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Thursday, February 25, 2021

Sarepta: FDA OKs AMONDYS 45™ (casimersen) Injection for Duchenne

  Sarepta Therapeutics, Inc. (NASDAQ:SRPT), the leader in precision genetic medicine for rare diseases, today announced that the U.S. Food and Drug Administration (FDA) has approved AMONDYS 45 (casimersen). AMONDYS 45 is an antisense oligonucleotide from Sarepta’s phosphorodiamidate morpholino oligomer (PMO) platform, indicated for the treatment of Duchenne muscular dystrophy (DMD) in patients with a confirmed mutation amenable to exon 45 skipping. This indication is based on a statistically significant increase in dystrophin production in skeletal muscle observed in patients treated with AMONDYS 45, which is reasonably likely to predict clinical benefit for those patients who are exon 45 amenable. Consistent with the accelerated approval pathway, the continued approval of AMONDYS 45 may be contingent on confirmation of a clinical benefit in confirmatory trials.

The ESSENCE trial – a placebo-controlled confirmatory trial to support the AMONDYS 45 approval – is ongoing and expected to conclude in 2024.

Although kidney toxicity was not observed in the clinical studies with AMONDYS 45, kidney toxicity, including potentially fatal glomerulonephritis, has been observed after administration of some antisense oligonucleotides. Kidney function should be monitored in patients taking AMONDYS 45. In the clinical trial, the most common adverse reactions observed in at least 20% of patients treated with AMONDYS 45 and at least 5% more frequently than in placebo were (AMONDYS 45, placebo): upper respiratory tract infections (65%, 55%), cough (33%, 26%), fever (33%, 23%), headache (32%, 19%), joint pain (21%, 10%), and pain in mouth and throat (21%, 7%).

“This is an important day for Sarepta and, far more importantly, for the patients that we serve. After years of scientific commitment, investment and development, the approval of AMONDYS 45, Sarepta’s third approved RNA therapy, offers treatment to the 8% of the DMD community who have a confirmed exon 45 amenable mutation,” said Doug Ingram, president and chief executive officer, Sarepta. “Along with our other approved RNA therapies, we can now offer treatment options for nearly 30% of Duchenne patients in the U.S. And our commitment to bring therapies to the greatest percentage of the DMD community as soon as possible continues.”

https://www.globenewswire.com/news-release/2021/02/25/2182845/0/en/Sarepta-Therapeutics-Announces-FDA-Approval-of-AMONDYS-45-casimersen-Injection-for-the-Treatment-of-Duchenne-Muscular-Dystrophy-DMD-in-Patients-Amenable-to-Skipping-Exon-45.html

Fraudsters offer 400 million 'ghost' COVID vaccines in EU: officials

 Fraudsters have offered 400 million doses of COVID-19 vaccines worth some 3 billion euros to European Union countries, two officials, showing how criminals seek to capitalise on a botched inoculation campaign weighing on the bloc’s economic recovery.

EU leaders will discuss by videoconference on Thursday how to protect their 450 million citizens from new, more contagious variants of the coronavirus, ensure stable vaccine deliveries, ramp up production and update jabs to counter new strains.

Two officials with the bloc’s executive European Commission estimated that around 400 million doses of “ghost” vaccine had been offered by fraudsters at a price of up to 3 billion euros ($3.67 billion).

“There is a really large quantity,” one said. “Nobody has any idea what is actually in these vials...The best case is it’s just not working, in the worst case it’s a very serious issue.”

The official, who noted that most of the shots offered to EU governments by traders were purportedly the AstraZeneca vaccine, compared the situation to the start of the coronavirus pandemic in early 2020 when criminal exploited a shortage of masks and other protective equipment.

A second official, who also spoke on condition of anonymity, said the Commission was worried about “ghost” vaccines.

“It is unclear whether these are genuine vaccine doses or if we are just talking about salt water in small vials,” the official told Reuters.

