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Thursday, June 25, 2020

Bristol Myers says Celgene buyout could supercharge sales to $20B

We already knew from data, FDA filings and approvals that Bristol Myers Squibb’s $74 billion bet on Celgene was beginning to pay off. Now, the Big Pharma is telling us by just how much.
In the first of a series of online meetings that started on Monday, the company upped its forecast of annual sales from its late-stage pipeline from $15 billion to $20 billion, starting in the second half of the decade. Of the eight near-term launches expected to rake that sum in, six products were picked up from Celgene.
Two of those—JAK inhibitor Inrebic and anemia med Reblozyl—scored the FDA nod before the megamerger closed. The agency cleared Zeposia for relapsing multiple sclerosis in March this year, but BMS decided to delay its rollout thanks to the COVID-19 pandemic.
As for the other three, CAR-T therapy lisocabtagene maraleucel, or liso-cel, is under FDA review for relapsed or refractory B-cell lymphoma with a decision expected by Nov. 16. Earlier this year, it had snagged a speedy review with an August decision date, but the FDA added three months to the timeline with a request for additional information.

The agency is expected to decide the fate of CC-486, a firstline maintenance therapy for acute myeloid leukemia, by Sept. 3. Finally, BMS plans to file idecabtagene vicleucel, or ide-cel, its bluebird-partnered CAR-T, for approval by the end of July. The Monday presentation focused on oncology, but the company will hold more meetings to cover its hematology and fibrosis pipelines.
Beyond these approved and late-stage programs, the drugmaker highlighted other oncology assets, notably relatlimab, a LAG-3 inhibitor that could boost the effects of its PD-1 med Opdivo, and bempegaldesleukin, or bempeg, a pegylated IL-2 that could do the same.
LAG-3 expression is linked to T-cell exhaustion, which help tumors resist PD-1 blockade. BMS is testing relatlimab in a phase 2/3 study in metastatic melanoma to see if adding it to Opdivo could help patients whose T cells are too tired to fight cancer.
As for Nektar-partnered bempeg, the IL-2 med is in registrational studies in multiple cancers, including melanoma, kidney cancer and bladder cancer, to see if it can boost Opdivo.
BMS counts 19 cancer assets in its early-stage pipeline, along with 15 in hematology, nine in immunology, and five each in cardiovascular disease and fibrosis. It’s particularly excited about a BCMA T-cell engager, which read out its first clinical results last year, and eventually, working on next-generation CAR-T therapies. That includes developing allogeneic, or off-the-shelf, CAR-Ts, treatments that target two antigens instead of just one, and CAR-Ts that carry armed payloads so they’re better equipped to overcome resistance in the tumor microenvironment.


Covid may have infected 10 times more Americans than reported – CDC

Government experts believe more than 20 million Americans could have contracted the coronavirus, 10 times more than official counts, indicating many people without symptoms have or have had the disease, senior administration officials said.
The estimate, from the Centers for Disease Control and Prevention, is based on serology testing used to determine the presence of antibodies that show whether an individual has had the disease, the officials said.
The officials, speaking to a small group of reporters on Wednesday night, said the estimate was based on the number of known cases, between 2.3 million and 2.4 million, multiplied by the average rate of antibodies seen from the serology tests, about an average of 10 to 1.
“If you multiply the cases by that ratio, that’s where you get that 20 million figure,” said one official.
If true, the estimate would suggest the percentage of U.S. deaths from the disease is lower than thought. More than 120,000 Americans have died from the disease since the pandemic erupted earlier this year.
The estimate comes as government officials note that many new cases are showing up in young people who do not exhibit symptoms and may not know they have it.
Officials said young people with no symptoms, but who are in regular contact with vulnerable populations, should proactively get tested to make sure they do not spread it.
“We have heard from Florida and Texas that roughly half of the new cases that are reporting are people under the age of 35, and many of them are asymptomatic,” one official said.
The CDC has sent 40 response teams to help deal with the outbreaks, they said.
More than 36,000 new cases of COVID-19 were recorded nationwide on Wednesday, just shy of the record 36,426 on April 24, concentrated on states that were spared the brunt of the initial outbreak or moved early to lift restrictions aimed at curbing the virus’ spread.

