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Saturday, June 9, 2018

Diabetes ‘technological wave’ has too much upside to ignore: JP Morgan

  • The ongoing changes to glucose monitoring are so important, Marcus added, that medical device companies such as Dexcom are set for “significant” upside.
  • “The diabetes space is currently experiencing its biggest technological wave of innovation from glucose measurement to insulin dosing,” analyst Robbie Marcus wrote Friday.
  • Dexcom’s stock is up more than 62 percent so far this year. Shares extended their 2018 gains Friday, climbing nearly 4 percent.
After the sensor warmed up, it was off by 25 mg.
CNBC | Erin Black
New technologies for diabetes treatment are becoming essential for those who suffer from the disease, according to J.P. Morgan, and that could make companies such as Dexcom compelling investment opportunities.
“The diabetes space is currently experiencing its biggest technological wave of innovation from glucose measurement (continuous glucose monitoring) to insulin dosing (insulin pumps),” analyst Robbie Marcus said in a note to clients Friday. “CGM is becoming an essential tool for patients and is now at the level of sensitivity that it is eliminating the need for fingersticks with blood glucose monitoring.”
Technological advances for glucose checking are so important, Marcus added, that medical device companies such as Dexcom are set for “significant” upside over the next few years. Marcus upgraded shares of Dexcom to overweight and raised his price target on the company to $115 from $80, implying 28 percent upside over the next year.
Dexcom, which produces devices that attach to a patient’s skin to monitor blood-glucose levels continuously, has the potential to crush consensus revenue estimates, the analyst added. He predicts that the San Diego-based company could reach $876 million this year, which would beat expectations of $860 million.
CNBC's Erin Black inserts the Dexcom G6 sensor
This diabetes monitor can read your blood sugar without any blood
“Treatment is shifting towards integrated pumps where the CGM dictates insulin dosing, and in our view the CGM is the much more valuable component of that equation than the pump,” Marcus explained. “We think the Street is being too conservative on the near-term sustainability of Dexcom’s hardware business (transmitters and receivers) and assuming a significant headwind to both new patient adds and base business patient attrition.”
Dexcom’s stock is up more than 62 percent so far this year. Shares extended their 2018 gains Friday, climbing nearly 4 percent.
“One of the hidden assets of Dexcom is this investment we’ve made in technology,” chief executive Kevin Sayer told “Mad Money” host Jim Cramer in November. “Our system offers features that competitors don’t. We connect to phones. We share data with people who watch patients. We offer performance and accuracy that others don’t.”

Need a little extra money? You'll soon be able to sell and rent your DNA

Feel like earning a little extra money and maybe improving your health at the same time?
 
Consumers will soon be able to sell or rent their DNA to scientists who are trying to fight diseases as different as dementia, lupus and leukemia.
Bio-brokers want to collect everything from someone's 23andMe and Ancestry.com gene  to fully sequenced genomes.
The data would be sold or rented to biomedical institutes, universities and pharmaceutical companies, generating money for consumers who share their genetic secrets.
The roundup is mostly led by LunaDNA of Solana Beach and Nebula Genomics of San Francisco, startups that are still figuring out how much a person would be paid for their contribution.
It's part of the booming bio-economy, where so-called "sequencing subsidies" are starting to emerge.
Scientists say they need enormous amounts of  from across different ethnic, racial and age groups, and different genders, to develop diagnostics and drugs.
The need for new and better therapeutics is deep and broad.
Most people never develop a genetic disorder. But single genes are responsible for causing more than 6,000 human diseases, including cystic fibrosis and muscular dystrophy. There are also many diseases influenced by multiple genes, notably obesity and type 2 diabetes.
LunaDNA is asking people to share data they've gotten from such direct-to-consumer personal genomics companies as 23andMe and Ancestry.com, both which are highly popular.
A subsidiary of Ancestry.com reportedly sold about 1.5 million saliva test kits last year between Black Friday and Cyber Monday.
"That's like 2,000 gallons of saliva—enough to fill a modest above-ground swimming pool with the genetic history of every person in the city of Philadelphia," said Wired.com.
Nebula Genomics wants people to contribute their entire genome, and is prepared to help consumers get sequenced at reduced costs. The consumer could then sell or rent the data on Nebula's data exchange. Consumers would be paid in some form of cryptocurrency that could be converted to dollars.
 
