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Thursday, September 27, 2018

Autolus Therapeutics: UK biotech raises bumper $2 billion, despite Brexit blues


Britain’s biotechnology industry has raised a bumper 1.56 billion pounds in the first eight months of this year, surpassing the 1.2 billion reached in the whole of 2017, despite anxiety in the sector about the fallout from Brexit.

The increase has been fuelled by recent changes to venture capital tax incentives, according to UK BioIndustry Association (BIA) CEO Steve Bates, as well as global investor enthusiasm for drug discoveries emanating from biotech labs.
Data published by the BIA and Informa Pharma Intelligence on Friday showed venture capital accounted for 927 million pounds of this year’s tally, with initial public offerings (IPOs) adding 228 million and other public financings 408 million.
Big venture rounds included 115 million pounds raised for Orchard Therapeutics, which bought GlaxoSmithKline rare disease gene therapy drugs, while cell therapy specialist Autolus banked 132 million pounds in a Nasdaq IPO.
Britain’s decision to leave the European Union is a worry for the life sciences sector, given uncertainty about future medicines regulation and concerns over access to top scientific talent.
The growing threat of a “no-deal” Brexit has led to warnings about possible disruption to drug supplies, prompting the government to ask companies to build an additional six weeks of medicine stockpiles.

Lilly says FDA has approved new migraine drug Emgality


Eli Lilly and Company [s:lly] said late Thursday that the U.S. Food and Drug Administration has approved its drug Emgality for the preventive treatment of migraine in adults. Emgality is delivered via a once-a-month, self-administered, subcutaneous injection. Lilly said the drug, one of three in a new class of drugs recently approved for migraines, will be available to patients shortly after approval. Patients with commercial insurance will be candidates to receive Emgality for up to 12 months free as part of Lilly’s patient-support program, the company said. Lilly also said Emgality will be available for pickup at retail pharmacies. The drug maker said the efficacy and safety of Emgality was demonstrated in two Phase 3 clinical trials in patients with episodic migraine and one Phase 3 clinical trial in patients with chronic migraine.

Powell: ‘Our uniquely expensive healthcare’ system will catch up with us


The Federal Reserve may primarily deal with monetary policy and financial regulation, but Fed Chair Jerome Powell called out the U.S. healthcare system that’s contributing to a ballooning federal budget deficit during the Fed meeting press conference on Wednesday.
“It’s no secret: It’s been true for a long time that with our uniquely expensive healthcare delivery system and the aging of our population, we’ve been on an unsustainable fiscal path for a long time,” Powell said while answering a question by Yahoo Finance’s Myles Udland. “And there’s no hiding from it.”
Federal spending on health care (mostly Medicare and Medicaid) has risen from 14.4% of all federal outlays in 1990 to about 31% in 2018 — one of the main reasons the national debt is $21.5 trillion and growing. And the amount of money Americans spend on health care is likely to rise by about 5.5% per year for the next several years, according to government projections on health spending through 2026.
Federal Reserve Chairman Jerome Powell speaks during a news conference in Washington, Wednesday, Sept. 26, 2018. REUTERS/Al Drago
Comments like Powell’s are not something people at the Fed take lightly, as the agency has traditionally been careful to avoid overstepping its bounds. In his answer, Powell prefaced his comments on healthcare by noting that the Fed will continue to take this approach and “stay in [its] lane.”
“We don’t have responsibility for fiscal policy. But in the longer run, fiscal policy will have a significant effect on the economy,” said Powell. “So for that reason, my predecessors have commented on fiscal policy, but have commented at a high level, rather than get involved in particular measures.”
Powell has expressed concerns about unsustainable deficits before. At a symposium sponsored by the Federal Reserve Bank of Kansas City, the Chair expressed concernover the shrinking tax-base/larger-entitlement situation that comes from an aging population.
At Wednesday’s press conference, the Chair doubled down on these words and made a gentle recommendation to deal with the problem.
“In the end, we will have to face [the unsustainable path] and the sooner the better,” he said. “Also these are good times. This is the economy at nearly full employment. Interest rates are low — it’s a good time to be addressing these things. I just put that out there and leave it at that.”

