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Friday, August 10, 2018

Synergy Pharma to License TRULANCE in China to Luoxin Pharmaceutical Group


Synergy Pharmaceuticals Inc. (NASDAQ: SGYP) announced today that the company has entered into a license agreement with Luoxin Pharmaceutical Group Co., Ltd., Shandong (Luoxin) providing Luoxin exclusive rights to develop and commercialize Synergy’s lead product TRULANCE (plecanatide) for the treatment of adults with chronic idiopathic constipation (CIC) and irritable bowel syndrome with constipation (IBS-C) in mainland China, Hong Kong and Macau.
‘Luoxin is a leading pharmaceutical company in China with strong capabilities for successfully delivering TRULANCE to patients in its market,’ said Troy Hamilton, Chief Executive Officer of Synergy Pharmaceuticals Inc. ‘This partnership builds on the Canadian licensing deal we announced for TRULANCE earlier this year and demonstrates our team’s continued execution towards our key business priorities of optimizing the value of TRULANCE, ensuring a strong financial foundation, and continuing to explore all strategic business development opportunities. We look forward to supporting the Luoxin team in their efforts to bring TRULANCE to patients suffering from CIC and IBS-C in China.’
‘We are pleased to partner with Synergy to bring this exciting new treatment option to benefit millions of patients suffering from these chronic gastrointestinal conditions in China,’ said Baoqi Liu, Chairman of Luoxin Pharmaceuticals. ‘Over the years, Luoxin Pharmaceuticals has established a strong product line of proton pump inhibitors to treat gastrointestinal diseases, and we are conducting a Phase III clinical trial on LXI-15028 (CJ-12420), a p-CAB inhibitor licensed in from the Korean pharmaceutical company CJ Healthcare and recently approved by Korean health authorities, which will further enrich our product line in digestive system. We believe TRULANCE will bring a great amount of value to our arsenal of solutions to fight these conditions. Luoxin Pharmaceuticalsadheres to our corporate mission of ‘Delivering Health’, and we look forward to working with Synergy on our mutual goal of making TRULANCE available to as many patients and their health care providers as possible.’
Under the terms of the agreement, Synergy will receive an upfront payment of $12 million. Synergy is also eligible, in the event that certain regulatory and commercial milestones are met, to receive additional payments of up to $56 million in aggregate. In addition, Synergy is eligible to receive tiered royalty payments on aggregate net sales. Luoxin will lead clinical development in China and be responsible for all activities and expenses relating to clinical development, regulatory approval, and commercialization in China. Yafo Capital acted as a financial advisor on this transaction.

New Colorado Law Prohibits Sale of OTC Cough Medicine to Minors


The Consumer Healthcare Products Association (CHPA) applauds Colorado for enacting a law prohibiting the sale of over-the-counter (OTC) medicines containing the cough suppressant dextromethorphan (DXM) to minors this week. HB 1307 was signed into law by Colorado Governor John Hickenlooper on May 11, 2018.
While millions of Americans use products containing DXM to safely treat their symptoms, according to the 2017 National Institute on Drug Abuse (NIDA) annual Monitoring the Future survey, one in 30 teens abuses OTC cough medicine containing DXM to get high.
“Colorado is the 16th state to pass an age-18 sales law, joining states across the country in recognizing that limiting teen access to DXM is a proven way to prevent abuse,” said CHPA President and CEO Scott Melville. “This is a common-sense law, that restricts access to teens who may abuse these products, while maintaining access for the millions of Americans who use them responsibly. Committed Colorado state lawmakers have been crucial allies in our abuse prevention efforts, and we thank them for their hard work.”

Gene-editing startups ignite the next ‘Frankenfood’ fight


In a suburban Minneapolis laboratory, a tiny company that has never turned a profit is poised to beat the world’s biggest agriculture firms to market with the next potential breakthrough in genetic engineering – a crop with “edited” DNA.