The bio-brokers sense that a grand opportunity is at hand.
The cost of sequencing a person's genome has fallen dramatically over the past 15 years and now stands at about $1,000. The price could drop to $100 within three years.
Scientists also are benefiting from the invention of Crispr, a quick, easy and accurate way to modify DNA for therapeutic purposes.
"Thanks to continuous technological advancement, we have now reached a tipping point where the genomics revolution will spread beyond academic laboratories and affect the lives of millions of people," said Dennis Grishin, co-founder of Nebula Genomics.
"If remaining challenges such as data privacy protection are addressed, the number of people who have their genomes sequenced is going to grow exponentially, possibly more than doubling every year.
"Genomics will become an integral part of personal healthcare. Pharma companies will be buying large genomic data sets and using them to develop new drugs."
The medical, financial, legal and ethical implications of such change will be daunting and, in some cases, hard to fathom. So the San Diego Union-Tribune decided to answer what are likely to be some common questions.
The answers were produced with help from scientists at the University of California, San Diego, the Scripps Translational Science Institute in La Jolla, Nebula Genomics and LunaDNA.
Q: What specific kind of data are scientists seeking from consumers?
A: You, me, the next person—we all have the same genes.
But there's variation in those genes. Some "variants" are neutral; they determine things like our hair color and height. Some are beneficial; they help protect us from illness. And some variants can make us susceptible to disease. We call those mutations.
Scientists are largely interested in the mutations because they can cause diseases and disorders.
23andMe tests the DNA in your saliva for more than 500,000 variants—with an eye for trouble. Last year, the FDA gave the company permission to screen people for genes associated with 10 diseases and disorders, including Huntington's disease and late-onset Alzheimer's disease. More recently, the agency gave 23andMe permission to screen for three genes associated with cancer.
The company uses this data to estimate a person's risk for developing the various diseases.
This is not a diagnosis; it is risk analysis based on an incomplete and changing understanding of human genetics.
"Tests like Ancestry and 23andMe only look at small areas of the genome, and aren't considered to be useful tests for medical care by most genetics experts," said Lisa Madlensky, director of the Family Cancer Genetics Program at UC San Diego.
"However, they can sometimes identify something medically important that needs to be confirmed in a medical genetics laboratory."
The data always has to be put into perspective. The FDA emphasized that point last year when it approved 23andMe's first screening tests, saying, "It is important that people understand that genetic risk is just one piece of the bigger puzzle. It does not mean they will or won't ultimately develop a disease."
Q: If I take one of these tests, do I own the data that's generated from my DNA?
A. Generally speaking, yes. But you have to read the fine print. You should make sure that you say no if you don't want a company like 23andMe selling your data to a pharmaceutical company or some other type of institution.
Nebula Genomics and LunaDNA are trying to build databases that would be of commercial and scientific interest to the bio-pharma industry. There's nothing wrong with that. You just need to be aware that they need your permission to sell your data.
Q: Is it likely that a consumer could make a significant amount of money from either of these two companies?
A: That remains to be seen. They're both startups, so they haven't finalized how they're going to do things. Dawn Barry, the president of LunaDNA, told the Union-Tribune:
"Individuals will be rewarded when proceeds are generated through the sale of access to the data.
"Think of it like a co-op where the value comes from the data set as a whole and dividends are paid out to the individuals that contribute their genomic and health information. The more data you share, the more shares in the database you own, the greater your percentage of the proceeds."
Q: Is Nebula Genomics looking for something different from consumers?
