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Sunday, December 27, 2020

Thai hospital banned from offer to sell COVID-19 vaccine

 A private Thai hospital was ordered on Sunday to stop advertising COVID-19 vaccinations for sale in advance on the grounds that no vaccine is yet approved in Thailand.

Vibhavadi Hospital told Reuters its online offer for 1,000 initial reservations for the two-dose Moderna vaccine had been the result of a misunderstanding. With reservations priced at 4,000 baht, the total cost of getting vaccinated would have been 10,000 baht ($330).

As the first governments begin vaccine rollouts around the world, questions have been raised over how the limited supplies are prioritised and whether people will be able to pay to jump the queue.

The Ministry of Health said in a statement that no COVID-19 vaccine had been approved for use in Thailand yet and that advertising one violated hospital regulations.

"The removal of the advertisement was ordered," it said.

Chaisit Kupwiwat, a director at Vibhavadi Hospital, told Reuters: "There was a misunderstanding and so we've stopped the programme... We planned to order the vaccines, but now we've stopped."

The hospital had sought reservations by Jan. 31 for vaccinations later in 2021.

Moderna did not respond immediately to an emailed request for comment on any such sale.

Thailand has signed an advance deal for AstraZeneca’s potential COVID-19 vaccine, but has not set rollout plans for any vaccine yet.

Moderna's vaccine this month became the second to get emergency use authorisation from the U.S. Food and Drug Administration after the Pfizer and BioNTech vaccine.

Moderna has said it will deliver approximately 20 million doses to the U.S. government this year and is expected to have between 100 million and 125 million delivered globally in the first quarter of 2021.

In August, Moderna said it was pricing its vaccine at $32 to $37 per dose for smaller deals.

Thailand is a major hub for medical tourism, drawing patients from Asia, the Middle East and beyond.

https://www.marketscreener.com/quote/stock/VIBHAVADI-MEDICAL-CENTER-26375883/news/Thai-hospital-banned-from-offer-to-sell-COVID-19-vaccine-32088592/

China's Walvax to make COVID-19 vaccine candidate similar to AstraZeneca's

 China's Walvax Biotechnology Co has started work on a plant to manufacture an early-stage coronavirus vaccine candidate similar to AstraZeneca PLC's product, state-backed media said on Sunday.

Mass production for the proposed vaccine could begin in mid-2021, with an estimated capacity of 200 million doses a year, said Health Times, a paper run by the People's Daily.

The treatment is based on a chimpanzee adenovirus to deliver materials that can trigger an immune response against the virus that causes COVID-19, a technique adopted in the candidate from AstraZeneca and Oxford University.

The Chinese candidate, jointly developed by China's Tsinghua University and Tianjin Medical University, has not been tested on humans. The AstraZeneca-Oxford treatment is in final-stage large trials.

AstraZeneca's late-stage trials in Britain and Brazil last month found an efficacy of 62% for trial participants given two full doses but 90% for a subgroup given a half, then a full dose. A Reuters investigation this week revealed problems with the Oxford/AstraZeneca vaccine study.

Adenovirus is used in other COVID-19 vaccine candidates, including one from China's CanSino Biologics Inc, which is based a harmless common cold virus known as adenovirus type-5 (Ad5).

Researchers on the CanSino vaccine have said it might be weaker in people who had been exposed to Ad5 and have pre-existing immunity against the adenovirus.

The potential Walvax vaccine might avoid this problem by using a rare adenovirus from chimpanzees to which humans normally do not have pre-existing immunity, Health Times said.

Walvax has another production facility in the works for a vaccine it is jointly developing with the Academy of Military Science and Suzhou Abogen Biosciences Co, which is in early-stage clinical trials.

China has moved at least five vaccine candidates into late-stage clinical trials.

https://www.marketscreener.com/quote/stock/WALVAX-BIOTECHNOLOGY-CO--11318055/news/China-s-Walvax-to-make-COVID-19-vaccine-candidate-similar-to-AstraZeneca-s-media-32088573/

UK to roll out Oxford COVID-19 vaccine from Jan. 4

 The United Kingdom will roll out Oxford University’s COVID-19 vaccine from Jan. 4, according to plans being drawn up by ministers, The Sunday Telegraph reported.