More Evidence that Screening Cuts Lung Cancer Deaths


Lung cancer mortality decreased by 26% in high-risk men and by as much as 61% in women who had screening chest CT scans, a large randomized European study called NELSON showed.
The trial showed a consistent reduction in lung cancer mortality of 24%-26% in screened versus unscreened men after 8-10 years of follow-up, whereas screening in the small group of women enrolled in the trial led to relative risk reductions of 40%-60%.
A difference in lung cancer mortality favoring the screened group became apparent within the first few years and persisted throughout the study, Harry J. de Koning, MD, PhD, of Erasmus Medical Center in Rotterdam, The Netherlands, reported here at the World Conference on Lung Cancer.
The study confirmed the benefits of lung cancer screening in high-risk individuals, first demonstrated in the landmark National Lung Screening Trial (NLST), and showed even larger reductions in lung cancer mortality.
“These results are more favorable than the NLST results and suggest gender differences,” said de Koning. “Volume CT lung cancer screening of high-risk former and current smokers results in low referral rates and a very substantial reduction in lung cancer mortality in both genders.”
The findings should have an immediate impact on existing screening programs and demonstration projects, said invited discussant John Fields, PhD, of the University of Liverpool in England. Current screening protocols should be reevaluated, as should existing recruitment strategies for men and women. Additionally, clinical trials should be integrated into lung cancer screening programs and include protocol-specified, personalized postsurgical interventions.
“There is now conclusive evidence for implementation of lung cancer screening based on two large randomized controlled trials,” said Fields.
Published in 2011, the NLST provided the first — and until now, the only — evidence that screening high-risk individuals can reduce the risk of dying of lung cancer. Involving more than 50,000 participants (59% men), the trial showed 20% reduction in lung cancer mortality in the trial participants randomized to annual screening with low-dose chest CT for 3 years.
Women appeared to derive more benefit from screening than men (relative risk reduction of 27% versus 8%), although a post-hoc analysis failed to show a significant difference in the benefit by sex (P=0.08).
De Koning said the sex difference is consistent with the natural history of lung cancer by histology and that CT screening in women might have increased the lead time for detection more so than in men.
Now Comes NELSON
Investigators in The Netherlands and Belgium designed NELSON as another randomized trial to investigate the potential lung cancer mortality benefits of screening with CT imaging in current and former smokers. Study participants were recruited by questionnaires from population registries. Eligibility included age 50-74, smoking history >10 cigarettes a day for >30 years or >15 cigarettes a day for >25 years, and smoking cessation within the past 10 years.
The randomized population consisted of 15,792 participants, 84% of whom were men. The screened and unscreened groups were balanced with respect to age, sex ratio, smoking history, and smoking cessation. Participants assigned to screening had chest CT imaging during the first and second years of the trial then at 4 and 6.5 years. Follow-up continued to year 10. Compliance with screening was 95.6% in year 1, 92.3% in year 2, 87.6% in year 5, and 66.8% with the last screen.
The trial protocol included centralized reading of CT image, monitoring of lung nodule volume and nodule doubling time, centralized adjudication of causes of death, and follow-up through national registries. Initially planned as a trial for high-risk men, the trial had statistical power to detect a 25% reduction in lung cancer mortality 10 years after randomization.
A total of 27,053 screening CT exams produced 2,503 (9.3%) indeterminate test results, 598 (2.2%) positive results, and 243 (0.9%) lung cancer detections. Comparing positive CT results with confirmed lung cancer detection, de Koning said the screening had a 41% positive predictive value.
Participants who had indeterminate screening results were told that an abnormality of uncertain significance had been identified and that they should return in 3 to 4 months for a follow-up CT scan to determine whether the abnormality had changed.
During follow-up to year 10, the screened group had about 400 lung cancers diagnosed versus about 350 in the control arm. Half the cancers in the screening arm were stage Ia at diagnosis, and 65%-70% were stages Ia-II. In contrast, about 70% of cancers in the control arm were stage III/IV at diagnosis.
De Koning reported that 214 patients in the control arm died of lung cancer, as compared with 147 in the screened group. The lung cancer mortality rate ratio for men in the screened versus unscreened arms was 0.75 at 8 years (95% CI 0.59-0.95, P=0.015), 0.76 at 9 years (95% CI 0.60-0.95, P=0.012), and 0.74 at 10 years (95% CI 0.60-0.91, P=0.003). Corresponding rates for women were 0.39 (95% CI 0.18-0.78, P=0.0037), 0.47 (95% CI 0.25-0.84, P=0.0069), and 0.61 (95% CI 0.35-1.04, P=0.0543).
The overall rate reduction for men was 0.74 (95% CI 0.60-0.91).
Roche Diagnostics and Perceptronix provided support for laboratory studies, and Siemens Germany provided workstations for uniform nodule assessment software. De Koning and co-investigators did not report any relationships with industry.