Calyxt Inc, an eight-year-old firm co-founded by a genetics professor, altered the genes of a soybean plant to produce healthier oil using the cutting-edge editing technique rather than conventional genetic modification.
Seventy-eight farmers planted those soybeans this spring across 17,000 acres in South Dakota and Minnesota, a crop expected to be the first gene-edited crop to sell commercially, beating out Fortune 500 companies.
Seed development giants such as Monsanto, Syngenta AG and DowDuPont Inc have dominated genetically modified crop technology that emerged in the 1990s. But they face a wider field of competition from start-ups and other smaller competitors because gene-edited crops have drastically lower development costs and the U.S. Department of Agriculture (USDA) has decided not to regulate them.
Relatively unknown firms including Calyxt, Cibus, and Benson Hill Biosystems are already advancing their own gene-edited projects in a race against Big Ag for dominance of the potentially transformational technology.
“It’s a very exciting time for such a young company,” said Calyxt CEO Federico Tripodi, who oversees 45 people. “The fact a company so small and nimble can accomplish those things has picked up interest in the industry.”
Gene-editing technology involves targeting specific genes in a single organism and disrupting those linked to undesirable characteristics or altering them to make a positive change. Traditional genetic modification, by contrast, involves transferring a gene from one kind of organism to another, a process that still does not have full consumer acceptance.
Gene-editing could mean bigger harvests of crops with a wide array of desirable traits – better-tasting tomatoes, low-gluten wheat, apples that don’t turn brown, drought-resistant soybeans or potatoes better suited for cold storage. The advances could also double the $15 billion global biotechnology seed market within a decade, said analyst Nick Anderson of investment bank Berenberg.
The USDA has fielded 23 inquiries about whether gene-edited crops need regulation and decided that none meet its criteria for oversight. That saves their developers years of time and untold amounts of money compared to traditional genetically modified crops. Of those 23 organisms, just three were being developed by major agriculture firms.
The newly competitive landscape could foster more partnerships and licensing deals between big and small firms, along with universities or other public research institutions, said Monsanto spokeswoman Camille Lynne Scott. Monsanto – which was recently acquired by Bayer AG – invested $100 million in startup Pairwise Plants this year to accelerate development of gene-edited plants.
North Carolina-based Benson Hill, founded in 2012 and named after two scientists, mainly licenses crop technology to other companies. But it decided to produce its own higher-yielding corn plant because of the low development costs, said Chief Executive Matt Crisp.
Calyxt plans to sell the oil from its gene-edited soybeans to food companies and has a dozen more gene-edited crops in the pipeline, including high-fiber wheat and potatoes that stay fresh longer.
Developing and marketing a traditional genetically modified crop might easily cost $150 million, which only a few large companies can afford, Crisp said. With gene-editing, that cost might fall as much as 90 percent, he said.
“We’re seeing a huge number of organizations interested in gene-editing,” Crisp said, referring to traditional crop-breeding companies, along with technology firms and food companies. “That speaks to the power of the technology and how we’re at a pivotal point in time to modernize the food system.”
UNCERTAIN REGULATORY, PUBLIC ACCEPTANCE
Supporters of gene-editing say it allows a higher level of precision than traditional modification.
With CRISPR, one popular type of gene-editing technology used by Syngenta, scientists transfer an RNA molecule and an enzyme into a crop cell. When the RNA encounters a targeted strand of DNA inside the cell, it binds to it and the enzyme creates a break in the cell’s DNA. Then, the cell repairs the broken DNA in ways that disrupt or improve the gene.

Biotech firms hope the technology can avoid the “Frankenfood” label that critics have pinned on traditional genetically modified crops. But acceptance by regulators and the public globally remains uncertain.
The Court of Justice of the European Union ruled on July 25 that gene-editing techniques are subject to regulations governing genetically modified crops.
The ruling will limit gene-editing in Europe to research and make it illegal to grow commercial crops. The German chemical industry association called the decision “hostile to progress.”
U.S. Agriculture Secretary Sonny Perdue blasted the ruling for enacting unnecessary barriers to innovation and stigmatizing gene-editing technology by subjecting it to the EU’s “regressive and outdated” regulations governing genetically modified crops.
The USDA also has no current plans to regulate gene-editing in animal products, according to a document provided by the agency.
The U.S. Food and Drug Administration, however, plans to regulate gene-editing in both plants and animals, FDA Commissioner Scott Gottlieb wrote in a June blog post. The agency is developing an “innovative and nimble” approach to regulating gene-editing, he wrote, that will aim to ensure its safety for both humans and animals while allowing companies to bring beneficial products to market.
The USDA, by contrast, chose not to regulate gene-edited crops because the process typically introduces characteristics that are “indistinguishable” from those created through traditional plant breeding, which take much longer, USDA Secretary Perdue said in a March statement.
Although there has been no widespread consumer resistance to gene-editing, activists who have long opposed genetically modified crops remain suspicious of any sort of tinkering with DNA. The new technique raises risks of creating undesired changes in the food supply and warrants increased regulation, said Lucy Sharratt, coordinator of the Canadian Biotechnology Action Network.
That kind of opposition is why agribusiness giant Cargill Inc [CARG.UL] is pursuing gene-edited technology with caution, said Randal Giroux, the firm’s vice-president of food safety, quality and regulatory affairs.
Cargill announced in February that it would collaborate with Precision BioSciences to develop healthier canola oil, but is proceeding slowly on agreements to store and transport other companies’ gene-edited crops pending clarity from regulators, Giroux said.
“We really do want to see gene-editing evolve in the marketplace,” Giroux said. “We’re watching to see how consumers adopt these products and react to these products.”
SECRET FIELD-TESTING
Other major agriculture biotech firms are moving more aggressively, hoping to take advantage of lighter regulation to speed development.
A gene-edited crop may take five years to move from development to commercialization in the United States, compared with a genetically modified crop that could take 12 years, said Dan Dyer, head of seeds development at Syngenta.
The firm is working on better-tasting tomatoes that take longer to spoil and hopes to launch a gene-edited crop in the mid-2020s, said Jeff Rowe, Syngenta’s president of global seeds.
DowDuPont – at a secret location in the U.S. Midwest – is field-testing waxy corn, a variety grown for industrial purposes that has been edited for higher yields. The company plans a commercial launch next spring.
Smaller firms will be nipping at the heels of these massive companies in the race to bring the next generation of genetically engineered foods to market, said Robert Wager, a biology faculty member at Vancouver Island University.
“The lack of USDA-regulated status is a huge game-changer,” he said, “for universities and small startups to enter the market.”