The government hopes to give the first dose of either the Oxford vaccine, which has been licensed to pharmaceuticals company AstraZeneca, or the Pfizer vaccine to 2 million people over the next two weeks, the newspaper said.

The Oxford vaccine is expected to be approved by medical regulators in days, the newspaper said.

https://www.reuters.com/article/us-health-coronavirus-britain-vaccine/uk-to-roll-out-oxford-covid-19-vaccine-from-jan-4-sunday-telegraph-says-idUSKBN2900KR

Fundamentals intact, MedTech to outperform in 2021 as vaccines drive recovery

 

  • Reversing the contraction this year, MedTech could outperform in 2021, J.P. Morgan Securities predict, citing the sector’s potential to combine the ‘strong vaccine-driven recovery trade’ with ‘positive underlying sector fundamentals.’ Despite a less bullish timeline for recovery, the analysts from SVB Leerink shared a similar view adding that the pandemic-driven in telehealth could benefit ‘all medtech subsectors.’
  • According to JPM forecasts, in 2021, the industry top-line and bottom-line will expand at 10.1% and 24.8% YoY, compared to an estimated decline of 0.5% and 12.7% YoY in 2020, respectively.
  • The analysts at JPM led by Robbie Marcus term the upcoming year as ‘a tale of two cities,’: a strong back half, benefited from the vaccine rollout, easy comps, and the deferred procedures, contrasting the first half likely impacted from the pandemic headwinds amid the ongoing surge in cases and another post-holiday COVID-19 wave.
  • Despite the near-term uncertainty, they view the ‘underlying fundamentals of MedTech as healthy,’ with ‘meaningful innovation and undertreated end-markets’ supporting ‘a return to normalized growth in the mid-single digits’ in the future.
  • The report from JPM name Medtronic (NYSE:MDT) and Dexcom (NASDAQ:DXCM) as top large-cap picks and Insulet (NASDAQ:PODD) and AtriCure (NASDAQ:ATRC) as top small-cap picks.
  • For Medtronic, the proven track record of execution, reinforced by the new management and improving fundamentals, should ‘shine-through’ in a post-pandemic scenario, the analysts point out, expecting the company, with a valuation gap to peers, to outperform the broader group with multiple expansion along the way.
  • With pharmacy channel headwinds behind, Dexcom is ‘well-positioned ahead of a G7 launch’ as the company focuses on deeper penetration and new market opportunities to ensure long-term success, the report suggests.
  • Having demonstrated resilience amid pandemic headwinds, both Insulet and AtriCure have a 'long runway for growth,’ the researchers write, citing their upcoming product launches.
  • In the Q3 2020 earnings call, Insulet’s CEO said the company was on track to launch OmniPod 5, its latest iteration of Insulin pump, in 1H 2021. Meanwhile, following successful trial results in May, AtriCure has made the final FDA submission seeking the regulatory approval for its hybrid Convergent ablation to treat patients with persistent atrial fibrillation.
  • https://seekingalpha.com/news/3647430-fundamentals-intact-medtech-to-outperform-in-2021-vaccines-drive-recovery

CytoDyn to amend Phase 3 trial protocol for COVID-19 therapy

 

  • CytoDyn (OTCQB:CYDY) has announced that the FDA has issued guidance to add an open-label extension to its Phase 3 trial (CD12) for Vyrologix™ (leronlimab-PRO 140) in severe-to-critically ill COVID-19 patients, including specific criteria for the continuation of eINDs for patients meeting the inclusion/exclusion criteria of CD12.
  • The company expects to amend the trial protocol and seek FDA submission on December 28. Upon regulatory clearance, the trial sites will have the option of enrolling additional qualified patients who will undergo the treatment until the trial’s data is unblinded.
  • The CEO of CytoDyn said the company will specify the requirements for the open-label extension study and physicians seeking eINDs, adding that the results of the CD10 Phase 2 clinical trial will not support an eIND request.
  • Earlier, the Phase 2 clinical trial (CD10) generated positive results, and the Phase 3 randomized trial completed the enrollment on December 16, with results expected in mid-January 2021.
  • https://seekingalpha.com/news/3647431-cytodyn-to-amend-phase-3-trial-protocol-for-covidminus-19-therapy

