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Wednesday, August 1, 2018

Novel COPD Therapy Deemed Safe in Early Study


An experimental bronchoscopic therapy for chronic obstructive pulmonary disease (COPD), which involves the use of electrical waves to disrupt airway passage nerve transmission, was found to be safe and feasible in a small, early study.
In 15 patients with moderate-to-severe COPD, targeted lung denervation (TLD) was associated with no serious adverse events when given as a single dose through 3 years of follow-up, according to Arschang Valipour, MD, PhD, of Ludwig Boltzmann Institute for COPD and Respiratory Epidemiology in Vienna, and colleagues.
The results confirm those of an earlier pilot studyinvolving 22 patients with COPD treated with TLD in both lungs.
“With long-term safety of targeted lung denervation established between two studies now, focus will be on optimizing the energy dose, further refining the procedure, studying potentially additive effects of targeted lung denervation on top of LAMA [long-acting muscarinic antagonist] treatment, and conducting careful patient phenotyping analysis to identify those patients most likely to benefit from this novel therapy,” the authors wrote in the International Journal of Chronic Obstructive Pulmonary Disease.
James F. Donohue, MD, of the University of North Carolina Chapel Hill, characterized the research as preliminary, but exciting. Donohue, who was not involved in the study, told MedPage Today, “This study, while small, was encouraging and shows the plausibility of this technique. Also the results were enduring at 1 year. But it’s a long way from a small plausible trial to formal FDA approval.”
TLD was performed with the intention of achieving bronchodilation through ablation of parasympathetic pulmonary nerves entering the lung and running along the outside of the two main bronchi, the researchers wrote.
While the earlier pilot study involved treatment of the lungs one at a time, the latest study was performed to examine the treatment given as a single procedure. Patients were also followed for 3 years.
TLD was delivered via a dual cooled radiofrequency generator system. As radiofrequency current is delivered through the airway and surrounding tissues, the tissues are heated and the nerves are ablated, while simultaneous cooling removes heat from the inner surface of the bronchi.
“The net effect is the targeted tissue ablation at depth with minimal heating and damage of the inner surface of the airway. The goal of targeted ablation is to disrupt motor axons within bronchial nerve branches running along the main bronchi, thereby blocking parasympathetic signaling to the lung and decreasing neuronal release of acetylcholine,” the researchers wrote.
The procedure was fully performed in all but one of the participants, with that patient receiving treatment in seven of the eight expected quadrants due to poor balloon contact.
A total of 15 patients (47% male, mean age 63.2) underwent TLD with a total procedure time of 89 minutes. The total fluoroscopy time was 2.5 minutes.
All patients met the primary safety endpoint of freedom from worsening of COPD. There were no procedural complications reported, and results of lung function analysis and exercise capacity demonstrated similar beneficial effects of TLD without bronchodilators when compared with long-acting anticholinergic therapy at 30 days, 180 days, 365 days, 2 years, and 3 years post-TLD.
Five of the 12 serious adverse events that were reported through 3 years of follow-up were respiratory related with no events being related to TLD therapy.
“No significant wall effects (i.e., ulcers and narrowing) were observed during this study at either the 90-day or 365-day follow-up bronchoscopy and CT assessment,” the researchers wrote.
No device-related adverse events were reported and no deaths occurred during the 3-year follow-up period.
The researchers noted that while improvements in lung function were accompanied by benefits in exercise capacity, “they did not translate into consistent benefits of health-related quality of life in this study.”
They hypothesized that this may be due to the small study size or the fact that several patients were not followed beyond 365 days.
The authors conceded that given the lack of a control group undergoing a sham treatment and the lack of direct measurements of therapeutic efficacy of TLD, such as histological proof of denervation in vivo, “improvements in lung function and exercise capacity observed in the current study may have been an intervention effect, rather than a result of the intended mechanism of action.”
“Given the magnitude of response with respect to the FEV[forced expiratory volume in 1 second] demonstrated in this study and a strict inhaler washout procedure prior to lung function measurements, however, there is a high likelihood of an independent treatment effect,” they added.
The study was funded by Nuvaira.
Valipour disclosed relevant relationships with AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Nuvaira, Olympus, PneumRx, PulmonX, and Uptake Medical. Co-authors disclosed multiple relevant relationships with industry.