A: The test used by 23andMe offers a very limited look at a person's genes. Nebula wants to get a complete look. So they're asking consumers to undergo so-called whole genome sequencing. As the name implies, this technique maps out a person's entire genetic makeup. Such data is widely used by biomedical researchers. And this kind of sequencing is moving into clinical settings. For example, this test is used to sequence bacteria, which helps hospitals fight infection diseases.
Q: There are many types of genetic testing. How accurate are the results?
A: Mistakes can be made in every type of testing. And it can be difficult to determine overall accuracy, especially with direct-to-consumer DNA tests that involve ethnicity and genealogy.
Some consumers have reported getting different results when they've used the tests marketed by 23andMe and Ancestry.com.
To be fair, Ancestry.com says that it's only providing an estimate when it calculates what percentage of your DNA that comes from different parts of the world.
But the company touts its reach, noting that it maintains "the world's largest online family history resource, which includes millions of family trees and over 20 billion historical records."
Tufts University researcher Sheldon Krimsky studied this kind of testing and told a campus publication, "Companies selling these services—and there are close to 40 of them—don't share their data, and their methods are not validated by an independent group of scientists and there are not agreed-upon standards of accuracy ...
"So you have to look at the percentages you receive back with skepticism."
Consumers also have to be prepared for surprises.
"You may discover things about yourself that trouble you and that you may not have the ability to control or change (e.g., your father is not genetically your father, surprising facts related to your ancestry, or that someone with your genotype may have a higher than average chance of developing a specific condition or disease)," says 23andMe's Terms of Service statement.
"These outcomes could have social, legal, or economic implications."
Sometimes, the outcome is joyful.
"I found my birth family using 23andMe, specifically my mother who had been trying to find me," BreAnne Custodio told the Union-Tribune. "We now talk weekly."
The results can also be jarring.
"You should not assume that any information we may be able to provide to you, whether now or as genetic research advances, will be welcome or positive," 23andMe says in its Terms of Service.
"You should also understand that as research advances, in order for you to assess the meaning of your DNA in the context of such advances, you may need to obtain further services from 23andMe, your physician, a genetic counselor, or other health care provider."
Q: Do most people understand the risk analysis they get from a company like 23andMe?
A: It's difficult to say.
DNA is a popular topic in books, movies, TV and on the web. Basic genetics is taught in school. Most people probably have a rudimentary understanding of DNA testing.
But drawing meaning from DNA is a complex, nuanced, fast-changing field. It can be hard for  to keep up.
The public also has to cope with conflicting claims. We saw an example of that in March after the FDA gave 23andMe permission to check to see if a person has any of three specific BRCA gene mutations that are associated with cancer.
The National Society of Genetic Counselors said the test could help reveal undetected mutations, but stressed that "the results may be confusing or misleading without appropriate education."
Such comments reminded Anne Wojcicki, chief executive officer of 23andMe, of how some physicians lobbied against the use of at-home pregnancy tests when they were introduced 40 years ago
"They thought women might not be able to handle such information on their own and claimed that the results might trigger them to make irrational decisions," Wojcicki told Stat News.
"Some went so far as to claim it would lead to suicides. Looking back, it seems unthinkable that we questioned women's ability to access this kind of information."
Q: Should I be worried about the privacy of my data?
A: Barry said, "An individual's data contains no personal identifiers and is combined with the broad population to create the scale and scope necessary to drive medical discoveries."
You hear similar things from other companies, and from the government.
Keep in mind that hackers have stolen data from everyone from the National Security Agency to local hospitals. Anyone can be hacked.
https://bit.ly/2xWXIMb