IPO on horizon for iTeos Therapeutics

ITeos Therapeutics (ITOS) has filed a preliminary prospectus for a $100M IPO.
The Cambridge, MA-based biopharmaceutical firm leverages its know-how in small molecule and monoclonal antibody development to discover novel cancer candidates that target immunometabolism and immunosuppression in the tumor microenvironment.
Lead small molecule candidate is EOS-850, an antagonist of the adenosine A2a receptor, a protein in a pathway that drives said immunosuppression across a broad range of cancers. An open-label Phase 1/2a clinical trial is in process with preliminary data expected in H1 2021.
Lead antibody candidate is EOS-448 which binds to an immune cell protein receptor called TIGIT, a checkpoint with a role in both inhibitory and stimulatory pathways in the immune system. A Phase 1/2a study was recently launched with preliminary data expected in H1 2021.
2019 Financials: Operating Expenses: $28.0M (+30%); Net Loss: ($22.5M) (-24%); Cash Burn: ($23.1M) (-21%).
TIGIT-related tickers: Roche (OTCQX:RHHBY), Phio Pharmaceuticals (NASDAQ:PHIO), Agenus (NASDAQ:AGEN), Arcus Biosciences (NYSE:RCUS), Bristol Myers Squibb (NYSE:BMY), Merck (NYSE:MRK)


New remdesivir fair price? Below $2,800 if dexamethasone lives up to promise

Nearly two months ago, an influential drug cost watchdog pegged $4,460 as the fair price for Gilead Sciences’ authorized COVID-19 therapy remdesivir. But on coronavirus time, that’s an eternity—and a lot has changed since then.
In an updated assessment published Wednesday, the Institute for Clinical and Economic Review (ICER) slightly dialed up its cost-effective price for remdesivir to a range of $4,580 to $5,080 based on detailed clinical data, updated cost estimates and interactions with Gilead.
Three cheers for the Big Biotech? Not so fast.
A recent announcement from U.K. researchers on the successful use of low-cost dexamethasone in a large COVID-19 clinical trial added another wrinkle to the price. That is, if the steroid’s benefits are confirmed in a peer-reviewed paper and therefore qualify it as the new standard of care, remdesivir’s cost should be cut to around $2,520 to $2,800, ICER said.
The new calculus pulls some additional data points into the mix. Once again, it relies on an external study to estimate that the raw materials needed to make remdesivir would cost about $10 for a 10-day course. But ICER also considers generic remdesivir now available in India from local drugmakers Hetero Labs and Cipla. Figures on those meds suggest hard costs for Gilead’s brand at $390 to $780 per treatment.
Meanwhile, Gilead has said it would spend about $1 billion on remdesivir R&D in 2020. Divide that by around 1 million courses ICER assumes Gilead could sell in the first year, and that’s an additional $1,000 to cover. Gilead recently said it’s expected to increase remdesivir supply to 2 million courses this year, though many doses have been committed to donations.
The watchdog combined those figures with detailed data from the National Institutes of Health’s ACTT-1 trial—including adjustments based on the age of patients at hospitalization, updated mortality results and time-to-recovery benefits—to reach its new $4,580-to-$5,080 base-case scenario.
That increase in remdesivir’s cost-effective price would have been good news for Gilead. But findings from the U.K. Recovery trial of dexamethasone add one major uncertainty.
According to results just published on preprint site medRxiv, dexamethasone treatment led to a 35% reduction in death rate among patients on invasive mechanical ventilation and 20% for those receiving oxygen without invasive ventilation.
Because of that showing, clinical experts told ICER that dexamethasone could soon become the new standard of care throughout the U.S., “and that the relative benefits of remdesivir will now be judged to be most pertinent as an adjunct to dexamethasone treatment,” the organization noted in its new analysis. In the ACTT-1 trial, the death rate for remdesivir among severe patients were reduced to 7.7% from 13% for placebo, a difference that was not statistically significant.