Quality Systems (QSII) Tops Q1 EPS by 1c, Offers Outlook


Quality Systems (NASDAQ: QSII) reported Q1 EPS of $0.19, $0.01 better than the analyst estimate of $0.18. Revenue for the quarter came in at $133.2 million versus the consensus estimate of $132.63 million.
GUIDANCE:
Quality Systems sees FY2019 EPS of $0.70-$0.78, versus the consensus of $0.74. Quality Systems sees FY2019 revenue of $532-548 million, versus the consensus of $540.55 million.

RXi Pharmaceuticals med for retinal scarring meets safety trial endpoint


RXi Pharmaceuticals announced ‘positive’ results with RXI-109 in a Phase 1/2 clinical trial. RXI-109-1501 is a study evaluating the safety and tolerability of RXI-109 injections in the eye of subjects with advanced neovascular age-related macular degeneration, and accompanying subretinal fibrosis. During this study, the clinical effect of these injections was evaluated as a secondary endpoint. The primary objective was met as shown by the absence of dose-limiting and serious toxicities, and study results show that RXI-109 was safe and well tolerated for all patients included in the three dosage groups. Several assessments were included to measure a potential clinical effect. There were no instances of Dose Limiting Toxicities or Serious Toxicities throughout the study. Compared to the baseline visit, all but one subject had an improved best corrected visual acuity of the study eye at the last follow up visit.

Humana expects PDP membership to decline in 2019


Says sees 2019 headwinds, tailwinds. Expects “PDP membership will decline given the competitive nature of the industry and the price discipline we are employing.” Expects decline to constrain growth of pharmacy business. Expects lower TRICARE profits in Group and Specialty segment. Says 2019 tailwinds include the positive Medicare rate notice, the HIF moratorium, the continued solitary impacts of tax reform and incremental membership from the statewide Florida Medicare. Expecta reasonable adjusted EBITDA growth in Healthcare Services segment as Kindred results are annualized.

More Euro pharmas stockpile drugs in case of no-deal Brexit


Sanofi and Novartis said on Wednesday they planned to increase stockpiles of medicines Britain in preparation for potential disruption if the UK crashes out of the European Union without a deal.
The move follows similar action by AstraZeneca , which said last month it would increase stockpiles of drugs that could be affected by Brexit by around 20 percent.

Roche , the world’s biggest maker of cancer medicines, also said it was taking “appropriate action” to review its stock levels in order to protect supplies to patients.
Britain’s largest drugmaker, GlaxoSmithKline , said last week it was taking steps to secure the supply of its medicines and vaccines ahead of the UK’s departure from the EU, without going into details.
Supplies of thousands of medicines are at risk of disruption if Britain leaves the EU without a deal, forcing manufacturers to prepare duplicate product testing and licensing arrangements to ensure their drugs stay on the market.
More than 2,600 drugs have some stage of manufacture in Britain and 45 million patient packs are supplied from the UK to other European countries each month, while another 37 million flow in the opposite direction, industry figures show.
Leading drugmakers have long been vocal in their concerns about Brexit and the need for the pharmaceuticals sector to stay within the European regulatory system.
British lawmakers have also called for an agreement that allows the country to have continued participation in the European medicines regulatory framework, but it remains unclear how this will play out in the broader EU negotiations.
Sanofi said it was confident its stockpiling measures would ensure British patients had access to its treatments after Britain leaves the EU, regardless of whether a deal over its future relations with the bloc is in place.
“The uncertainty in the Brexit negotiations means that Sanofi has always been planning for a no deal scenario,” a spokesman with the French drugmaker said in an emailed statement.
“We have made arrangements for additional warehouse capacity in order to stockpile our products in the UK and increase UK-based resources to prepare for any changes to customs or regulatory processes.”
Novartis said it planned to hold increased inventories in Britain across its portfolio of medicines from both Novartis itself and Sandoz, the Swiss company’s generic drugs division.
“We have apprised officials and ministers of our preparedness plans and status, including plans to increase our UK inventory holding,” Novartis said.
The European Medicines Agency has warned drugmakers they needed to be ready for a possible hard Brexit in 2019. It has also expressed “serious concerns” over the availability of some 108 medicines that are manufactured exclusively in the UK.