The EU had warned already that vaccine fraud was on the rise, with fake doses circulating on the market, but the extent of the problem has been unclear until now.

https://www.reuters.com/article/us-health-coronavirus-eu-vaccines/fraudsters-offer-400-million-ghost-covid-vaccines-in-eu-officials-idUSKBN2AP1GN

GSK narrows focus on elderly in trial to treat pneumonia from COVID-19

  GlaxoSmithKline will extend a trial testing an experimental rheumatoid arthritis drug on patients suffering from pneumonia related to COVID-19 to focus on the elderly as it seeks to firm up encouraging findings so far.

A trial started in May last year has shown that the drug known as otilimab helps patients over 70 with severe COVID-19 get off mechanical ventilation or high-flow oxygen support faster, the British drugmaker said on Thursday.

The benefit for younger trial participants was not clear enough to merit further investigation, prompting the re-focus on the elderly in a follow-up trial with a targeted 350 participants.

After 28 days of treatment, 65.1% of elderly patients on otilimab plus standard of care were alive and free of intensive respiratory support, compared to 45.9% of patients who received the standard of care alone, according to the trial results.

Effective COVID-19 treatments are still in high demand as vaccination campaigns are only ramping up gradually and as new variants of the coronavirus spread rapidly.

“Given the profound impact this pandemic is having on the elderly and the encouraging data we are sharing today, we are hopeful this finding will be replicated in the additional cohort,” said Christopher Corsico, GSK Senior Vice President Development.

GSK, which acquired rights to otilimab from German biotech firm Morphosys in 2013, said it expects first results of the extended trial in the third quarter of this year, to be followed by talks with regulators if the initial findings are confirmed.

Many patients with severe COVID-19 suffer from an over-reaction of the immune system known as cytokine storm and GSK aims to reaffirm that the drug, originally designed to fight an autoimmune disease, can help.

Attempts to repurpose existing drugs to rein in an overactive immune system in COVID-19 patients have had mixed results.

AstraZeneca’s blood cancer drug Calquence failed to help severely ill COVID-19 patients. Roche’s arthritis drug Actemra, in turn, was shown to cut the risk of death among patients hospitalised with severe COVID-19.

GSK, and other drugmakers, are also working on antibody-based drugs that block the virus directly.

GSK has also brought to bear its knowledge on adjuvants, which are efficacy boosters used in many vaccines, working with partners including France’s Sanofi.

In addition, it is collaborating with CureVac on a next generation of vaccines that protect against new coronavirus variants.

https://www.reuters.com/article/us-health-coronavirus-gsk-otilimab/gsk-narrows-focus-on-elderly-in-trial-to-treat-pneumonia-from-covid-19-idUSKBN2AP1IJ

Moderna expects $18.4 billion in COVID-19 vaccine sales in 2021

 Moderna Inc said on Thursday it expects COVID-19 vaccine sales of $18.4 billion this year, above the $15 billion in sales forecast by Pfizer Inc for the only other vaccine authorized for emergency use in the United States so far.

Both vaccines, developed using a technology based on messenger RNA (mRNA), are being distributed at an unprecedented speed as cases mount in the United States, with deaths from COVID-19 surpassing the dire milestone of 500,000.

Moderna, whose shares rose 4% to $150.7 in trading before the bell, has been aiming to ramp up production of the vaccine, its first and only revenue-generating product.

It now aims to produce at least 700 million doses this year and expects to raise production to as much as 1 billion doses by improving its manufacturing process..

“2020 demonstrated the power of harnessing mRNA to make medicines,” Chief Executive Officer Stéphane Bancel said in a statement.

“I believe that 2021 will be an inflection year for Moderna.”

Moderna expects cost of sales to be about 20% of product sales in 2021, well above the 4% it recorded a year earlier.

The company also said it had completed enrollment for a mid-to-late stage study of the vaccine in adolescents between the ages of 12 and 17, while a study in children aged six months to 11 years will start in the near-term.

