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Thursday, August 13, 2020

U.S. recruits scientists abroad for Covid vax trials, pledges access to supply

The Trump administration’s coronavirus vaccine project is recruiting scientists in South Africa and Latin America to help test possible vaccines in U.S.- backed clinical trials, pledging to ease their countries’ access to any successful products, Reuters has learned.

Moncef Slaoui, a former pharmaceutical executive who heads Operation Warp Speed, a multi-billion dollar U.S. collaboration between the federal government and drugmakers, made the commitment to international scientists late last month, two people familiar with the matter said.

Researchers in South Africa, Mexico, Brazil, Peru and Argentina are in discussions to join U.S. counterparts in conducting large-scale human trials of an experimental vaccine from Johnson & Johnson (JNJ.N) beginning next month, according to half a dozen government officials and scientists with knowledge of the effort.

The U.S. government so far has committed nearly $11 billion to fund the development, testing, manufacture and stockpiling of hundreds of millions of COVID-19 vaccine doses. In addition to J&J, it is working with drugmakers including Moderna Inc (MRNA.O), Novavax Inc (NVAX.O) and AstraZeneca PLC (AZN.L) to coordinate large-scale, or Phase 3, clinical trials.

Tens of thousands of volunteers must be recruited and scientists involved say it makes sense to test the vaccines for safety and effectiveness in diverse populations, including in other nations. U.S. health officials expect a successful vaccine to be identified by early 2021.

It is not yet clear what specific commitments, if any, have been made to South Africa and the Latin American countries. The advantage of working with Operation Warp Speed, which is backing at least half a dozen potential vaccines, is that it increases the chances that international partners would receive an effective product.

President Donald Trump raised the possibility of sharing the U.S. vaccine supply when he announced the formation of Operation Warp Speed in May, without providing details. Earlier this week, Health and Human Services (HHS) Secretary Alex Azar said that any U.S. vaccine for COVID-19 would be shared “fairly” around the world after U.S. needs are met.

The international scientists gearing up to participate have worked with U.S. vaccine researchers for years and want assurances that their countries would get access to the Operation Warp Speed vaccines.

“There was a concern by the international sites that we are rolling up our sleeves and contributing to the vaccine endeavor, and we don’t want to be in a position that these vaccines will be available and our countries can’t get them,” said Dr. Glenda Gray, the president and CEO of the South African Medical Research Council, who is preparing to set up sites for the vaccine developed by J&J’s Janssen division.

A spokeswoman for HHS, which helps oversee Operation Warp Speed, did not respond to questions about the project’s work with particular countries but confirmed that Slaoui is committed to ensuring international partners get access to vaccines.

In a statement, J&J’s Janssen unit said a number of countries are seeking regulatory approval to run a trial of its vaccine but that it could not confirm individual sites.

“Once proven to be safe and effective, Johnson & Johnson is committed to making its vaccine accessible globally,” the company said.

The U.S. National Institutes of Health, which is helping coordinate the trials, declined to comment. The White House did not immediately respond to questions.

A GLOBAL NEED


Global health agencies have lamented the rush by the United States and other wealthy nations to lock up vaccine doses in advance through direct deals with drugmakers. They say there should be a global distribution of vaccines based on infection risk, and want to make sure poorer nations have access. The coronavirus has infected nearly 21 million people and killed close to 750,000 worldwide.

“Anything short of a global strategy to vaccinate at risk populations is going to be a less effective strategy,” said Stephen Thomas, a vaccine developer who is chief of infectious disease at SUNY Upstate Medical University.

Slaoui has said publicly that between 70 and 75 million people in the United States, including healthcare workers and elderly patients with underlying chronic conditions, are at greatest risk for coronavirus.

He told the scientists late last month that those at-risk groups could be immunized during the first quarter of 2021, the two people familiar with the matter said. After that, he told them, Operation Warp Speed and the companies may arrange for donations or access to vaccine supplies to the countries participating in trials.

The NIH and Operation Warp Speed are considering holding a scientific summit this summer to discuss how any successful COVID-19 vaccines might be distributed, both nationally and globally, the sources said.

Countries like Brazil and Mexico, hot spots for the virus, are not waiting on the U.S. vaccine project for help. They also are forging deals directly with drugmakers that promise to supply vaccines after they run clinical trials.

Multiple pharmaceutical companies and countries, including China, are also courting international partners. South Africa and Brazil, for instance, have developed medical infrastructures for clinical trials. They have a choice of partners and an opportunity to seek vaccine access in return.

“We are a prime site for any vaccine trial,” said Gray, a vaccine scientist renowned for her work on HIV. “There are a lot of countries that are approaching South Africa.” Slideshow (2 Images)

South African scientists are expected to enroll between 10,000 and 12,000 people at about 30 sites for J&J’s Janssen division, Gray said. The trials will receive funding from both J&J and the NIH.

South Africa’s health ministry did not comment.