Plans to rescind Obama-era rule cracking down on for-profit colleges


Betsy DeVos’s Department of Education plans to rescind a controversial Obama-era rule aimed at protecting students from career training programs that fail to prepare students for decent paying jobs and saddle them with debt.
The Department released a document Friday outlining a proposal to scrap the gainful employment regulations. The rules, developed under the Obama administration required all programs that explicitly prepare students for careers — such as cosmetology and culinary training programs — prove that graduates were earning enough to repay the debt they incurred to complete the program. Many of these programs are at for-profit colleges. Programs that failed this test repeatedly could lose access to federal financial-aid dollars, a major source of revenue for many colleges.
The proposal is the latest effort by DeVos’s Department of Education to overhaul the Obama-era student-loan agenda. Officials announced major changes to another regulation last month aimed at making borrowers whole who say they’ve been defrauded by their colleges. Friday’s announcement also comes after a series of efforts to delay implementation of the gainful employment rule.
“Instead of targeting schools simply by their tax status, this administration is working to ensure students have transparent, meaningful information about all colleges and all programs,” DeVos said in a statement announcing the proposal. “Our new approach will aid students across all sectors of higher education and improve accountability.”
Borrower advocates roundly derided the proposal saying it would put students at risk of taking on debt to enroll in programs that don’t serve them well. “It’s really a common sense regulation that not only protects students and guarantees that they can get jobs that allows them to pay back their loans, but protects the taxpayer,” said Aaron Ament, the president of the National Student Legal Defense Network, a litigation and advocacy organization.
Officials first began developing the regulations in the early years of the Obama administration. The rules faced multiple court challenges by the for-profit college industry before becoming law. Under the final rule, career training programs are required to prove that their graduates’ loan payments don’t exceed 20% of their discretionary income or 8% of their total earnings. Programs that didn’t meet those requirements for two out of three years would lose access to federal financial-aid dollars.
In the memo released Friday, officials proposed scrapping that debt-to-earnings ratio and the accountability requirements that went with it. In its place, they plan to add more robust program-level information to the College Scorecard, a government website students and families can use to compare colleges. The document also asks the public to provide feedback on whether programs at these types of colleges should be required to provide information such as cost and completion rates on its website.
Critics say gainful employment regulations unfairly targeted for-profit colleges
Those provisions appear to assuage critics who said the regulation unfairly targeted the for-profit sector. Steve Gunderson the president of Career Education Colleges and Universities, a for-profit college trade group, called the proposal “the most significant action” by any Department of Education to provide transparency on higher education outcomes.
“By making available, in a student-friendly and transparent manner, key data points on debt, loan repayment, completion, and earnings of graduates, the Department will empower prospective students with the information needed to select their preferred academic and career preparation pathway,” Gunderson said in a statement.
But borrower advocates argue that simply providing more information to students won’t actually push bad-acting programs to change their behavior. During the first year the Department released outcomes under the gainful employment rule, more than 800 programs failed. Already, some of those programs have shut down or are re-accessing their offerings.
“You can’t expect the data to just all of the sudden drive these decisions because students have to be able to find the data, understand the data and make choices about it,” said Ben Miller, the senior director of postsecondary education at the Center for American Progress, a left-leaning think tank. What’s more, an approach that emphasizes only making more data available, “assumes that you don’t have substantial sophisticated marketing occupations on the other side,” he added.
The for-profit college industry has a history of using questionable marketing tactics
And, indeed, the for-profit college industry has a history of using questionable marketing tactics to draw students and their student loan dollars. Corinthian Colleges, a major for-profit college chain collapsed in 2015, amid allegations the school used inflated job placement and graduation rates to lure students. ITT Technical Institutes filed for bankruptcy a year later under the weight of similar allegations.
Borrower advocates have argued that rules like gainful employment can prevent these types of large scale flame outs — and the taxpayer losses that come with them — by policing poor performing programs before they reach too many students. The document released by the Department Friday estimates that repealing the gainful employment regulation would cost $5.3 billion because the government would be doling out more in federal-aid dollars to students to attend schools that would otherwise be ineligible for them.
In the past, the for-profit college industry has argued that one of the major reasons its outcomes may not hold up to metrics measured by rules like gainful employment is because they educate students who have historically been underserved by other colleges and who may not earn as much in the job market.
The memo released Friday picks up on that rationale and argues the debt-to-earnings ratio is flawed in other ways, but it doesn’t truly wrestle with the best way to measure whether a program is preparing students for gainful employment, Miller said. “It was a giveaway to places that leave their grads with way too much debt compared to their earnings and students will suffer as a result,” he said.
It’s too early to tell whether the proposal released Friday will become law. In the meantime, critics have accused the Department of Education of not enforcing the law currently on the books; the agency has yet to release the second year of school outcomes under the rule.
The public will have a period to comment on the new proposed regulation and then the Department will issue a final rule. At that point, legal advocates and states attorneys general will be looking closely to see whether the Department has violated any laws in promulgating the new regulation, said Ament, who previously worked on for-profit college issues in various positions in the Obama administration.
“I anticipate if they continue along this path you’ll see several challenges,” he said.