Relocating its US HQ to Boston, French pharma Ipsen to add 250 jobs


Boston’s biotech hub has attracted yet another HQ, as French pharma company Ipsen said Thursday it will relocate its US operations from New Jersey to Kendall Square.

The company announced the move on the last day of the BIO International Convention, promising to add 250 new jobs with the expansion of its Boston presence. Ipsen, which has a $11.2 billion market cap, already opened two outposts in the city back in 2015: a commercial/manufacturing site at One Kendall Square and an R&D site at 650 East Kendall St. Now, it’s moving all 150 of its Boston employees into the East Kendall location.
The new jobs were part of a deal struck between Ipsen and the Massachusetts Life Science Center, which pledged $1.2 million in state tax incentives to Ipsen. The incentives would be funded by a new life science bill that lawmakers are expected to soon send to Governor Charlie Baker.
“We are entering into a new era of innovation and growth for Ipsen as a leading global biotech company. By bringing our headquarters to Cambridge, we will build a sustainable innovation engine to advance opportunities for our employees and our overall business,” said Richard Paulson, CEO of Ipsen North America, in a statement. “The Massachusetts Life Science Center has been instrumental throughout this process, and we look forward to continuing to partner with them as we grow our footprint even further in Cambridge and ultimately address patient needs.”
Ipsen’s current US headquarters are in Basking Ridge, New Jersey, where the company plans to maintain a core services center. The headquarters will transition to Cambridge over the next 12 months, the company said.

With former Shire cancer unit, French pharma Servier expands in Boston


Servier, the French pharma giant that just acquired Shire’s oncology unit for $2.4 billion, is putting a US innovation outpost in Kendall Square. The new unit will be called Servier BioInnovation, and it’s just recruited two executives to head it up — likely hunters for partnerships and tech that will advance Servier’s pipeline.

This marks the second French pharma giant to announce a Kendall Square outpost in the past 24 hours. Just yesterday, Ipsen announced it was moving its US headquarters from New Jersey to Boston.
The two directors of Servier BioInnovation are ex-Biogen exec Christian Schubert and University of Massachusetts’ director of tech commercialization Rekha Paleyanda. They’ll be in charge of heading up Servier’s US R&D and external innovation, and business development and licensing activities.

Today, Servier already has a bit of a US presence with some academic collaborations with Harvard and MIT in Boston. It’s also partnered with biotechs and pharma throughout the US, and supports the LabCentral incubator. And after the April news that Servier was buying up Shire’s oncology unit, the French company will have a much bigger footprint on this side of the Atlantic. In a statement, Servier said the acquisition allows Servier to establish an “immediate and direct commercial presence in the US.”

“Servier BioInnovation represents Servier’s commitment to expanding its growing presence in the U.S. for the long-term through R&D and business development and licensing activities,” said Christophe Thurieau, director of research centers and the Servier International Research Network (SIRN) at Servier’s R&D headquarters. “Christian Schubert and Rekha Paleyanda are established leaders in external innovation, business development and licensing in the biotechnology sector with deep experience in both academic research and commercial business development. The Boston area provides an amazing concentration of innovation, especially in the field of oncology, for partnerships that will advance science and build on Servier’s history as a leading global pharmaceutical innovator.”
The US outpost is just the start, Servier said. It has plans to broaden the SIRN presence worldwide, opening up offices in Beijing, China next.

More biotech IPOs in the wings: Kezar, Eidos

Biotechs are coming out of the woodwork this morning to set terms for their IPOs. So far, we’ve tracked five companies raising roughly $486 million combined, including an IPO from ex-con Sam Waksal’s Kadmon spinoff MeiraGTx $MGTX.
MeriaGTx — $75 million

The company’s founder, Waksal, is a biotech exec once sentenced to prison for his insider trading conviction involving Martha Stewart. He was also the founder of Kadmon, a company he had to bail from before it could file its own IPO back in 2016. And now his brainchild — under the direction of former Kadmon commercial chief Alexandria Forbes — has filed to raise $75 million.