A FLURRY OF DEALS


With an explosion of coronavirus cases in Latin America, countries there also are announcing deals with drugmakers, some involved in Operation Warp Speed. In addition, they are planning to participate in vaccine research backed by China and other countries.

On Tuesday, Mexico announced it would provide trial sites for vaccines developed by J&J, as well as for Chinese companies CanSino Biologics Inc (6185.HK) and Walvax Biotechnology Co Ltd (300142.SZ).

A major reason behind Mexico’s move to join those trials is to secure access to a vaccine, according to its foreign minister, Marcelo Ebrard..

Brazil medical research institute Fiocruz is in talks to join the J&J trial, Marco Krieger, a vice president at the federally funded institute, told Reuters. He said there had been no assurances yet about vaccine access.

Argentina also plans to be a site for the J&J trial, Pedro Cahn, director of Argentina’s Fundación Huesped, said in an email to Reuters. But when asked if he received specific assurances about supply, he said “not so far.”

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Argentina’s health ministry did not comment.

José Sánchez, coordinator of the biomedical research center at Peru’s National University of San Marcos, said in an interview with the university’s in-house channel on Tuesday that the center was evaluating agreements with J&J, AstraZeneca and Moderna to carry out clinical trials in Peru. Moderna declined to comment.

The center receives funding from the U.S. government and the agreements are being coordinated with Peru’s National Institute of Health (INS), Sánchez said.

“Janssen is definitely going to come to Peru,” Sánchez said.


Three more U.S. states launching coronavirus exposure warning apps

August 13, 2020

North Dakota, Wyoming and Alabama are the latest U.S. states launching apps to warn users about potential exposure to the novel coronavirus by tracking their encounters, representatives for the states told Reuters on Thursday.
Virginia last week became the first U.S. state to urge residents to download such an app using technology developed by smartphone software giants Apple Inc (AAPL.O) and Alphabet Inc’s (GOOGL.O) Google.
About 316,000 people have downloaded Virginia’s app, COVIDWISE, Jeff Stover, a state health department official, told Reuters during an online event hosted by the Responsible Data Foundation as part of a series on pandemic-related technology.
North Dakota launched its app, Care19 Alert, on Thursday and Wyoming will release an app on Friday, Tim Brookins, whose company ProudCrowd developed the apps, also said during the event.
Alabama, which has been testing its app among some university students and staff, plans to begin marketing it statewide on Monday, said Sue Feldman, director of graduate programs in health informatics at University of Alabama at Birmingham.
Washington, which recently tested its app at a hospital, and Pennsylvania are among other states that could formally launch apps in the coming weeks with the Apple-Google technology.
The technology enables phones to exchange Bluetooth signals to keep an anonymous list of close encounters. A user who becomes infected can anonymously notify recent contacts to get tested or quarantine.
But developers acknowledge that they still face challenges in convincing users that the tracking and notification systems are private and reliable.
For instance, getting contact tracing apps from different states to communicate with each other, as users cross borders, is untested with North Dakota’s app now the first and only in the U.S. to support that functionality.

Convalescent plasma players rally on positive results from COVID-19 study

August 13, 2020

Results from a large-scale study involving more than 35K severely ill COVID-19 patients demonstrated that the early administration of convalescent plasma, containing anti-SARS-CoV-2 antibodies from patients who recovered from the infection, lowered the mortality rate.
Data from the Mayo Clinic-run study showed a seven-day death rate of 8.7% in patients who received convalescent plasma within three days of diagnosis compared to 11.9% in those treated after four or more days, a statistically significant difference.
One large caveat, however, was the absence of a placebo group so it cannot be determined how efficacious the treatment was or can be.
Nevertheless, the FDA is on board with continuing the expanded access program before the expected nod for emergency use.
Selected tickers: Kamada (KMDA +11.8%), Grifols (GRFS +0.5%), XBiotech (XBIT +2.7%), Cerus (CERS +1.5%), ADMA Biologics (ADMA +4.0%)

Digital depression therapy offers hope during COVID-19 pandemic

A new digital therapy is aiming to tackle depression during the COVID-19 pandemic, using a brain stimulation headset and therapy app that claims to have similar beneficial effects to drugs but with fewer side-effects.

Flow is the first drug-free at-home treatment of its type to be approved in the EU and UK.

While using the Flow headset, patients engaged with a therapy app program, which offers personalised behavioural therapy in areas proven to reduce symptoms of depression, including nutrition, exercise and sleep. NHS trusts and healthcare professionals can now recommend the Flow app to patients as it was recently added to the ORCHA App Library.

UK clinics, including The Chelsea Psychology Clinic in London, are now offering patients the Flow treatment in combination with traditional therapy options.

In a user analysis, the manufacturer said 81% of 850 patients involved reported feeling better after three weeks of treatment while 34% of patients reported an improvement in their mood.

Meanwhile 32% of patients reported a reduction in anxiety and 29% reported a reduction in suicidal thoughts.