U.S. judge dismisses Teva lawsuits against Lilly on migraine drug


A federal judge on Thursday dismissed a pair of patent infringement lawsuits by Teva Pharmaceutical Industries Ltd that sought to block Eli Lilly and Co from bringing its migraine drug Emgality to market in the United States.
U.S. District Judge Allison Burroughs in Boston said the lawsuits failed to raise an actual controversy that would allow her to rule in advance of the U.S. Food and Drug Administration’s approving Lilly’s product on whether it infringed Teva’s patents.
The FDA approved Teva’s own migraine drug, Ajovy, on Sept. 14.

Globus Medical ‘top pick’ among spine names at NASS, says Piper Jaffray


Piper Jaffray analyst Matt O’Brien kept his Overweight rating and $58 price target on Globus Medical as part of his broader research note on the companies participating in the North American Spine Society, or NASS, Annual Meeting, saying it is his “top pick”. The analyst says its Excelsius robotic system sales should go higher and possibly above expectations given the “very strong interest” shown by the practitioners at the meeting, adding that the management has been “surprised” by the pullthrough of its sales efforts into “competitive accounts”.
https://thefly.com/landingPageNews.php?id=2796821

3 big waves reshaping investment strategies in early-stage biotech


We are at a time in life sciences when significant strides are being made to solve some of the most complex medical challenges. Rapid advancements in science and technology coupled with abundant capital are leading to new investment strategies that may permanently change how companies at the cutting edge of drug development are funded.
Let’s take a step back. For years, early-stage investors and drug development companies faced impossibly high fundraising hurdles, hampered by the high cost of capital, low clinical success rates and a long regulatory process that might stretch years.
Now, this is all changing. Biopharma investing overall is on pace to reach new heights in 2018. In particular, biopharma Series A investments are exploding; by mid-year 2018, these have already exceeded full-year 2017 totals. Some early-stage companies are now attracting investments at levels once seen only in later-stage deals.

Move to portfolio-style investing
What is driving this shift in investor confidence and fueling new biopharma company creation? Forward-thinking investors and entrepreneurs are looking at early-stage drug development opportunities from a mutual fund perspective. Their goal is to increase the odds of a large return from a single successful drug investment, while reducing the typically high risk of a single early-stage investment. They achieve this by building and investing in a portfolio of drug development assets that, when pooled, carry a lower correlation of risk and a high-enough probability that at least one will reach clinical and regulatory success. The odds are improved by that fact that lifesaving advances are being made to unlock mechanisms underlying many specific diseases, leading to more effective treatments.
While this new model remains capital-intensive, it works to spread the risk and, by extension, provides a more predictable pattern for returns. As a result, private equity and deep-pocketed investors now have more confidence in early-stage biopharma — in a few cases enough that some portfolio assets are being spun out as independent companies.
This shift in early-stage biopharma investing, in fact, has evolved in three waves.