Moderna’s chief medical officer, Tal Zaks, would leave the company in late September, the company added.

https://www.reuters.com/article/us-health-coronavirus-moderna/moderna-expects-18-4-billion-in-covid-19-vaccine-sales-in-2021-idUSKBN2AP1JL

Regeneron to stop giving placebo in COVID-19 drug trial after 'clear efficacy'

 Regeneron Pharmaceuticals said on Thursday that an independent panel found the company’s COVID-19 antibody cocktail to have “clear clinical efficacy” in reducing the rates of hospitalization and deaths in patients.

The cocktail, a combination of two antibodies casirivimab and imdevimab, was authorized in November for emergency use by the U.S. Food and Drug Administration.

Independent Data Monitoring Committee found that both 1,200mg and 2,400mg doses of the cocktail had reduced the rate of hospitalization and deaths compared with placebo, according to the company. The panel has recommended that Regeneron should stop enrolling patients in the placebo group for its ongoing late-stage trial.

The company plans to immediately follow the panel’s recommendation and also share details of unblinded data from the trial once it becomes available in March.

The Regeneron treatment is part of a class of drugs known as monoclonal antibodies, which are manufactured copies of antibodies created by the human body to fight infections.

In January, the U.S. government said it will buy 1.25 million additional doses of Regeneron Pharmaceuticals’ COVID-19 antibody cocktail for about $2.63 billion, bringing the total supply of the treatment to more than 1.5 million doses.

https://www.reuters.com/article/us-health-coronavirus-regeneron/regeneron-to-stop-giving-placebo-in-covid-19-drug-trial-after-clear-efficacy-idUSKBN2AP1J8

China approves two more domestic COVID-19 vaccines, increasing number to four

 China’s National Medical Products Administration said on Thursday that it had approved two more COVID-19 vaccines for public use, increasing the number of domestic vaccines approved in China to four.

The two newly approved vaccines are made by CanSino Biologics Inc and Wuhan Institute of Biological Products, an affiliate of China National Pharmaceutical Group (Sinopharm).

They join a vaccine from Sinovac Biotech approved earlier this month, and another from Sinopharm’s Beijing unit approved last year.

So far, China has not approved COVID-19 vaccines developed by Western drug makers.

Sinopharm’s Wuhan unit said on Wednesday its vaccine had an efficacy rate of 72.51% against the COVID-19 disease caused by the virus, citing interim analysis of late-stage clinical trial data, without offering more details.

It is one of two candidates from Sinopharm that have entered Phase III clinical trials overseas, and was earlier given to a limited group of people at higher infection risk.

The four approved Chinese vaccines can be stored at normal freezer temperatures, making them a potentially attractive option for developing countries which might have difficulty deploying vaccines from Pfizer and Moderna that require much colder temperatures for longer-term storage.

China has been exporting the Sinovac and earlier Sinopharm vaccines to countries around the world.

https://www.reuters.com/article/us-health-coronavirus-china-vaccine/china-approves-two-more-domestic-covid-19-vaccines-increasing-number-to-four-idUSKBN2AP1MW

Wanted: More high-tech manufacturing space for global vaccine push

 The number of available COVID-19 vaccine doses is steadily rising, but a shortage of physical space that meets standards for pharmaceutical manufacturing is a major bottleneck to further expansion, according to drugmakers, industry construction experts and officials involved in the U.S. vaccine program.

The production of raw materials, vaccine formulation and vial filling all require “clean rooms” with features like air cleaners, sterile water and sterilizing steam designed and in some cases built by specialists.

Moderna Inc on Wednesday announced plans to expand vaccine manufacturing capacity, but said it will be a year before that can add to its production.

With vaccines needed for billions of people to end a pandemic that has claimed more than 2.5 million lives globally, drugmakers have even had to turn to rivals for help to churn out doses. Space at third-party contract manufacturers in the United States is largely allocated, according to one major contract manufacturer and other smaller companies.

A recent U.S. Government Accountability Office report flagged a shortage of manufacturing capacity as a challenge in scaling up vaccine production.

And the emergence of new coronavirus variants is likely to increase the strain on production capacity.

