After an FDA cold shoulder, FibroGen and partner AstraZeneca still aim to pave a way to market for anemia therapy roxadustat–even if it means conducting another clinical trial. The two companies are now betting the drug’s U.S. future on an upcoming meeting with the FDA.
FibroGen and AZ have scheduled a meeting with the FDA to discuss a potential path forward for roxadustat in anemia of chronic kidney disease, FibroGen CEO Enrique Conterno told investors on a conference call Tuesday.
“The question is really, how can we ensure that we can conduct a trial that meets the complete response letter for us to be able to have commercial access in the U.S. in anemia of CKD,” Conterno said. The company aims to run the trial “in an expeditious manner,” he added.
As the partners navigate that process, FibroGen has started cutting expenses to focus on roxadustat and pancreatic cancer candidate pamrevlumab. The California biotech plans to reduce its projected spending by about $100 million a year for the next three years, Conterno said. It will also remove about 100 U.S. positions, of which 30% are existing jobs.
In August, the FDA turned down roxadustat’s application in anemia for kidney disease patients following negative opinions from an external advisory committee and a rough FDA internal review. Previously, industry watchers thought roxa could become the first drug in the oral HIF-PHI class to reach the U.S. market. Analysts had pegged blockbuster expectations to roxa based on the notion that it could offer safety benefits over traditional erythropoietin therapies.
But the agency rejected roxa in both dialysis- and nondialysis-dependent patients after linking it with an increased risk of blood clots, serious infections, seizures and other metabolic and gastrointestinal side effects. Given the obvious defeat from roxa’s existing trials, a separate study seems inevitable if FibroGen and AZ still intend to pursue an FDA approval.
The most concerning safety signal flagged by the FDA centers on roxa’s heart safety profile, including an elevated risk of a composite marker of major adverse cardiovascular events. Both the FDA and FibroGen have hypothesized that the problem might stem from a fast hemoglobin overshoot seen with roxa. But as experts on the advisory committee pointed out in rejecting FibroGen’s proposal of a different dosing strategy, it’s only a theory without a clinical trial to back it up.
“That’s something we’re clearly going to explore with the FDA,” Mark Eisner, FibroGen’s chief medical officer, said of the dose adjustment plan during this week’s call. FibroGen still intends to eventually get a label that covers both dialysis and nondialysis patients, he added.
Roxa has scored approvals in China, Japan and most recently Europe as Evrenzo. In the third quarter, roxa sales in China reached $57.8 million, FibroGen said.
After the FDA rebuff, analysts speculated that AZ might walk away from the partnership. But CEO Conterno said the AZ relationship is “healthy” as the two try to “have an aligned path forward.”
Whether AZ will keep its toe in roxa is likely dependent on the outcome of the FDA meeting, SVB Leerink analyst Geoffrey Porges wrote in a Wednesday note to investors. The size, duration and cost of the required trial or trials, the potential breadth of the drug’s label and the estimated timing of an approval relative to competitors are possible determinants, Porges added.
GlaxoSmithKline’s daprodustat, approved in Japan under the brand Duvroq, seems to have the best profile in the HIF-PHI class. Detailed data unveiled last week showed that the GSK med matched up to erythropoiesis-stimulating agents in terms of heart safety in both dialysis and nondialysis patients. By contrast, Akebia Therapeutics’ vadadustat missed its MACE goal in the nondialysis population.
You Say Trintellix, I Say Brintellix: Why a Drug Name in the US Won’t Always Translate Across the Pond Feedzy
As a British citizen living in England but writing on American drug names, I’m in a perfect position to know that many drugs approved in Europe and the U.K. can have very different names from those in the U.S.
Why is that? Well, to find out, Fierce Pharma Marketing sat down with Scott Piergrossi, president of creative at the Brand Institute, a company that has helped name some of the world’s biggest drugs. He’s not explaining the reasoning behind any drug name changes mentioned in this piece, but offering up insight into why different regions may need tweaks–or complete rethinks–in branding for the same drug.