The gene therapy company said it’s priced its IPO at $15 per share, intending to use the new cash to push five of its product candidates into Phase I/II trials. The company has been building out gene therapy manufacturing operations to support its work, which is initially focused on ophthalmology, or eye diseases, where the first generation of developers found some early successes. MeiraGTx said much of the new IPO money will go toward four ophthalmology programs and one salivary gland program.
Magenta Therapeutics — $100M
Joining MeiraGTx in pricing this morning is Magenta Therapeutics $MGTA, which plans to sell at $14 to $16 per share. We covered Magenta’s IPO plans late last month, when the company had penciled in a $100 million public offering. At the range Magenta announced today, the company should raise right around that mark.
According to a statement filed with the SEC, the cash will be used to push forward Magenta’s most advanced clinical program: a cell therapy called MGTA-456. The drug, currently in Phase II trials, is being tested in patients with inherited metabolic disorders. Magenta says new IPO money would advance the treatment through a pivotal trial, pay for some commercialization activities, and also fund research into additional indications for the therapy, such as sickle cell disease and blood cancers. Beyond that, Magenta might use the new funds to back MGTA-145, a novel stem cell mobilization product candidate.
Kezar Life Scienes — $86M
Next up is Kezar Life Sciences, which expects to sell between $14 and $16 per share. This one also isn’t brand new to us, as we covered their initial S-1 filing in late May.  The company’s amended S-1 notes the max capital raised could be $85.9 million.
Kezar $KZR has plans to use the IPO money to push forward its pipeline of autoimmune drugs. Spun out of Amgen with small molecules from the plate of the former Onyx Pharmaceuticals, Kezar’s lead product is KZR-616. The drug is a selective immunoproteasome inhibitor that’s about to be tested in a Phase Ib/II trial in lupus and lupus nephritis. The IPO might also fuel KZR-616 for the treatment of idiopathic inflammatory myopathies and up to three additional autoimmune indications into Phase Ib or Phase II clinical trials.
Autolus Therapeutics — $125M
Then there’s London-based Autolus Therapeutics, which is developing cancer therapies based on CAR-T cell technology. The company plans to raise $125 million by offering 7.8 million shares between $15 and $17 per share.
The company, founded in 2014, will use a big chunk of the proceeds to get proof-of-concept in Phase I/II clinical trials of AUTO2 in multiple myeloma, AUTO3 in pediatric ALL and DLBCL, and AUTO4 in peripheral T-cell lymphoma. It hopes to advance three product candidates through later phases of clinical development and, potentially, registration, according to its F-1.
Eidos Therapeutics — $100M

Last up is San Francisco-based Eidos Therapeutics, BridgeBio’s startup focused on TTR amyloidosis. The biotech is out of the IPO chute looking at $100 million by offering 6.3 million shares at $15 to $17 per share. Insiders are buying up half.
BridgeBio chief Neil Kumar has been bullish about this particular subsidiary in the group, even though it’s up against some heavyweight players in drug development, including Alnylam, Ionis and even Pfizer.
Their drug was initially advanced by Isabella Graef at Stanford and Mamoun Alhamadsheh, the company scientific co-founders, who nailed down preclinical evidence that the drug can stabilize TTR and prevent the cascade of events that causes the disease — a disease modifying approach that will now head to the clinic.
Eidos says most of the proceeds will fund the clinical development of AG10 for the treatment of ATTR-CM and ATTR-PN, including its ongoing Phase II ATTR-CM and planned Phase III ATTR-PN clinical trials.