Opioid Use Rising in ADHD Patients on Stimulants


More frequent long-term opioid use was seen among adults with attention-deficit/hyperactivity disorder (ADHD) if they were taking stimulants, an observational study of Medicaid prescription data found.
Opioid use (≥30 days) was seen among 16.5% of those who used stimulants, compared with 13% of those who did not, reported Yu-Jung Jenny Wei, PhD, of the University of Florida in Gainesville, and colleagues.
The probability of concurrently using both drugs also increased over time. From 1999 to 2010, long-term opioid use in patients taking long-term stimulants jumped by 12% (adjusted prevalence relative ratio [aPRR] 1.12, 95% CI 1.10-1.14), the authors wrote in JAMA Network Open.
“A lot of effort has been put on patients who have chronic pain, trauma pain, and a whole gamut of pain indications. This is another population who have a psychological disorder associated with substance abuse issues and we see the opioid pattern as well,” co-author Almut Winterstein, PhD, also of the University of Florida, told MedPage Today.
“To me research should not only focus on pain management,” she said. “This is a population that should be looked at and deserves attention.”
With the exception of schizophrenic patients, who demonstrated less frequent long-term dual use (aPRR 0.95), those with mental health disorders more commonly used both drugs concurrently. Researchers measured several comorbid conditions and reported a slightly but significantly higher frequency of use among patients with:
  • Depression (aPRR 1.02)
  • Anxiety (aPRR 1.05)
  • Substance abuse disorder (aPRR 1.04)
As did patients with cardiovascular disease and chronic obstructive pulmonary disease (aPRR 1.02 and aPRR 1.05, respectively).
According to the study, the use of opioids may be enhanced by the presence of stimulants, and lead to euphoric effects, which could increase the risk of drug dependence or overdose. The U.S. allows the pairing of the two substances for individuals diagnosed with substance abuse disorder, though this practice is restricted in Norway, for example, the authors noted.
The study collected data from the Medicaid Analytic eXtract (MAX) files of 29 states from 1999 to 2010 to conduct their analysis. Adults ages 20 to 64 years who had at least one inpatient visit or two outpatient visits coded with an ADHD diagnosis qualified.
For each patient, researchers used data from a randomly selected 12-month period in which the patient was continuously enrolled in Medicaid. The first 6 months established baseline characteristics to which the latter 6 months were compared in order to determine the patient’s long-term concurrent stimulant-opioid use.
Of the 66,406 adults with ADHD, 56% were women, 79.1% were non-Hispanic white, and 70.8% were non-rural residents; 57.5% qualified for Medicaid due to disability.
Long-term stimulant-opioid use was significantly higher in white patients (aPRR 0.93 for black patients, aPRR 0.97 for “other” patients), as well as in those residing in the South (aPRR 0.98 for the Midwest, aPRR 0.94 for the Northeast, aPRR 0.95 for the West).
Concomitant use increased with age. Compared with those ages 20-30, patients 31-40 years of age used both types of drugs more frequently (aPRR 1.07). Patients ages 41-50 and 51-64 exhibited even higher rates (aPRR 1.14 and aPRR 1.17, respectively).
“Our study contributes to the understanding of the potential risk factors associated with long-term concurrent stimulant-opioid use among adults with ADHD,” the authors wrote. “Identifying these high-risk patients allows for early intervention and may reduce the number of adverse events associated with the long-term use of these medications.”
The authors reported several limitations. First, the MAX data excluded patients paying for prescriptions with cash or illicitly, as well as ADHD patients who did not seek medical care. Second, the data did not provide context on whether or not ADHD patients were using opioids for their intended use, which may lead to underestimated results. Lastly, since the study’s conclusion in 2010, several efforts have been made to educate physicians and reduce opioid prescriptions, changes that would not be reflected in this data set.
No disclosures were reported.

