Spot­light­ing sub­group analy­sis, Ther­a­vance tries to carve out 'nar­row, but crit­i­cal­ly im­por­tan­t' mar­ket for failed drug

When Ther­a­vance Bio­phar­ma re­vealed last Sep­tem­ber that its first Phase III tri­al for am­prelox­e­tine had end­ed in fail­ure, it de­mot­ed the drug from lead sta­tus and laid off 75% of its work­force to stay afloat. But CEO Rick Win­ning­ham vowed to “con­tin­ue to an­a­lyze the da­ta to bet­ter un­der­stand the find­ings.”

As it re­ports a sec­ond flop for the same can­di­date, it’s stick­ing to the same ap­proach to find a sil­ver lin­ing in the da­ta.

In a Phase III tri­al dubbed Study 0170, Ther­a­vance said the drug failed the pri­ma­ry end­point of re­duc­ing the odds of treat­ment fail­ure over place­bo across a mixed pop­u­la­tion of pa­tients with dif­fer­ent dis­eases.

Zoom­ing in­to the pa­tients with mul­ti­ple sys­tem at­ro­phy, though, sug­gests that this par­tic­u­lar group did ben­e­fit from the drug. And that has ex­ecs hope­ful about a fu­ture, even if it’s not the one orig­i­nal­ly en­vi­sioned.

Rick Win­ning­ham

“Giv­en the clear un­met need for MSA pa­tients suf­fer­ing from symp­to­matic nOH, we are en­gag­ing po­ten­tial part­ners and plan­ning health au­thor­i­ty in­ter­ac­tions to de­ter­mine a path for­ward in hopes of ex­pe­dit­ing am­prelox­e­tine as a pos­si­ble treat­ment op­tion for peo­ple with MSA,” Win­ning­ham said in a state­ment.

Ther­a­vance des­per­ate­ly needs a win as the am­prelox­e­tine dis­ap­point­ment came af­ter its oth­er lead drug, a J&J-part­nered JAK in­hibitor, missed the bar in ul­cer­a­tive col­i­tis, forc­ing a shift to res­pi­ra­to­ry ther­a­peu­tics. Clutch­ing $173.5 mil­lion in cash, cash equiv­a­lents and mar­ketable se­cu­ri­ties at the end of 2021, the com­pa­ny promised to be “sus­tain­ably cash-flow pos­i­tive” be­gin­ning in the sec­ond half of 2022.

Pre­vi­ous­ly dubbed TD-9855, am­prelox­e­tine is a nor­ep­i­neph­rine re­up­take in­hibitor de­signed to treat symp­to­matic neu­ro­genic or­tho­sta­t­ic hy­poten­sion, a rare dis­or­der char­ac­ter­ized by a sus­tained fall in or­tho­sta­t­ic blood pres­sure that ren­ders a pa­tient un­able to stand for more than a few sec­onds with­out feel­ing dizzy or faint­ing. It can be caused by a num­ber of dif­fer­ent un­der­ly­ing con­di­tions, in­clud­ing MSA, Parkin­son’s dis­ease and pure au­to­nom­ic fail­ure — which were rep­re­sent­ed in Ther­a­vance’s tri­als.

In the ear­li­er Phase III study, am­prelox­e­tine failed to im­prove OHSA #1, a mea­sure­ment for symp­toms.

The way Study 0170 is de­signed, pa­tients start out on a 16-week open-la­bel pe­ri­od be­fore en­ter­ing a place­bo-con­trolled, ran­dom­ized with­draw­al pe­ri­od.

For the over­all group, pa­tients re­ceiv­ing am­prelox­e­tine saw a 40% re­duc­tion in the odds of treat­ment fail­ure com­pared to place­bo, but the dif­fer­ence was not sta­tis­ti­cal­ly sig­nif­i­cant with a p-val­ue of p=0.196.

Look­ing at a sub­group analy­sis, Ther­a­vance found that the 40% ben­e­fit was large­ly dri­ven by MSA pa­tients. There were 40 of them in the 128-per­son tri­al, and among this group in­ves­ti­ga­tors tracked a 72% re­duc­tion in the odds of treat­ment fail­ure.

“There is an ur­gency to treat MSA pa­tients suf­fer­ing with nOH due to the im­pact on qual­i­ty of life and the ex­treme care­giv­er bur­den,” Roy Free­man, a pro­fes­sor at Beth Is­rael Dea­coness Med­ical Cen­ter who helped de­sign the study, said in a pre­pared state­ment. “Am­prelox­e­tine ap­pears to im­prove a nar­row, but crit­i­cal­ly im­por­tant group of symp­toms re­lat­ed to blood pres­sure con­trol, and along with the safe­ty pro­file, may rep­re­sent a po­ten­tial ther­a­py for MSA pa­tients.”

Vac­cine doc­u­ments, young lead­ers and mar­ket tur­moil: End­points' 10 biggest sto­ries of 2022

It’s been a volatile year in the world of biopharma. Market declines reset M&A valuations, and may be beginning to tempt bigger buyers back into dealmaking. Russia’s war in Ukraine disrupted drug sales and clinical trials. A new generation of young biotech leaders emerged in the Endpoints 20(+1) Under 40. And as capital runs dry in a tough environment for raising new funds, companies big and small are taking a look at their headcounts and operations for ways to make it through lean times.