Shire’s fast-track NASH drug abruptly stopped in phase 2


Shire has quietly cut the trial of an FDA fast-tracked fatty liver disease drug, although it’s not giving much away about what happened.
Buried within its second-quarter financials this morning, Shire said it was curtains for SHP626 (volixibat), its phase 2 experimental drug for steatohepatitis (NASH) with liver fibrosis.
It was being worked as a once-a-day, oral inhibitor of the apical sodium dependent bile acid transporter (ASBT), a protein which is primarily responsible for recycling bile acids from the intestine to the liver.

There’s not much to go on from Shire, accept to say that: “In June 2018, Shire announced that the phase 2 clinical study of SHP626 has been discontinued. Shire is evaluating other options for the program.”
Shire has previously noted that “The most common adverse events occurring in phase 1 trials of SHP626 were gastrointestinal in nature, predominantly diarrhea. While this occurred in most patients, it was not considered serious. There was one serious adverse event reported that was considered related to SHP626, alanine aminotransferase elevation, that led to discontinuation of drug.”

Almost exactly two years ago, the biopharma was given an FDA fast track for the drug, which can help speed up its pathway to approval, based on the phase 1 as well as preclinical data.
Its phase 2 for SHP626 was a randomized, placebo-controlled, double-blind study to seek out safety, tolerability and efficacy of three doses of volixibat over 48 weeks in adult patients with NASH. The test was carried out in the U.S., Canada and the U.K.
NASH is set to be a multibillion-dollar market with a number of biopharmas, including Shire, Bristol-Myers Squibb, GenFit, Intercept and others trying to break into this therapy area.
Many have suffered setbacks in these efforts, however, with a number of different MOAs being used to try and attack the fatty buildup that can occur in the liver in obese patients, which can in turn lead to scarring and potentially liver disease and failure.
The drug was originally licensed from Lumena Pharmaceuticals. This is the second drug to hit trouble from that deal, with Shire’s other liver drug, SHP625, also beset with issues.
Back in 2016, the phase 2 “Cameo” trial, a 14-week study in patients with primary sclerosing cholangitis (PSC), an uncommon chronic liver disease, missed its secondary endpoints.
That came exactly a year after Shire posted data from SHP625 (formerly known as LUM001) that showed it missed all of its objectives in the phase 2 Imago study involving 20 children with the genetic disease Alagille syndrome (ALGS).

Bayer to sell prescription dermatology unit and transfer 450 employees


With an ambition to expand its position as a leading dermatology company, Leo Pharma has agreed to acquire Bayer’s prescription dermatology business, which delivered €280 million ($328 million) in 2017 sales.
The drugs to be sold include Bayer’s topical acne drug Skinoren, fungal skin infections dual Travogen and Travocort, rosacea remedy Finacea and several topical steroids, including Advantan, Nerisona and Desonate. Bayer, however, isn’t ready to let go of its over-the-counter dermatology franchise, which includes two key brands, Bepanthen, which delivered €379 million in 2017 sales, and Canesten, with 2017 sales of €278 million.
Financial details were not disclosed, but Leo said the acquisition will first close this year for the U.S., and during the second half of 2019 for the rest of markets. There were reports when Bayer first looked at selling its dermatology assets that they might go for as much as $1.1 billion.
“We are very excited about this agreement. With the strong prescription dermatology brands and the new colleagues from Bayer, Leo Pharma advances significantly towards our goal of helping 125 million patients by 2025,” said Gitte Aabo, Leo’s president and CEO, in a statement.

The deal follows Leo Pharma’s $725 million buyout of Astellas’ dermatology portfolio, which closed in 2016. The Danish company said the Bayer deal represents a chance to further expand its presence in key markets around the world and broaden its dermatology treatment range.
The dermatology unit became part of Bayer in 2006 when the German drug giant acquired Schering. Now, Leo will take over the sales and marketing organization in 14 countries, a factory in Segrate, Italy, and about 450 employees as part of this transaction.

“Moving forward, we believe that Leo Pharma is the right owner to grow and further develop the prescription dermatology business while enabling us to focus on building our core over-the-counter brands,” said Bayer Consumer Health head Heiko Schipper in a statement.