The clock is tick­ing for Iterum af­ter FDA hands down CRL for Pfiz­er castoff an­tibi­ot­ic

Iterum knew its odds were slim as it await­ed an FDA rul­ing on a key uri­nary tract in­fec­tion drug with its bank ac­count run­ning low. The FDA, how­ev­er, wasn’t im­pressed, and Iterum’s days look num­bered.

The FDA has sent the tiny biotech a com­plete re­sponse let­ter for the an­tibi­ot­ic su­lopen­em, shut­ting down hopes at get­ting the oral med­ica­tion across the fin­ish line, the drug­mak­er re­vealed Mon­day.

In Iterum’s telling of the de­tails — the let­ter was not made pub­lic — the FDA pushed back on the drug’s ap­pli­ca­tion in women with un­com­pli­cat­ed UTIs caused by “des­ig­nat­ed sus­cep­ti­ble mi­croor­gan­isms proven or strong­ly sus­pect­ed to be non-sus­cep­ti­ble to a quinolone” due to a lack of clin­i­cal da­ta.

How­ev­er, the agency did ac­knowl­edge the drug showed clin­i­cal ef­fi­ca­cy in terms of over­all re­sponse rate com­pared with com­mon an­tibi­ot­ic ciprofloxacin in pa­tients re­sis­tant to that drug, Iterum said. The biotech al­so said there were no man­u­fac­tur­ing or safe­ty is­sues cit­ed in the let­ter.

The agency rec­om­mend­ed at least one “ad­e­quate and well-con­trolled” clin­i­cal tri­al for those pa­tients, pos­si­bly us­ing a dif­fer­ent com­para­tor drug, Iterum said. The drug­mak­er said it would dis­cuss the best path for­ward for the FDA as it takes stock of the sit­u­a­tion.

That ef­fec­tive­ly rep­re­sents go­ing back to the draw­ing board, and in­vestors are pick­ing that up. Shares of $ITRM were trad­ing down around 40% be­fore the open­ing bell Mon­day.

The set­back of­fi­cial­ly puts a shot clock on Iterum’s ef­forts as the drug­mak­er said it has around $100 mil­lion in the bank, enough scratch to take op­er­a­tions through mid-2023, by its lights. It’s a slight­ly bet­ter po­si­tion than Iterum faced late last year, when it had just $8.7 mil­lion in the bank and a small win­dow to keep the lights on.

The UTI in­di­ca­tion here was ac­tu­al­ly one of a few Iterum has looked at for su­lopen­em, a Pfiz­er castoff drug, with pos­i­tive Phase III re­sults po­ten­tial­ly crack­ing open a mar­ket with as many as 6 mil­lion US pa­tients. Mean­while, oth­er shots on goal haven’t been as suc­cess­ful. A reg­i­men of the in­tra­venous for­mu­la­tion fol­lowed by tablets couldn’t match oth­er es­tab­lished an­tibi­otics in com­pli­cat­ed in­tra-ab­dom­i­nal in­fec­tions or com­pli­cat­ed uri­nary tract in­fec­tion.

Mean­while, Iterum’s set­back is pret­ty par for the course in an an­tibi­ot­ic R&D space that has seen lit­tle in­no­va­tion in re­cent years with Big Phar­ma run­ning for the hills and few­er and few­er biotech teams will­ing to spend the time and mon­ey look­ing for a break­through.

Can Iterum beat the clock for 2023? We’ll have to wait and see.

Health­care Dis­par­i­ties and Sick­le Cell Dis­ease

In the complicated U.S. healthcare system, navigating a serious illness such as cancer or heart disease can be remarkably challenging for patients and caregivers. When that illness is classified as a rare disease, those challenges can become even more acute. And when that rare disease occurs in a population that experiences health disparities, such as people with sickle cell disease (SCD) who are primarily Black and Latino, challenges can become almost insurmountable.

David Meek, new Mirati CEO (Marlene Awaad/Bloomberg via Getty Images)

Fresh off Fer­Gene's melt­down, David Meek takes over at Mi­rati with lead KRAS drug rac­ing to an ap­proval

In the insular world of biotech, a spectacular failure can sometimes stay on any executive’s record for a long time. But for David Meek, the man at the helm of FerGene’s recent implosion, two questionable exits made way for what could be an excellent rebound.

Meek, most recently FerGene’s CEO and a past head at Ipsen, has become CEO at Mirati Therapeutics, taking the reins from founding CEO Charles Baum, who will step over into the role of president and head of R&D, according to a release.