Often, the change in name can be very minor. Let’s take Amgen’s new non-small cell lung cancer drug as an example: In the U.S., the FDA approved the drug as Lumakras, but in in Europe, its counterparts at the European Medicines Agency approved the med as Lumykras earlier this month.
You’ll see this U.S.-Europe divide a lot with drug names–but why? Piergrossi explains that changing a single letter can often provide enough differentiation to satisfy regulatory requirements, which can be different in the U.S. and Europe, “such as changing a vowel to a y, or adding/removing a letter or two.” Just as we see with Lumakras/Lumykras.
Another key reason an agency might reject a name is if they think the name is overly promotional–what the FDA refers to as “misbranding,” such as making misrepresentations about safety or efficacy. Hence, you don’t have antivirals called KillsCOVIDNoSideEffects.
Some examples can seem obvious, but Piergrossi explains there can be more subtle and subjective naming differences that create misleading suggestions in a name.
Take the FDA-approved osteoporosis drug Boniva. In Europe and elsewhere, the drug is sold under the brand name Bonviva. “The latter perhaps suggesting ‘good life’ more so than the former,” Piergrossi says, though he adds that extracting meaning from an invented name, in his experience, is “highly subjective.”
There’s also the rare example of a change mandated after the agency has approved a drug and its name. We saw this with Trintellix, an antidepressant from Takeda and Lundbeck. That’s its newer name: Originally approved as Brintellix, the drug had to change–per the FDA–given that name’s similarity to AstraZeneca’s anti-blood-clotting therapy, Brilinta. Prescribers were actually confusing the two brands, triggering medication errors. Brintellix still bears that name in Europe and elsewhere.
Sometimes, it just comes down to regional preferences at a company. Global pharmas have global teams working on product marketing and name development. “A regional team might prefer one spelling versus another, assuming they are given the latitude to make those decisions, so the name is modified accordingly,” said Piergrossi.
Original Article: fiercepharma.com
GlaxoSmithKline Rushes to Accelerate COVID-19 Antibody Output Amid Omicron-driven Demand Feedzy
GlaxoSmithKline and Vir Biotechnology are rushing to speed up production of their COVID-19 therapy, now that they’re the only companies with an antibody that appears to be truly effective against omicron.
The FDA on Dec. 30 cleared a Samsung Biologics site as a second manufacturing facility to make GSK and Vir’s Xevudy (sotrovimab), a GSK spokesperson told Fierce Pharma.
Along with adding the new facility, GSK and Vir worked with external partners to secure additional batches of drug substance to support supply this year, the spokesperson said via email.
GSK had been planning to commission a new production facility to scale up production and establish a second manufacturing site amid pandemic uncertainty, the spokesperson said. But omicron’s emergence suddenly pushed the acceleration button.
GSK and Vir recently found that sotrovimab retains its strength against omicron in cell cultures, while lab data showed that Eli Lilly’s antibody combo of bamlanivimab and etesevimab and Regeneron’s REGEN-COV cocktail are unlikely to be able to tackle the new variant.
That means, among the three FDA-authorized antibody drugs to treat infected patients, only sotrovimab is still powerful enough to fight omicron. AstraZeneca’s Evusheld is authorized as a prevention method for immuno-compromised people.
After those lab tests, the U.S. government in December temporarily halted distribution of Lilly’s and Regeneron’s offerings. Although the two products are now shipping again, their ability to fight the now-dominant omicron remains questionable.
Demand naturally started to shift to Xevudy. Last week, the Biden administration signed a deal to buy 600,000 additional doses for distribution this quarter.
“We were on the phone with the U.S. government immediately, sharing the data, discussing what was possible from a supply perspective,” said Bart Murray, who leads GSK’s COVID operation in the U.S., as quoted by The Wall Street Journal.
