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Wednesday, December 4, 2019

Anavex up on long-term blarcamesine data in Alzheimer’s

Anavex Life Sciences (NASDAQ:AVXL) is up 7% premarket on average volume on the heels of two-year data from a Phase 2a extension study evaluating Anavex 2-73 (blarcamesine) in patients with mild-to-moderate Alzheimer’s disease. The results are being presented at the Clinical Trials on Alzheimer’s Disease Conference in San Diego.
At week 104, patients receiving blarcamesine experienced a lower decline (-1.1) in MMSE score (Alzheimer’s scale) compared to the control cohort (-4.4) from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database (p<0.01).
Phase 2b/3 study in early Alzheimer’s patients is in process. The primary endpoints are the changes from baseline in two scales, ADAS-Cog and ADCS-ADL, at week 48 compared to placebo. The estimated primary completion date is September 2021.

Analyst action, Dec. 4

CNS Pharmaceuticals (NASDAQ:CNSP) initiated with Speculative Buy rating at Benchmark.
Proteostasis Therapeutics (NASDAQ:PTI) resumed with Overweight rating and $8 (203% upside) price target at Cantor Fitzgerald. Shares up 3% premarket.
SpringWorks Therapeutics (NASDAQ:SWTX) initiated with Buy rating and $33 (27% upside) price target at H.C. Wainwright.
STAAR Surgical Company (NASDAQ:STAA) initiated with Buy rating and $46 (25% upside) price target at BTIG Research.
Cidara Therapeutics (NASDAQ:CDTX) upgraded to Buy at WBB Securities.
Zimmer Biomet Holdings (NYSE:ZBH) upgraded to Strong Buy with a $170 (19% upside) price target at Raymond James. Shares up 1% premarket.
ViewRay (NASDAQ:VRAY) downgraded to Neutral with a $199 price target at Compass Point. Shares down 6% premarket in response to its equity offering.

TransMedics up on positive heart system news

Thinly traded micro cap TransMedics Group (NASDAQ:TMDX) perks up 3% premarket on light volume on the heels of its announcement of the first successful heart transplants from DCD (donation after circulatory death) donors in the U.S. enabled by its OCS Heart System.
The device is used to resuscitate the donor heart to a normal beating rate before transplantation (based on a clinical assessment at that time).
Heretofore, DCD donors are not considered viable transplant candidates due to the potential injury to the heart once beating ceases.

Zealand Pharma up 6% on dasiglucagon developments

Ultra-thinly traded Zealand Pharma (ZEAL +6.3%) is up, albeit on turnover of only 3,200 shares, in apparent reaction to dasiglucagon-related news, in late-stage development for severe hypoglycemia (low blood sugar).
Earlier today the company announced a second Phase 3 study in children with congenital hyperinsulinism (CHI), an inherited disorder that causes hypoglycemia due to excess amounts of insulin secreted by the pancreas.
It also announced that the FDA has granted Rare Pediatric Disease designation to the glucagon analog for CHI which provides for the issuance of a rare pediatric disease priority review voucher following the agency’s nod. The voucher can be used for accelerated approval of a future application or it can be sold to a third party.
Shares rose 8% in Copenhagen today closing at DKK220.0.

Tandem down 7% on expected headwinds before Control-IQ approval

Tandem Diabetes Care (TNDM -6.9%) slumps on average volume on the heels of its presentation at the Piper Jaffray Healthcare Conference today.
Investors appear to be reacting to a temporary slowdown in business as U.S. customers wait for the FDA nod on Control-IQ, expected in the near future. The company said that it saw a slowdown in late Q3 that will extend through almost all of Q4. About 105K U.S. patients currently use their pump and 80% of those can be updated to Control-IQ (company plans to offer the update at no charge).
There is also looming competition from a new Medtronic device, expected about mid-2020.
U.S. market for insulin pumps currently 30% penetrated compared to 24% ~15 years ago (analyst comment) but the company envisions 50% penetration in the next 3-5 years driven primarily by much improved ease of use.
The company’s income is ~$4K per pump in the U.S. versus ~$2K in Europe (due to broader range of distributor responsibilities there).
Agreement with Abbott should be finalized shortly. May be about a year before commercialization begins on Libre 2.0 device. Meaningful revenue expected no earlier than 2021.

