handed another indication by the FDA.

The US regulator announced on Thursday that it has approved Keytruda to serve as an adjuvant treatment for non-small cell lung cancer (NSCLC), which is its fifth indication in NSCLC and 34th indication overall.

According to a Merck release, the approval is based on data from a Phase III trial, dubbed Keynote-091, which measured disease-free survival in patients who received chemotherapy following surgery. The data from Merck displayed that Keytruda cut down on the risk of disease recurrence or death by 27% versus placebo.

The FDA hasn’t detected any potential safety signals, including for stroke, in people aged 65 years and older who have received Pfizer’s bivalent Covid booster, one senior official told members of the agency’s Vaccines and Related Biological Products Advisory Committee (VRBPAC) on Thursday.

The update comes as the FDA and CDC investigate a “preliminary signal” that may indicate an increased risk of ischemic stroke in older Americans who received Pfizer’s updated shot.

The FDA has stopped use of another drug as a result of the new coronavirus variants. On Thursday, the agency announced that AstraZeneca’s antibody combo Evusheld, which was an important prevention option for many immunocompromised people and others, is no longer authorized.

The FDA said it made its decision based on the fact that Evusheld works on fewer than 10% of circulating variants.

Evusheld was initially given emergency authorization at the end of 2021. However, as Omicron emerged, so did studies that showed Evusheld might not work against the dominant Omicron strain. In October, the FDA warned healthcare providers that Evusheld was useless against the Omicron subvariant BA.4.6. It followed that up with another announcement earlier this month that it did not think Evusheld would work against the latest Omicron subvariant XBB.1.5.