Could a glaucoma drug also fight obesity?


Scientists have examined many ways to “beige” unhealthy white fat, turning it into energy-burning brown fat to fight obesity. But what if we could stop fat from entering body tissues in the first place? Researchers at Yale University believe they’ve found a target for preventing fat uptake at the point of entry, and a new class of glaucoma drugs that could help accomplish that feat.
Once consumed, dietary fats are carried by little packets known as chylomicrons from the digestive system to the bloodstream. Those chylomicrons are absorbed into the body’s cells through lymphatic vessels called lacteals. The team found that if they narrowed lacteal junctions, they could stop chylomicrons from entering tissues.
Previous studies had shown that inhibiting production of vascular endothelial growth factor A (VEGF-A)—a protein known to stimulate the formation of blood vessels—can block the growth of lacteals. That appeared to limit fat uptake, but the exact mechanism was not clear.

The Yale study involved mice that normally express two VEGF-A receptors called FLT1 and NRP1, said lead author Feng Zhang, Ph.D., a scientist with the Yale Cardiovascular Research Center, in an interview with FierceBiotechResearch. The team genetically modified the mice to delete FLT1 and NRP1 in endothelial cells and fed them a high-fat diet for eight weeks. Mice that had the receptors disabled didn’t gain weight, while normal mice doubled in weight, the researchers reported in their paper, which was published in Science.
What exactly happened with those receptors knockout mice? Normally, lacteals have button-like gaps along the lining, through which chylomicrons can slip into the surrounding tissues. However, in the engineered mice, the gaps turned into narrower, zipper-shaped openings, which made it hard for fat-carrying chylomicrons to pass through.
“We show that FLT1 and NRP1 are decoy factors of VEGF-A signaling. When we remove the two receptors, VEGF-A signaling is over-activated,” Zhang said. Therefore, he believes VEGF-A signaling activating agents would achieve the same results. What’s more, the team found an inhibitor of Rho kinase (ROCK) can also induce lacteal junction zippering and prevent fat absorption.
ROCK inhibition is a well-established treatment path for glaucoma. Last December, Aerie Pharmaceuticals’ Rhopressa became the first FDA-approved ROCK inhibitor to treat that disease.

Many recent studies have focused on treating obesity by lowering levels of unhealthy white fat and increasing brown fat. Researchers at American University discovered a reservoir of dormant stem cells in the body that could transform into healthy fat, for example. Another team from American University and the University of Michigan identified a signaling pathway called CHRNA2 that helps turn white fat into brown fat, and they found that nicotine can promote the process.
But Zhang and collaborators now suggest that lacteal could be a target for future obesity therapies, especially because there are already drugs on the market targeting key players like ROCK. “Based on our results, we believe that such drugs should be tested for effects on lipid absorption and weight loss,” Zhang said.