Who are the women su­per­charg­ing bio­phar­ma R&D? Nom­i­nate them for this year's spe­cial re­port

The biotech industry has faced repeated calls to diversify its workforce — and in the last year, those calls got a lot louder. Though women account for just under half of all biotech employees around the world, they occupy very few places in C-suites, and even fewer make it to the helm.

Some companies are listening, according to a recent BIO survey which showed that this year’s companies were 2.5 times more likely to have a diversity and inclusion program compared to last year’s sample. But we still have a long way to go. Women represent just 31% of biotech executives, BIO reported. And those numbers are even more stark for women of color.

Jacob Van Naarden (Eli Lilly)

Ex­clu­sives: Eli Lil­ly out to crash the megablock­buster PD-(L)1 par­ty with 'dis­rup­tive' pric­ing; re­veals can­cer biotech buy­out

It’s taken 7 years, but Eli Lilly is promising to finally start hammering the small and affluent PD-(L)1 club with a “disruptive” pricing strategy for their checkpoint therapy allied with China’s Innovent.

Lilly in-licensed global rights to sintilimab a year ago, building on the China alliance they have with Innovent. That cost the pharma giant $200 million in cash upfront, which they plan to capitalize on now with a long-awaited plan to bust up the high-price market in lung cancer and other cancers that have created a market worth tens of billions of dollars.

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When ef­fi­ca­cy is bor­der­line: FDA needs to get more con­sis­tent on close-call drug ap­provals, agency-fund­ed re­search finds

In the exceedingly rare instances in which clinical efficacy is the only barrier to a new drug’s approval, new FDA-funded research from FDA and Stanford found that the agency does not have a consistent standard for defining “substantial evidence” when flexible criteria are used for an approval.

The research comes as the FDA is at a crossroads with its expedited-review pathways. The accelerated approval pathway is under fire as the agency recently signed off on a controversial new Alzheimer’s drug, with little precedent to explain its decision. Meanwhile, top officials like Rick Pazdur have called for a major push to simplify and clarify all of the various expedited pathways, which have grown to be must-haves for sponsors of nearly every newly approved drug.

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FDA hands ac­cel­er­at­ed nod to Seagen, Gen­mab's so­lo ADC in cer­vi­cal can­cer, but com­bo stud­ies look even more promis­ing

Biopharma’s resident antibody-drug conjugate expert Seagen has scored a clutch of oncology approvals in recent years, finding gold in what are known as “third-gen” ADCs. Now, another of their partnered conjugates is ready for prime time.

The FDA on Monday handed an accelerated approval to Seagen and Genmab’s Tivdak (tisotumab vedotin-tftv, or “TV”) in second-line patients with recurrent or metastatic cervical cancer who previously progressed after chemotherapy rather than PD-(L)1 systemic therapy, the companies said in a release.

Ted White, Verrica CEO

Ver­ri­ca hits an­oth­er bump in the road with CMO re­lat­ed let­ter from FDA

The FDA has rejected Verrica’s new drug application for VP-102 again, with the company pinning the CRL on problems at a CMO that it was partnered with, the company announced Monday.

The FDA didn’t raise issues that directly relate to the manufacturing of VP-102, the company said, but raised “general quality issues” at the CMO’s facility. There were also no clinical concerns, it said, or need to collect more data.

Jay Bradner (Jeff Rumans for Endpoints News)

Div­ing deep­er in­to in­her­it­ed reti­nal dis­or­ders, No­var­tis gob­bles up an­oth­er bite-sized op­to­ge­net­ics biotech

Right about a year ago, a Novartis team led by Jay Bradner and Cynthia Grosskreutz at NIBR swooped in to scoop up a Cambridge, MA-based opthalmology gene therapy company called Vedere. Their focus was on a specific market niche: inherited retinal dystrophies that include a wide range of genetic retinal disorders marked by the loss of photoreceptor cells and progressive vision loss.

But that was just the first deal that whet their appetite.

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Take­da snaps up the Japan­ese rights to an old Shire cast-off; Boehringer In­gel­heim ac­quires Abexxa Bi­o­log­ics

A week before the FDA is set to decide on Mirum Pharmaceuticals’ lead liver disease drug — an old Shire cast-off called maralixibat — Takeda is swooping in to secure the rights in Japan.

Maralixibat’s roots trace back to Lumena, which was snapped up by Shire for $260 million-plus back in 2014. While the candidate had failed mid-stage studies at Shire, Mirum believes better trial design and patient selection will deliver the wins it needs. The drug is currently in development for Alagille syndrome (a condition called ALGS in which bile builds up in the liver), progressive familial intrahepatic cholestasis (PFIC, which causes progressive liver disease) and biliary atresia (a blockage in the ducts that carry bile from the liver to the gallbladder).