First wave: Spin off a single asset
In the first wave, exemplified by Adimab and Nimbus Therapeutics, smaller companies directly took on the risks of drug discovery. For example, Adimab launched as an LLC with no clear intention of ever exiting as a whole company, an event that traditionally would have led to a big lump-sum payday for investors. Instead, Adimab’s business model centered on de-risking the earliest stages of drug discovery for larger biopharma and profiting from the overall decreased uncertainty. This provided investors with a somewhat predictable dividend stream from regular asset-licensing deals, and the large biopharma asset purchaser with a source of less risky assets. Still, the larger biopharma company had to move early to acquire the asset, and as a result assumed a relatively high risk of failure. Without transferring all the risk, the investors were left with some constraints that limited their returns.
Second wave: Build to buy
The next wave took the concept a step further. Instead of developing a single drug candidate, “build-to-buy” companies were established around each asset and spun out as new companies. Versant Ventures’ Inception Sciences, a drug discovery incubator that spawned young companies, and orphan drug company Dauntless Pharmaceuticals are prime examples. Very early on, they partnered with a big biopharma company that gained the exclusive acquisition rights at preset terms. However, early-stage investors had to take a smaller return on their investments to compensate for the lower risk associated with a predefined exit. On the flipside, strategic partners were willing to pay slightly more than normal because they were acquiring more-mature assets, often with scientific teams in place to help bring the drug candidates to the finish line, instead of having to dedicate their own R&D staff.
Third wave: Portfolio-theory approach
Now, investors are experimenting with a full portfolio-theory approach, which is partially based on an investor theory called “research-backed obligations,” developed by economics professors Andrew W. Lo and Roger Stein of the Massachusetts Institute of Technology. Most investors are familiar with the concept, known as portfolio investing. It works like this: The goal is to own a controlling interest in a large number of high-risk, potentially high-return early-stage companies built around single assets. The idea is to spread the risk across a large enough number of companies that the binary risk of failure is reduced, in the hopes that one company will significantly outperform.
To do this today in biopharma, an investing entity needs massive sums of capital, which in the past was targeted only to late-stage companies. As a result, the pioneers in portfolio investing with early-stage companies have very deep-pockets. For example, BridgeBio is backed by private equity firms KKR, Viking Global Investors and Perceptive Advisors. BridgeBio has funded subsidiary companies working on a variety of drugs to treat everything from skin conditions to inherited heart disorders, most of which are early-stage. In these cases, the investors may be prepared to take a loss of tens of millions of dollars in the short term with the expectation that clinical breakthroughs will lead to at least some of these bets paying big returns in the end.
The future of biopharma investing
Other companies are applying a portfolio-theory approach to biopharma R&D with a broader strategy beyond pre-clinical R&D. Velocity Pharmaceutical Development (VPD), for example, is based on investing in underfunded or shelved drugs. VPD established a “project-focused company” around the asset. Similarly, Roivant Sciences, which incubates and launches new subsidiaries known as “Vants,” is pooling assets and has attracted some massive investments. As its first biopharma investment in August 2017, SoftBank Vision Fund made a $1.1 billion investment in Roivant Sciences, not its subsidiaries. Mereo BioPharma Group is another portfolio play that keeps development of clinical-phase assets under a single entity.
Looking ahead, as the portfolio-theory approach evolves we envision large pools of low-correlation risk assets combined with a more predictable financial return model, attracting huge new sources of capital from investors, even retail investors. This has the promise of fueling new drug development at earlier stages and solving medical challenges faster. These models also lend themselves to very sophisticated capital enhancements, such as leverage and securitization. We could be at the very beginning of a new investing strategy that may lead to major disruptions in traditional scientific investing as we know it.
Jennifer Friel Goldstein, BSE, MB, MBA, is the head of Silicon Valley Bank’s West Coast life science and healthcare practice. Andrew Olson, PhD, is a senior manager leading market research in support of Silicon Valley Bank’s life science practice.