The transcranial direct current stimulation (tDCS) used in the Flow headset has been shown in several clinical randomised controlled trials, including New England Journal of Medicine and the British Journal of Psychiatry, to have a similar impact to antidepressants, but with fewer and less-severe side effects.

The manufacturer said that the tool could be used during the pandemic when home-based treatments are becoming increasingly popular.

Daniel Mansson, clinical psychologist and co-founder of Flow, said: “COVID is changing how depression is managed, and driving a meaningful increase in demand for effective, at-home treatments that are safe, have minimal side effects and do not require a prescription.

“The results in this user analysis are comparable to antidepressants and demonstrate the significant benefits of using Flow to self-manage depression.

“They add to the growing body of medical evidence that supports the use of transcranial direct current stimulation (tDCS) for the treatment of depression.”

The headset can be bought over the internet for £399, which can be split into three payments, and the app is free to download on AppStore and GooglePlay.


ThermoGenesis inks supply agreement for new COVID-19 diagnostic kit

ThermoGenesis (THMO -0.2%) entered into a supply agreement with BioHit Healthcare to market, ThermoGenesis branded SARS-CoV-2 IgM/IgG Antibody Test Kit, which has already received FDA Emergency Use Authorization (EUA).

The Company simultaneously withdrew its own EUA submission for the previously announced SARS-CoV-2 antibody Fast Detection Kit (Colloidal Gold).

The new branded antibody test kit is expected to initiate marketing from Monday.


Neogen’s BioSentry 904 disinfectant effective against SARS-CoV-2 August 13, 2020

Neogen (NEOG -1.2%) has announced that its BioSentry 904 Disinfectant has been proven effective by the U.S. Environmental Protection Agency (EPA), against SARS-CoV-2.

BioSentry 904 Disinfectant is a hospital-grade-, broad-spectrum sanitizer and has been proven effective against the virus when the surface has been left visibly wet for at least three minutes.

The disinfectant had earlier received an emergency approval for use against SARS-CoV-2 by the EPA.


Nippon Shinyaku takes on Sarepta

A new competitor enters the exon 53 skipping niche, and might well take it over.



US approval for Nippon Shinyaku’s Viltepso gives the 8% of Duchenne muscular dystrophy patients who have the right kind of mutation a second therapeutic option. The exon 53-skipper is now in direct competition with Sarepta’s Vyondys 53 – and a look at the clinical data on dystrophin production suggests that Viltepso has an edge.

That is, if you’re willing to accept the weight of a study in just 16 patients, only eight of whom received the approved dose of Viltepso. The trial makes the data on which Vyondys 53 was approved – in 25 patients – look like a model of rigour. A larger study looking at measures of motor performance is in the works, and until data from that appear it seems likely that pricing, which the Japanese group has yet to announce, will dictate which product sells best.

The phase I/II trials on which the two rival therapies were approved looked at the same efficacy measure: production of dystrophin protein in patents’ muscles, a surrogate for muscle function.

In its US trial Viltepso brought the levels of dystrophin in the eight patients given 80mg/kg up to 5.9% of normal after 24 weeks of treatment, a 5.3-point increase from baseline. Vyondys 53 could only manage an improvement of less than one percentage point – over twice as long a treatment period.

Battle of the Exon 53 skippers
DrugViltepso 40mg/kgViltepso 80mg/kgVyondys 53 30mg/kg
Trial IDNCT02740972NCT02310906
No of subjects8825
Treatment duration24 weeks48 weeks
Normal dystrophin levels achieved5.7%5.9%1.0%
Change from baseline (pct points)5.30.9
Source: drug labels. 

Comparing data across trials is fraught with difficulty, and this is especially true when the patient populations are as minuscule as they are here. But that is the task facing paediatricians, until harder data arrive from the confirmatory trials that are ongoing for both drugs. 

Racer53 will enrol 74 patients amenable to exon 53 skipping who will be treated with Viltepso or placebo for 48 weeks, with the primary endpoint being the time to stand test. The Essence trial of Vyondys 53 is rather larger, at 222 patients, with a placebo-controlled portion and an open-label part. The primary endpoint is the six-minute walk test at week 96.

Essence is expected to read out in 2022, with Racer53 data coming two years later. 

Controversy

The US approval of Viltepso on the strength of such tiny patient numbers is perhaps not too surprising after the controversy over Vyondys 53’s green light. Sarepta’s product was waved through by the FDA just four months after it had been rejected, and the decision to approve had been fiercely disputed within the agency (Internal FDA documents reveal a familiar story for Sarepta, January 22, 2020).

The sellside sees Viltepso outselling Vyondys 53 as soon as 2022, according to consensus forecasts from EvaluatePharma. Sarepta can probably view this with equanimity; with projections for its Duchenne’s gene therapy SRP-9001 outpacing those for its exon-skippers it might be the winner in this disorder in the long term anyway.