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Tuesday, November 2, 2021

First Day Trading a Letdown for LianBio in Shadow of Beijing Market Crackdown

 Monday was a big day for LianBio, as the Shanghai-based company launched on the Nasdaq with an impressive $325 million initial public offering (IPO). However, the initial market result was less thrilling as the company fell 14% in its U.S. trading debut. 

The bicontinental biotech, which was launched by Perceptive Advisors in August 2020, hit the U.S. market in the shadow of a cybersecurity probe into Didi Global Inc., which debuted on the Nasdaq at the end of June. This preceded a perceived crackdown on China’s corporations in July. 

Didi Global’s U.S. listing was the largest by a Chinese company since 2014 and the probe triggered a reduction of about $1 trillion from the aggregate market value of China’s listed firms. LianBio, which has its headquarters in both Shanghai and Princeton, New Jersey, was the first to test the waters following this change in tone.

At the stated IPO price of $16 for each of its 20.3 million American shares, LianBio should have had a market value of $1.68 billion based on the outstanding shares listed in its filings with the U.S. Securities and Exchange Commission. However, shares opened Monday trading at $15.50 and closed at $13.70 in New York, leaving the company instead, with a market value of $1.44 billion. At press time, LianBio was trading at $13.55 per share. 

LianBio, which came out of stealth mode already boasting multiple strategic alliances with BridgeBio Pharma, MyoKardia, and BridgeBio Pharma affiliate companies Navire Pharma and QED Therapeutics, has since also partnered with Pfizer in an open-ended development collaboration and Landos Biopharma on a pair of colitis and Crohn’s drugs. 

With a mission to bring the most innovative medicines to the Chinese marketplace, particularly in areas of highest unmet need for the region, LianBio’s lead asset is Myokardia (BMS)’s mavacamten. The drug is being developed for Hypertrophic Cardiomyopathy (HCM), a chronic, progressive disease driven by excessive cardiac contractility that causes the heart's walls to thicken. 

According to LianBio, there are 290 million people in China with cardiovascular disease. The company also has assets across the oncology, respiratory, ophthalmology and inflammatory disease spaces. LianBio is headed by bicontinental pharma industry veteran Yizhe Wang, Ph.D., who signed on as CEO in May.

Bloomberg revealed that even Chinese companies with little to no presence in mainland China are warning about risks they are facing from Beijing’s crackdown on businesses. For example, when Billionaire Richard Li’s FWD Group Holdings Ltd. filed for a U.S. IPO in September, its prospectus stated that though it has “no substantive operations” on the mainland, Chinese laws – if applied – could have a material impact on its business.

Though LianBio’s prospectus claimed it does not hold personally identifiable data on patients in China or have a variable interest entity in its corporate structure, it still highlighted on the front page that there are “significant legal and operational risks associated with having the majority of our operations in China.” The company specifically pointed to potential changes in the Chinese government's legal, political, and economic policies.

https://www.biospace.com/article/first-day-trading-a-letdown-for-lianbio-in-shadow-of-beijing-market-crackdown/

Report: BlueCrossBlueShield Post Shows Biogen Aduhelm Seen 'Medically Necessary' For Alzheimers

 https://www.benzinga.com/news/21/11/23835932/biogen-shares-move-higher-traders-circulate-bluecrossblueshield-posting-showing-cos-aduhelm-consider

Semler Scientific: Lake Street Adjusts Semler Scientific PT to $175 From $200

 Maintains Buy Rating

https://www.marketscreener.com/quote/stock/SEMLER-SCIENTIFIC-INC-120795486/news/Lake-Street-Adjusts-Semler-Scientific-PT-to-175-From-200-Maintains-Buy-Rating-36870139/

Pfizer Vaccine Trial Had Major Flaws, Whistleblower Tells Peer-Reviewed Journal

 A whistleblower involved in Pfizer's pivotal phase III Covid-19 vaccine trial has leaked evidence to a notable peer-reviewed medical publication that poor practices at the contract research company she worked for raise questions about data integrity and regulatory oversight.