Saturday, December 26, 2020

Trials of blood thinners in critically ill COVID-19 patients pause due to futility

 Three clinical trial platforms working together to test the effects of full doses of anticoagulants (blood thinners) in COVID-19 patients have paused enrollment for one group of patients. Among critically ill COVID-19 patients requiring intensive care unit (ICU) support, full dose anticoagulation drugs did not improve outcomes. Enrollment continues for moderately ill hospitalized COVID-19 patients in the trials.

As is normal for clinical trials, these trials are overseen by independent boards that routinely review the data and are composed of experts in ethics, biostatistics, clinical trials, and blood clotting disorders. Informed by the deliberations of these oversight boards, all of the trial sites have paused enrollment of the most critically ill hospitalized patients with COVID-19. A potential for harm in this sub-group could not be excluded. Increased bleeding is a known complication of full-dose anticoagulation. The trials are working urgently to undertake additional analyses which will be made available as soon as possible.

At the recommendation of the oversight boards patients who do not require ICU care at the time of enrollment will continue to be enrolled in the trial. Whether the use of full-dose compared to low-dose blood thinners leads to better outcomes in hospitalized patients with less severe disease remains a very important question.

COVID-19 is associated with significant inflammation and clinical and pathologic evidence of widespread blood clots. These trials were launched because clinicians have observed that many patients ill with COVID-19, including those who have died from the disease, formed blood clots throughout their bodies, even in their smallest blood vessels. This unusual clotting can cause multiple health complications, including lung failure, heart attack, and stroke.

"In only our most critically ill patients with COVID-19, all of our trial sites have paused enrollment while we further analyze the data. These results question the benefit of giving full dose anticoagulants routinely in COVID-19 patients who are admitted to an ICU," said Ryan Zarychanski, M.D., M.Sc., Israels associate professor of medicine at the University of Manitoba and CancerCare Manitoba in Canada, a hematologist and critical care physician, who led the harmonization of the three trials.

The multiple platform randomized controlled trial (mpRCT) represents an unprecedented collaboration between three international partners. The Randomized, Embedded, Multi-factorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) Therapeutic Anticoagulation; Accelerating COVID-19 Therapeutic Interventions and Vaccines-4 (ACTIV-4) Antithrombotics Inpatient; and Antithrombotic Therapy to Ameliorate Complications of COVID-19 (ATTACC) are a set of clinical trial platforms spanning five continents with the common goal of testing whether there is a benefit of full doses of blood thinners to treat adults hospitalized for COVID-19 illness on the ward or in the ICU compared to the lower dose used to prevent blood clots in hospitalized patients. To meet the challenge of this pandemic, investigators worldwide joined forces to answer this question as rapidly as possible.

"These results represent an immense collaborative effort involving patients, clinicians, and research staff around the world enabling us to rapidly learn how best to treat Covid-19," says Ewan Goligher, MD, PhD, assistant professor of medicine, University of Toronto and scientist, Toronto General Hospital Research Institute, University Health Network, and critical care physician. "The strength of the multiplatform clinical trial design enables us to pause in one subset and continue parts of the study."

###

The trials are supported by multiple international funding organizations including Canadian Institutes of Health Research (CAN), National Institutes of Health Research (UK), National Health and Medical Research Council (AUS) and the National Institutes of Health (US) and the PREPARE and RECOVER consortia (EU).