Alnylam Gets Landmark FDA OK For First-Ever RNAi Drug


The FDA has just approved Alnylam’s patisiran (Onpattro), making it the first medicine specifically cleared to treat a rare and deadly disease called hereditary transthyretin amyloidosis (hATTR). The decision is a scientific milestone too: it marks the first-ever approval for a medicine that uses RNA interference (RNAi), a method cells can use to silence a gene before it makes a harmful protein. The FDA’s approval is specifically for the treatment of the peripheral nerve damage suffered by hATTR patients. The agency’s press release doesn’t mention the heart problems patients also often deal with.
Alnylam’s triumph, however, doesn’t guarantee a big revenue surge from sales of the company’s first product. The class of U.S. patients who can now be treated with patisiran is unknown; it remains to be seen whether insurers will cover the cost; and a competing company’s similar drug could be approved in the U.S. soon.
Nonetheless, patisiran’s approval is a noteworthy scientific achievement. It is the culmination of nearly two decades of scientific work that began when scientists Andrew Fire and Craig Mello discovered RNAi 20 years ago. They won a Nobel Prize for their discovery in 2006.
Since 2002, Alnylam, the RNAi field’s biggest company, has tried to use the method to make drugs, undergoing a series of ups and downs, clinical setbacks, and more before getting patisiran to the finish line.
It took years to figure out how to deliver large RNA molecules safely and effectively into cells, and pharmaceutical companies fell in and out of love with RNAi along the way. But Alnylam has survived, in large part, because of early partnerships that left it with enough cash to weather the storm.
After burning through almost $2.4 billion, SEC filings show, the company is now a commercial business with a product soon to be on the market. Three other Alnylam RNAi medicines for hemophilia, high cholesterol, and acute hepatic porphyria (a rare liver disease) are in late-stage testing.
“After 16 years, tireless perseverance through near-death moments, billions of dollars in investment, we’ve finally succeeded in advancing RNAi therapeutics as a whole new class of innovative medicines,” said CEO John Maraganore (pictured) in an e-mail to Xconomy. “What matters most? The difference we can now make in the lives of patients with hATTR amyloidosis.”
hATTR is estimated to affect 50,000 people worldwide. People who have the disease make a mutated version of the protein transthyretin (TTR), which builds up in misfolded clumps, causing damage to a variety of tissues around the body. Some patients suffer just the nerve damage, which starts with numbness in the toes, then feet, and moves upwards. Others suffer a corrosion of the heart’s wiring that can lead to heart failure and death. Most patients have elements of both issues.
The only treatments to date in the U.S. are liver transplants or diflunisal, a generic anti-inflammatory drug used off-label to “stabilize” the TTR protein and slow the progressive nerve damage. But liver transplants are risky, tough to get, and don’t always work. And diflunisal can cause stomach or kidney problems, so it isn’t for everyone.
The treatment paradigm for hATTR is now being upended, however. With the arrival of patisiran and a rival, similar-type drug, inotersen, from Akcea Therapeutics (NASDAQ: AKCA), new drugs are emerging that could give patients the chance to halt the progression of their nerve damage—and in some cases, improve nerve function. European regulators approved inotersen in July and the FDA could approve it by Oct. 6. Patisiran is currently under review in Europe.
Then there’s tafamidis (Vyndaqel), a Pfizer drug which is similar to diflunisal and is approved in Europe but not in the U.S. Pfizer (NYSE: PFE) could soon file for approval for hATTR patients with heart problems, and detailed results from a Phase 3 study are expected later this month. Those results, and whether the FDA ultimately approves tafamidis—it rejected the drug several years ago—could affect the commercial potential of both patisiran and inotersen.
Last week, Xconomy delved into the impact patisiran’s approval could have on patients, clinicians, and payers, and the questions and challenges ahead. It’s unclear how long patisiran and inotersen’s benefits will hold up, who will respond, or whether any safety problems will crop up over time. There is also little information about the impact the drugs have on cardiac symptoms—like thickening of the heart tissue—that can kill patients more quickly. All of which could play into how insurers cover the drugs, how physicians prescribe them, and who might be able to access them.
Clinical trials have different designs and circumstances, so comparing one drug to the other is fraught with caveats. But the biggest differences between the two drugs is how they are administered, and their side effects. Alnylam’s drug is given via infusion at a clinic once every three weeks and patients are given precautionary analgesics and corticosteroids before each dose. Inotersen is a twice-weekly self-administered subcutaneous injection. Alnylam has touted patisiran’s safety profile, while worrisome kidney problems and dangerously low platelet counts have cropped up in clinical studies of inotersen—meaning patients will likely require frequent monitoring.