Public health experts say global vaccination as soon as possible is critical to curbing the rise of highly contagious additional variants. Many are counting on authorization of Johnson & Johnson’s vaccine this week.

Longer term, tackling COVID-19 may require annual shots to protect against new virus mutations, similar to the flu. Vaccine companies are already designing potential booster shots addressing variants first identified in South Africa and Brazil.

“What’s happening now indicates the importance of markedly strengthening the capacity of manufacturing capabilities in the United States,” said Larry Corey, a virologist at the Fred Hutchinson Cancer Research Center who helped design U.S.-backed vaccine trials. “We should be investing, large scale, in our abilities to manufacture.”

Pfizer and Moderna can increase output some by speeding fill and finish, said Moncef Slaoui, former chief scientific adviser for the government’s Operation Warp Speed vaccine program. Making much more vaccine itself is more challenging.

“To change that substantially in terms of drug substance would take ramping up global manufacturing infrastructure. That takes months,” he said. “You would have to build, train, validate, and get regulators to visit and approve a site.”

Leading vaccine developers Pfizer and partner BioNTech, Moderna, AstraZeneca, J&J, Novavax, Russia’s Gamaleya Research Institute, and CureVac are aiming to make enough vaccine with manufacturing partners to inoculate some 5.2 billion people in 2021, according to a Reuters tally of public statements and media reports.

China’s Sinovac and Sinopharm will likely deliver significant supplies as well, though their 2021 targets are unclear. Several drugmakers have struggled to meet early production targets.

BUILDING FASTER

Building new facilities and even expanding existing manufacturing sites has typically taken years. During the pandemic, some projects have been completed in as little as 6-to-10 months, according to some specialized construction companies involved with Warp Speed.

Emergent BioSolutions , which is making J&J and AstraZeneca vaccines for the United States, cannot add any more equipment to facilities dedicated to those vaccines.

The company is not alone. “The contract manufacturing network, like our facility, is pretty full,” said Emergent Executive Vice President Sean Kirk.

Adding new clean rooms that meet good manufacturing practices standards is complex and time consuming, said Phil DeSantis, a consultant and pharmaceutical engineer.

“Building the clean room is probably what we call the critical path,” he said. “That’s the part that takes the longest.”

Vaccine makers have sidestepped this in part by retrofitting existing facilities. BioNTech bought a facility in Marburg, Germany, from Novartis in September, and began producing messenger RNA - the active ingredient in its vaccine - in early February.

When Emergent joined Warp Speed last year, it stopped everything else it was working on at its Baltimore facility to make room for the COVID-19 vaccines.

The U.S. government can use the Defense Production Act to force that kind of reshuffling. Supply orders with a federal “rating” under the law must be filled first. But there are limits to what it can do without threatening supplies of other injectable medicines.

Pfizer last week said it had engaged two U.S. contract manufacturers and would add capacity to formulate vaccines and make raw materials at its own sites, but did not specify whether new clean rooms would be installed.

In adding clean room space to existing sites, drugmakers and their suppliers have leaned heavily on pre-fabricated wall panels and pods that speed the process, according to specialist companies that build those spaces.

G-CON Manufacturing provided pods to some Warp Speed projects. One contract manufacturer dedicated space to COVID-19 vaccines, and then used G-CON pods to add clean room space for a different project for an existing customer, said Chief Executive Maik Jornitz.

“It was sort of the only way,” Peter Walters, director of advanced therapies at CRB, which designs and manages construction of the facilities, said of the pre-fabricated systems.

CRB has worked on more than 20 coronavirus vaccine-related projects. The program has “certainly redefined, to a lot of the industry, what could be possible,” Walters said.

Adding more capacity would help the United States tackle COVID-19 variants and future pandemics, said Prashant Yadav, a senior fellow at the U.S.-based Center for Global Development.

“We can use it for our own needs,” he said. “We can use it to serve the world.”

https://www.reuters.com/article/us-health-coronavirus-vaccines-manufactu/wanted-more-high-tech-manufacturing-space-for-a-global-vaccine-push-idUSKBN2AP1HV