As ICER notes, the Recovery data haven’t been peer reviewed yet. But if patients indeed enjoy a significantly lower risk of death thanks to dexamethasone, remdesivir would have a reduced role to play, ICER figures. And that, in turn, would push the cost-effective price for remdesivir down to $2,520 to $2,800.
Now, the ball is back in Gilead’s court. As the initial 1.5 million doses of donated remdeisivr are expected to run out this month, the biotech will soon unveil its commercial pricing strategy in a moment that could define the conversation around pharma reputation for years to come.

Regeneron to fight DOJ lawsuit alleging charity donations were Eylea kickbacks

Like many biopharma companies, Regeneron has been ensnared in a U.S. probe over its charity contributions for several years. But while many drugmakers have already settled allegations their contributions were kickbacks, the New York company is pledging to fight a new lawsuit from federal authorities.
In a lawsuit Wednesday, the U.S. Attorney’s Office for the District of Massachusetts alleged Regeneron gave tens of millions of dollars to a patient foundation that acted as a “conduit” to boost sales. The funds were used to pay Medicare patients’ copays on blockbuster eye medicine Eylea, the DOJ says, but not for rival medications.
“Regeneron allegedly paid these substantial sums only after confirming that the foundation needed the money to cover co-pays only for Eylea, and not for competing drugs, and that the company’s payments would generate a handsome return on investment, or ‘ROI,’ in the form of Medicare payments for Eylea,” U.S. attorney Andrew Lelling said in a statement. “Furthermore, senior company executives allegedly took extensive measures to cover up the scheme.”
Regeneron took a tough stance against the lawsuit—and picked a bone with its timing. It’s “unfortunate that the government chose to bring these baseless allegations related to our 2013 and early 2014 patient assistance donations at a time when Regeneron employees have been coming to work in the epicenter of the COVID-19 pandemic with the goal of providing an effective treatment,” Regeneron’s general counsel Joseph LaRosa said in a statement.
The company’s donations to “independent charity foundations help elderly patients access medicines that are prescribed by their physicians,” he added.
Regeneron’s decision to defend itself against the allegations comes after many of its peers have decided to settle allegations that charity contributions were kickbacks. Pfizer, Sanofi, Astellas, Amgen, Alexion and United Therapeutics are among the many companies that have settled their allegations amid an industrywide probe that has lasted several years.

Ekso Bionics shares rocket on FDA nod on exoskeleton for brain injury

Ekso Bionics climbs (EKSO +81.6%) is up big in early trade on a whopping 184x surge in volume in reaction to its announcement that the FDA has approved robotic exoskeleton EksoNR for use in patients with acquired brain injury (ABI), the first such device approved for this population.
EksoNR is the next-generation version of the company’s first robotic exoskeleton, approved in 2016 for stroke and spinal cord injury rehabilitation.

Hospitals/device makers under pressure on dim outlook for elective surgeries

June 25, 2020

Certain hospital operators and medical device makers are in the red as investors head for the exits on diminished expectations for a rebound in elective surgeries due to nagging COVID-19 infection rates. Elective procedures are big revenue and profit drivers for hospital chains. Less procedures mean lower product sales for manufacturers.
Selected tickers: Surgery Partners (SGRY -4.3%), SunLink Health Systems (SSY -4.6%), Tenet Healthcare (THC -2.1%), Community Health Systems (CYH -1.3%), HCA Healthcare (HCA -1.7%), Humana (HUM -0.1%), Becton, Dickinson (BDX -2.4%), Stryker (SYK -2.5%), Medtronic (MDT -0.7%), Zimmer Biomet (ZBH -4.3%), Boston Scientific (BSX -1.9%), Intuitive Surgical (ISRG -1.2%)