Other countries have also been snagging supplies of Xevudy. A few days ago, Canada signed on for 20,000 doses. GSK also has agreements with Japan, U.K., Singapore, Australia and others. All told,
GSK and Vir have said they expect to manufacture about 2 million doses globally in the first half of 2022.
Before the new deal, GSK had delivered the 440,000 doses it agreed to supply to the U.S. in 2021. The government is still allocating that supply to healthcare facilities. The company now expects to start shipping the 600,000 doses in February and March, the spokesperson said.
Both Regeneron and Eli Lilly have started developing new antibody treatments that could neutralize omicron.
Meanwhile, China’s Brii Biosciences is seeking an FDA green light for its antibody combo of amubarvimab and romlusevimab, which won Chinese approval in December. The company recently said its cocktail also held up against omicron. The U.S. doesn’t yet have any supply agreement with Brii.
Fierce JPM Week: Bristol Myers’ Next-gen Autoimmune Med Not Just Another JAK Drug, Exec Says Feedzy
After a high-profile study turned up safety risks for Pfizer’s JAK inhibitor Xeljanz last year, the FDA put the entire class under a microscope–and it only recently went back to granting new approvals in that class. Bristol Myers Squibb, meanwhile, has a new candidate that the company’s chief medical officer says is safer than the other JAKs.
Speaking during the Fierce JPM Week virtual conference, Bristol’s CMO, Samit Hirawat, said the company’s deucravacitinib is a novel TYK2 inhibitor “with a very specific downstream effect of integrating IL-12, IL-23 and interferon and sparing other cytokines and sparing JAK 1, 2 and 3.”
While Bristol aims to highlight its med’s differences from drugs in the JAK class, TYK2 is known colloquially as JAK4 and is part of the Janus kinase family. That has some industry watchers worried that the FDA may take a tough stance on the candidate amid safety concerns for the larger drug class.
After an FDA submission last year, deucravacitinib is under review to treat moderate to severe plaque psoriasis. The agency’s decision deadline is set for Sept. 10, 2022.
So far in deucravacitinib’s studies, BMS doesn’t “see the hematologic impact that JAK inhibitors do show [and] we don’t see the dysfunction in the liver enzymes that is seen with JAK inhibitors,” Hirawat said during Fierce JPM Week.
Further, “we don’t see dyslipidemia that is shown by JAK inhibitors,” Hirawat added.
Since Xeljanz post-marketing study showed heightened risks of cardiovascular problems and cancer, the FDA has put the entire JAK inhibitor class in a protracted safety review. That process triggered missed approval deadlines for new drug candidates and delayed label expansions for existing meds.
More recently, the FDA started giving new blessings for JAK drugs–but under the condition that they’re used behind old-school TNF inhibitors such as Humira. Pfizer’s new Cibinqo and AbbVie’s Rinvoq recently won eczema approvals, for instance.
As for deucravacitinib, Hirawat said the Poetyk PSO-1 and Poetyk PSO-2 studies–plus trials in Japan and China–show that the med is a “first-in-class” medicine, apparently hoping to differentiate the drug from existing meds at the center of the FDA safety review.
When Bristol bought Celgene for $74 billion back in early 2019, the company had to sell the lucrative psoriasis drug Otezla to score antitrust approval for the deal. The company opted to stick with deucravacitinib, which later beat Otezla in the Poetyk studies by helping more patients achieve 75% skin clearance.
These days, Amgen markets Otezla and is generating blockbuster sales from the psoriasis medicine. For its part, Bristol figures deucravacitinib can generate $4 billion at peak.
And deucravacitinib has some other new indications in the works. BMS is “looking forward to seeing the data imminently” for a phase 2 trial in systemic lupus erythematosus, Hirawat said. If that result is “supportive,” BMS will launch a phase 3 program, he said.
Meanwhile, the drug didn’t meet proof of concept criteria in inflammatory bowel disease last October, but Hirawat said the company is running two studies with higher doses and is “absolutely” committed in that disease. With those results, the company expects to have more information about potential indications to “pursue in the future,” Hirawat said.
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