White House officials call for accountable care organization rule changes


Accountable care organizations are failing to meet their promise to save Medicare money, and regulations governing the model need to change, according to senior White House officials.
“There are a lot of broken promises and failed estimates in the Affordable Care Act, and the hope and promise of this complicated value design is one of them,” Joseph Grogan, associate director of health programs at the White House’s Office of Management and Budget, said Wednesday at the National ACO, Bundled Payment and MACRA Summit.
Grogan based his comments on recent findings from Avalere that Medicare Shared Savings Program ACOs cost the agency $384 million from 2013 to 2016, despite a 2010 Congressional Budget Office prediction that the models would save $4.9 billion through 2019.
Policy changes are coming to Medicare Shared Savings Program ACOs via a proposed rule posted on OMB’s website. The rule will aim to facilitate ACOs’ transition to downside risk, according to a HHS summary of the rule.
Clinicians working within ACOs have heard the rule will slash how long they can stay in the Medicare Shared Savings Program without taking on downside risk. Grogan did not provide details about the rule on Wednesday. HHS submitted it for review on May 1 and OMB has up to 90 days to review the regulation.
Under Obama-era regulations, ACOs have the option to stay in Track 1, which only involves upside risk, for up to six years or two contract periods. Sources in the provider community said the agency will cut that period to three years or one contract period.
There are 561 Medicare ACOs this year, 82% of which are in Track 1.
Grogan did not confirm the report in his remarks. However, he said that one of the barriers to ACOs’ success is their resistance to face penalties if they miss savings goals.
“ACOs need to accept risk sooner rather than later,” Grogan said.
ACOs have pushed back against taking on risk because the CMS doesn’t provide enough information ahead of time on the patients they’ll be judged on, or goals they must meet to avoid financial penalties.
Grogan agreed that the CMS must be more transparent in its ACO evaluations before they can take on more risk. It’s unclear if the proposed rule will offer these assurances.

Link Between Screen Time and Eye Symptoms in Kids


My name is Priyanka Kumar. I am an attending ophthalmologist at the Children’s Hospital of Philadelphia and an assistant professor of ophthalmology at the Perelman School of Medicine at University of Pennsylvania. I am here today to talk to you about screen time and the recommendations for screen time in children.
The guidelines from the American Academy of Pediatrics and the American Academy of Ophthalmology are based on consensus statements.[1,2,3] We recommend that children under 18 months of age avoid all digital screen time, with the exception of video chatting with apps such as FaceTime, Skype, WhatsApp, and similar types of programs. This is to make sure that we are stimulating them with natural visual stimuli in order to support visual development.
For children aged 18-24 months of age, it is recommended that parents and families slowly introduce digital screen time to their children. Parents should be actively involved with what is being watched, monitoring what is being seen, and educating their children about the program and the content.
For children who are 2-5 years of age, we recommend limiting screen time to about an hour a day. It is important to remember that this includes TV, computer, iPad, tablets, iPhones, and other types of electronic programming, with the exception of video chatting. It is really important to try to make sure that parents are showing their children high-quality programming and are still actively involved in terms of what is being watched and teaching their children about what is being seen.
For kids age 6 years and over, the limits are a little less clear. We understand that it can be very difficult to limit screen time based on the amount of homework that is being prescribed and the time that children need to spend on the computer to successfully accomplish their schoolwork. With that being said, it is important to really encourage children to do other things with their time. We still recommend limiting screen time in general to 1-2 hours a day, if possible.
This is important because we know that adults develop symptoms associated with a computer vision syndrome when they spend excess time on the computer or screens of any kind.[4] These symptoms include headaches, fatigue, and asthenopia [eye strain]. We would assume that children are at risk of developing these same symptoms. That is why these limits are in place.
Interestingly enough, these [recommended] limits and [expectation of types of symptoms that may occur] are not based on any hard and fast science. However, more and more research is being done that tells us there is probably a correlation between these symptoms and screen time. A paper published in 2017[5] found that children with more than 3 hours a day of total screen time are at a higher risk of developing asthenopia, headaches, motor tics, and potentially even refractive error.
This study was retrospective and observational, with a small cohort, and thus highlights the fact that we need more research in this area. We would really like to understand this a little better.
The flip side is that more work is being done examining the role of video games and dichoptic computer games to treat amblyopia which, for decades, has been treated with patching, eye drops, and glasses. I think this is an interesting area of research because children would much prefer to play a video game to having to wear a patch on their eye.
The research is showing us that all of these modalities used together potentially could treat amblyopia equally as effectively and improve compliance. Look out for the results from the next papers about these types of studies. Hopefully, we will have more information about this topic in general.