Gilead’s converting Truvada PrEP users to Descovy faster than expected: analyst

One big task for Gilead Sciences’ HIV franchise in the coming year is to save some $2.5 billion in annual sales by switching as many PrEP patients as possible from Truvada to newly approved Descovy before generics hit.
So far, the company’s doing a good job.
In just two months since the FDA approved Descovy to prevent HIV, Gilead has converted about 10% of Truvada patients to the new drug, a Jefferies team led by analyst Michael Yee noted in a Friday report based on IQVIA scripts data.
For the week ended Nov. 22, Descovy’s total U.S. prescriptions hit 19,295—up about 4,000 from the week ended Oct. 11, the first after its FDA go-ahead. During the same period, Truvada scripts per week dropped by around 3,000 from between 34,000 and 35,000.
At that rate, Gilead could switch about 50% to 60% of PrEP users off Truvada by the time Teva launches its copycat in September 2020, Yee estimates. That’s well ahead of the 35% Wall Street currently expects.
Yee’s team also mapped out a scenario in which all Truvada scripts were transferred at a steady weekly rate to Descovy by Teva’s anticipated launch date, and it found that Descovy is tracking even faster than that. But of course, 100% conversion is almost impossible, and Yee attributed some of Descovy’s growth to organic expansion beyond Truvada switch-overs. Some of that is coming from tandem use with ViiV Healthcare’s Tivicay (dolutgravir) for the treatment of HIV, rather than prevention.
A recent Jefferies doctor survey also suggested the Truvada-Descovy swap would go slower than the HIV treatment switchover from TDF-to-TAF-based regimens, which now stands at about 75%. The difference between Descovy and Truvada is that, besides the shared component of emtricitabine, the newer drug uses tenofovir alafenamide (TAF), which is generally considered a safer option than the tenofovir disoproxil fumarate (TDF) used in the latter.

Gilead’s playing up that advantage in convincing doctors and patients to use the new version. The Big Biotech recently detailed data from the phase 3 Discover trial, showing significantly better bone mineral density and renal safety outcomes for Descovy patients than for those on Truvada.
The company knows what’s at stake: about $2.6 billion in Truvada annual sales is on the line. With that in mind, it has bulked up Descovy’s rep ranks, moving many sales reps off a cardiopulmonary portfolio that’s been hit by generics and retraining them to detail Descovy, Gilead’s chief commercial officer, Johanna Mercier, told investors on a conference call in October.
Mercier noted that over half of PrEP scripts are “very concentrated,” coming from a couple of thousand specialists who are also treating HIV patients. These docs have been Gilead’s initial target for the Descovy swap because they “have experienced converting from TDF to TAF and also understand the value of Descovy and its clinical profile specifically around the safety with bone and renal,” she said.

Blockbuster in the balance: Celgene Reblozyl faces FDA panel

In its final days as an independent company, Celgene scored a win last month with the FDA’s approval of rare blood disease med Reblozyl––a potential blockbuster in some analysts’ eyes. Now, the FDA wants a closer look at Reblozyl as a treatment for a group of rare blood cancers.
An FDA advisory committee will review Reblozyl on Dec. 18 to treat patients with myelodysplastic syndromes (MDS), a suite of rare blood cancers in which mutations prevent bone marrow stem cells from making healthy blood cells, leading to chronic anemia.
“Anemia associated with MDS remains a significant area of unmet need for these patients, as current treatment options are limited, consisting primarily of medicines that stimulate the production of erythropoietin and regular RBC transfusions,” new Celgene owner Bristol-Myers Squibb said in a statement.
The FDA set an action date on Reblozyl’s application for April 4. Bristol didn’t disclose what data the FDA was set to review at the advisory committee meeting.
If Reblozly wins an MDS nod, it could reach a $2 billion in yearly sales, according to Jefferies analysts.
In early November, the FDA approved Reblozyl (luspatercept) as an anemia treatment in patients with beta thalassemia who require regular red blood cell transfusions. Though these transfusions are a lifesaving treatment, they can eventually lead to iron overload that can cause organ failure and shorten a patient’s life span.
Reblozyl, co-developed with Cambridge, Massachusetts-based biotech Acceleron, became the first FDA-approved treatment for anemia in beta thalassemia. However, the drug came with label warnings for blood clots, hypertension and embryo-fetal toxicity, the company said.
Serious side effects, including cerebrovascular accidents and deep vein thrombosis, were reported in 1% of trial patients, and one patient reportedly died during clinical testing due to an unconfirmed case of acute myeloid leukemia, Celgene said.
Reblozyl’s win closely followed an FDA approval for Celgene’s JAK inhibitor Inrebic (fedratinib) in August as a first-line or follow-up treatment for myelofibrosis. The once-daily oral drug became the first new treatment in nearly a decade approved to treat the disease, Celgene said.
Inrebic hit the market with a black box warning for serious and fatal encephalopathy, including Wernicke’s. The drugmaker said serious encephalopathy was reported in 1.3% of trial patients treated with Inrebic and one of those patients died.

Both approvals were major wins for Bristol, which is now in the clear on its Celgene merger after the Federal Trade Commission (FTC) voted 3-2 in mid-November to approve the transaction pending the offloading of Celgene psoriasis med Otezla.
Bristol touted Celgene’s “Big 5” late-stage drug candidates––including Reblozly and Inrebic––as major drivers of the merger, with peak sales estimates of more than $5 billion per year. The rest of the list includes multiple sclerosis hopeful ozanimod, which had its application picked up by the FDA in June, and a pair of CAR-T therapies: bluebird bio-partnered bb2121 for multiple myeloma and lisocabtagene maraleucel (liso-cel), formerly called JCAR017, the blood cancer treatment Celgene picked up in its $9 billion Juno Therapeutics buyout.