In Canada, the collaboration was funded by Canadian Institutes of Health Research, LifeArc Foundation, Research Manitoba, Thistledown Foundation, Province of Ontario and the Peter Munk Cardiac Centre at UHN.

https://www.eurekalert.org/pub_releases/2020-12/uhn-tob122220.php

With COVID exacerbating superbug threat, researchers ID new weapon

 As scientists around the globe wage war against a novel, deadly virus, one University of Colorado Boulder lab is working on new weapons to battle a different microbial threat: a rising tide of antibiotic-resistant bacteria which, if left unchecked, could kill an estimated 10 million people annually by 2050.

"The COVID-19 situation is definitely putting us at risk for increasing resistance to antibiotics, so it's more important now than ever that we come up with alternative treatments," said Corrie Detweiler, a professor of molecular, cellular and developmental biology who has spent her career seeking those alternatives.

In a paper published Friday in the journal PLOS Pathogens, Detweiler and her research team unveil their latest discovery--a chemical compound that works with a host's innate immune response to push past cellular barriers that help bacteria resist antibiotics.

Along with their other recently published discoveries, the authors say, the finding could lead to a new arsenal for fighting what could be the next big public health threat.

"If we don't solve the problem of finding new antibiotics or somehow making old antibiotics work again, we are going to see sharply increasing deaths from bacterial infections we thought we had beaten decades ago," said Detweiler. "This study offers a totally new approach and could point the way toward new drugs that work better and have fewer side effects."

In the United States alone, 35,000 people die annually from bacterial infections that could not be treated because they've grown resistant to existing drugs. Countless others suffer life-threatening bouts with once-easily treatable illnesses like strep throat, urinary tract infections and pneumonia. By 2050, the authors note, there could be more deaths from antibiotic resistance than from cancer.

"As our existing antibiotics adapt and work less, we risk essentially going back to a period 100 years ago, when even a minor infection could mean death," said Detweiler.

The pandemic has shone even more light on the problem, she notes, as many patients die not from the virus itself but from hard-to-treat secondary bacterial infections.

Meanwhile, she and other scholars worry that heightened use of antibiotics to prevent or treat those secondary infections, while at times necessary, may be exacerbating resistance.

Most antibiotics in use today were developed in the 1950s, and pharmaceutical companies have since scaled back on research in the field in favor of more profitable ventures.

To feed the pipeline, Detweiler's lab developed a technique called SAFIRE for screening for new small molecules which work differently than older drugs.

Of 14,400 candidates screened from a library of existing chemicals, SAFIRE identified 70 that hold promise.

The new paper centers around "JD1," which appears to be particularly effective at infiltrating what are known as "Gram-negative bacteria."

With a tough exterior membrane that prevents antibiotics from accessing the cell, and another interior membrane providing a buffer, these bacteria (including Salmonella and E. coli) are inherently difficult to treat.

But unlike other drugs, JD1 takes advantage of the host's initial immune assault on that outer bacterial membrane, then slips inside and goes after the inner membrane too.

"This is the first study to show that you can target a Gram-negative bacteria's inner membrane by exploiting the innate immune response of the host," Detweiler said.

In laboratory and rodent experiments, JD1 reduced survival and spread of Gram-negative bacteria called Salmonella enterica by 95%.

But while it damaged the bacterial cell membranes, it couldn't penetrate the fine layer of cholesterol that lined its mammalian host's cell membranes.

"Bacteria are vulnerable to JD1 in a way that our cells are not," said Detweiler, noting that for this reason, side-effects would likely be minimal.

Further studies are underway to explore JD1 and other compounds like it.

Meanwhile, Detweiler has formed a spin-off company to help commercialize other compounds which work by inhibiting pumps, called "efflux pumps," that bacteria use to pump out antibiotics.

"The reality is, evolution is way smarter than all of the scientists put together and these bacteria will continue to evolve to resist what we throw at them," she said. "We cannot rest on our laurels. We have to keep feeding the pipeline."

https://www.eurekalert.org/pub_releases/2020-12/uoca-wce122320.php