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Tom Riga, Spectrum Pharmaceuticals CEO

Spec­trum im­plodes af­ter a harsh pub­lic slap­down and now a CRL from Richard Paz­dur

The FDA has gone out of its way several times to flatten any expectations for Spectrum’s lung cancer drug poziotinib, including slamming the regulatory door in the biotech’s face four years ago when the their executive crew came calling for a breakthrough drug designation and encouragement from the oncology wing of the FDA.

That stinging early rebuke pointed straight down the path to a corrosive in-house agency review of Spectrum’s attempt to land an accelerated approval for the oral EGFR TKI and a public whipping that included a classic takedown by none other than Richard Pazdur, who slammed the company for “poor drug development” that led to confusion over the dose needed for a slice of NSCLC patients harboring HER2 exon 20 insertion mutations.

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Big Phar­ma's Twit­ter ex­o­dus; Mer­ck wa­gers $1.35B on buy­out; $3.5M gene ther­a­py; and more

Welcome back to Endpoints Weekly, your review of the week’s top biopharma headlines. Want this in your inbox every Saturday morning? Current Endpoints readers can visit their reader profile to add Endpoints Weekly. New to Endpoints? Sign up here.

As you start planning for #JPM23, we hope you will consider joining Endpoints News for our live and virtual events. For those who are celebrating Thanksgiving, we hope you are enjoying the long weekend with loved ones. And if you’re not — we’ll see you next week!

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Robert Califf, FDA commissioner (Jose Luis Magana/AP Images)

Fourth ac­cel­er­at­ed ap­proval in Duchenne? Sarep­ta gets pri­or­i­ty re­view for gene ther­a­py amid FDA scruti­ny

Sarepta is once again on the accelerated approval path for a Duchenne drug, picking up a priority review Monday morning.

The FDA granted the accelerated review to SRP-9001, Sarepta announced Monday, which would become the biotech’s fourth Duchenne drug if approved. Much like SRP-9001 will do, each of the previous three therapies went through the accelerated approval pathway. But unlike the others, SRP-9001 is a gene therapy.

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Albert Bourla, Pfizer CEO (John Thys/POOL/AFP via Getty Images)

Pfiz­er CEO un­der fire from UK watch­dog over vac­cine com­ments — re­port

Pfizer CEO Albert Bourla told the BBC last December that he had “no doubt in my mind that the benefits, completely, are in favor” of vaccinating 5- to 11-year-olds for Covid-19. Almost a year later, those comments have reportedly landed him in trouble with a UK pharma watchdog.

Children’s advocacy group UsForThem filed a complaint with the UK’s Prescription Medicines Code of Practice Authority (PMCPA) last year accusing Bourla of making “disgracefully misleading” statements during the BBC interview, including one that “Covid in schools is thriving.” At the time, UK regulators had not yet cleared the vaccine for the 5 to 11 age group, though the vaccine did have a positive opinion from the EMA’s human medicines committee.

FDA tells Catal­ent to fix is­sues at two man­u­fac­tur­ing sites on its own

The CDMO Catalent will have to fix issues at two manufacturing plants in the US and Europe that were subject to inspections by the FDA this summer, giving the company room to correct the issues without facing further regulatory action.

The FDA gave Catalent a “voluntary action indicated” response to two inspections at the contract manufacturer’s site in Bloomington, IN, and Brussels, Belgium. Fixing the issues on its own is a preferable outcome to facing an “official action indicated” response, meaning that an official warning would be sent out or a sit-down with the FDA would be required.

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Sanofi's new headquarters, La Maison Sanofi, in Paris (Credit: Luc Boegly)

Sanofi wel­comes 500 staffers to new Paris HQ af­ter €30M ren­o­va­tion

When Paul Hudson took the helm at Sanofi back in 2019, he promised to reinvent the pharma giant — including its Paris headquarters. This week, the company set up shop in new “state-of-the-art” digs.

La Maison Sanofi, as the new HQ is called, is officially open for business, Hudson announced on Monday. The 9,000-square-meter (just under 97,000-square-foot) space accommodates 500 employees across the company’s government and global support functions teams, including finance, HR, legal and corporate affairs — and it was built with environmental sustainability and hybrid work in mind.

Sta­da to place $50M+ in­vest­ment in a new fa­cil­i­ty in Ro­ma­nia

While Romania may conjure up images of vast mountain ranges and tales of medieval kings, one generic manufacturer has broken ground on a new facility there.

German pharma company Stada said Monday that it has placed a €50 million ($51.9 million) investment into a 100,000 square-meter (1.08 million square-foot) site in Turda, Romania, a city in the Southeast of the country. According to a Stada spokesperson in an email to Endpoints News, the company has developed only 281,500 square feet of the site so far.

Rachael Rollins (Charles Krupa/AP Images)

US seeks jail time for co-CEO of New Eng­land com­pound­ing cen­ter af­ter dead­ly 2012 fun­gal out­break

The US attorney for the district of Massachusetts late last week called on the state’s district court to sentence the former co-owner of the now-defunct New England Compounding Center to 18 months of jail time for his role in the center’s quality deviations that led to more than 100 people dead from a fungal meningitis outbreak.

Gregory Conigliaro was convicted of conspiring with more than a dozen others at NECC to deceive the FDA and misrepresent the fact that the center was only dispensing drugs pursuant to patient-specific prescriptions.