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Takeda Launches Value-based Pricing Program for Lung Cancer Med Alunbrig, Promises More Deals to Come Feedzy




As the targeted treatment space for ALK-positive non-small cell lung cancer becomes more crowded, Takeda is trying to get ahead of the competition with a drug pricing tool that’s rarely used among U.S. oncology players.

Takeda recently launched a value-based pricing program for its ALK lung cancer med Alunbrig in collaboration with Point32Health, a combination of Tufts Health Plan and Harvard Pilgrim Health Care covering 2 million people in the New England area.

Under the agreement, Takeda will offer a “significant” rebate to Point32Health if a patient doesn’t stay on Alunbrig past three months because of efficacy or tolerability reasons, Dion Warren, Takeda Oncology’s U.S. head, explained in an interview. The size of the refund would be tied to the number of members on the drug, a Point32Health spokesperson told Fierce Pharma. Patients would also get a refund from their plans for out-of-pocket costs, the spokesperson said.

Takeda’s move comes shortly after Pfizer launched a pilot program called Pfizer Pledge for its first-generation ALK med Xalkori, as Stat reported last month. The Pfizer program, based on warranties, promises to refund the entire cost of Xalkori if a patient stops treatment within the first three months. Xalkori currently bears a monthly wholesale acquisition cost of about $19,100, while Alunbrig’s list price is about $17,000 per month.

Xalkori is the old ALK med that every subsequent offering in the class has bested during clinical trials. For Takeda’s Alunbrig, the drug reduced the risk of disease progression or death by 51% over Xalkori in newly diagnosed patients with ALK-positive non-small cell lung cancer. The phase 3 Alta-1L data earned Alunbrig an FDA nod for first-line use last May.

RELATED: Takeda’s Alunbrig scores nod for earlier lung cancer use, but a Roche showdown awaits

The new Point32Health deal was meant to “broaden access and stand behind the value of Alunbrig,” Warren said. The program is unique in that it doesn’t have any eligibility limitations, so it’s available for all potential patients, he said.

Takeda chose Alunbrig for its first value-based purchase deal because of the ALK drug’s clear efficacy and safety profile. Still, for any drug, some patients may discontinue treatment early because they don’t respond to or can’t tolerate it.

“What we’re trying to do is offer this risk-sharing agreement to take some of those initial concerns … off the table,” Warren said.

With Alunbrig being a single-agent therapy, it’s also straightforward for Takeda to track and understand the med’s performance in the real world while executing the data-driven agreement, he added.

But the three-month refund window Takeda is offering is much shorter than the time many patients experienced without disease progression in the med’s late-stage clinical trial. To hear Warren tell it, the first three months of treatment often determine whether a treatment is right for a patient.

RELATED: Pfizer’s Lorbrena breaks into front-line ALK lung cancer, jostling with Novartis, Roche and Takeda

Alunbrig is only one of several of Big Pharma’s ALK medicines that are fighting for share in a niche market. The current market leader is Roche’s Alecensa, which got its front-line label in 2017. With a monthly list price of about $16,078, Alecensa brought in third-quarter sales of 357 million Swiss francs ($390 million), up 18% year over year. By contrast, Alunbrig’s haul during the three months were 3.1 billion Japanese yen ($27.3 million).

“While we don’t currently have a rebate program for Alecensa, we’re conducting a number of pilots across our oncology portfolio, including ways to reimburse medicines based on different indications, outcomes, and regimens,” a spokesperson for Roche’s Genentech said in a statement to Fierce Pharma.

Zykadia maker Novartis also doesn’t have a dedicated outcome-based program for its ALK drug, a company spokesperson said. But the company offers patient assistance programs and a co-pay support project, where a patient can get a drug with no out-of-pocket costs or free of charge, the spokesperson added.

Meanwhile, Pfizer in March moved its third-generation tyrosine kinase inhibitor Lorbrena into front-line ALK-positive lung cancer on the back of phase 3 data showing it could improve upon Xalkori’s progression-free survival showing by 72%. And small biotech Xcovery has been looking for a marketing partner for its phase 3 candidate ensartinib, though it hasn’t had any luck.

RELATED: Ready to rival J&J, Takeda’s growth plan bears fruit with FDA nod for niche lung cancer drug Exkivity

Outcomes-based drug pricing is still fairly rare in the U.S., although players in the drug reimbursement system are increasingly looking to new strategies to pay for expensive drugs. Novartis, for example, offers a program for its spinal muscular atrophy gene therapy Zolgensma where payments can be made in installments over years only when the drug continues to work.

Takeda, while testing the water with Alunbrig’s Point32Health deal, plans to expand value-based pricing with other payers and into other cancer drugs. It’s a “key approach” that the Japanese pharma intends to use more broadly, Warren said.

“We need to learn through this experience and continue to broaden our approach to access so we can benefit as many patients as possible,” Warren said. “This is the first for us–it’s not going to be the last.”

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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.

RELATED: Surprise! Amgen’s hot KRAS drug seals early FDA approval, winning a shot against ‘undruggable’ cancer

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.”

RELATED: Brintellix? Nope, Trintellix. Takeda rebrands to end name confusion

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.

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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.

RELATED: GlaxoSmithKline and Vir’s sotrovimab stands up to omicron despite other COVID antibodies falling short

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.

RELATED: GSK, Vir file for emergency FDA authorization of intramuscular formulation of COVID-19 antibody

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.


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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.

RELATED: Bristol Myers Squibb’s next-gen autoimmune med starts high-stakes FDA review amid classwide JAK scrutiny

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.

RELATED: Bristol Myers Squibb’s deucravacitinib flunks midphase IBD trial, raising questions about potential blockbuster

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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