Brook Jackson, a now-fired regional director at Ventavia Research Group, revealed to The BMJ that vaccine trials at several sites in Texas last year had major problems - including falsified data, broke fundamental rules, and were 'slow' to report adverse reactions.

When she notified superiors of the issues she found, they fired her.

A regional director who was employed at the research organisation Ventavia Research Group has told The BMJ that the company falsified data, unblinded patients, employed inadequately trained vaccinators, and was slow to follow up on adverse events reported in Pfizer’s pivotal phase III trial. Staff who conducted quality control checks were overwhelmed by the volume of problems they were finding. After repeatedly notifying Ventavia of these problems, the regional director, Brook Jackson, emailed a complaint to the US Food and Drug Administration (FDA). Ventavia fired her later the same day. Jackson has provided The BMJ with dozens of internal company documents, photos, audio recordings, and emails. -The BMJ

Poor laboratory management

Jackson, a trained clinical trial auditor with more than 15 years' experience, says she repeatedly warned her superiors of poor laboratory management, patient safety concerns, and data integrity issues. After she was ignored, she started documenting problems with the camera on her mobile phone.

One photo, provided to The BMJ, showed needles discarded in a plastic biohazard bag instead of a sharps container box. Another showed vaccine packaging materials with trial participants’ identification numbers written on them left out in the open, potentially unblinding participants. Ventavia executives later questioned Jackson for taking the photos.

The unblinding was potentially far more severe as well. Per the trial's design, unblinded staff prepared and administered either Pfizer's Covid-19 vaccine or a placebo. This was done to preserve the blinding of trial participants and other staff - including the principal investigator. At Ventavia, however, Jackson says that drug assignments were left in participants' charts and accessible to blinded personnel. The breach was corrected last September, two months into the trial at which point there were around 1,000 participants already enrolled.

Jackson recorded a September 2020 meeting with two Ventavia directors, at which an executive can be heard saying that the company couldn't quantify the types and number of errors with their testing.

"In my mind, it's something new every day," they said, adding "We know that it's significant."

According to the report, Ventavia also failed to keep up with data entry - as a Sept. 2020 email from Pfizer partner ICON reveals.

"The expectation for this study is that all queries are addressed within 24hrs.” ICON then highlighted over 100 outstanding queries older than three days in yellow. Examples included two individuals for which “Subject has reported with Severe symptoms/reactions … Per protocol, subjects experiencing Grade 3 local reactions should be contacted. Please confirm if an UNPLANNED CONTACT was made and update the corresponding form as appropriate.” According to the trial protocol a telephone contact should have occurred “to ascertain further details and determine whether a site visit is clinically indicated.”

FDA Inspection woes

Other documents provided to The BMJ reveal that Ventavia officials were worried about three employees . In an email in early August 2020, an executive identified three site staff members with whom they need to "Go over e-diary issue/falsifying data, etc."

One of the employees was "verbally counseled for changing data and not noting late entry," a note reveals.

During the September meeting, Ventavia executives and Jackson discussed the potential for the FDA to show up for an inspection. On former Ventavia employee told The BMJ that the company was petrified over the potential for an FDA audit, and were in fact expecting one over the Pfizer vaccine trial.

"People working in clinical research are terrified of FDA audits," Jill Fisher told the journal, adding however that the agency rarely does anything except review paperwork - usually months after a trial is over. "I don’t know why they’re so afraid of them," she added - saying that she was surprised that the agency failed to inspect Ventavia following an employee complaint.

"You would think if there’s a specific and credible complaint that they would have to investigate that."

FDA notified

Jackson sent a Sept. 25 email to the FDA in which she wrote that Ventavia had enrolled over 1,000 participants at three sites, out of the full trial's 44,000 participants across 153 sites which included various academic institutions and commercial companies. She raised concerns over issues she had witnessed, including:

  • Participants placed in a hallway after injection and not being monitored by clinical staff

  • Lack of timely follow-up of patients who experienced adverse events

  • Protocol deviations not being reported

  • Vaccines not being stored at proper temperatures

  • Mislabelled laboratory specimens, and

  • Targeting of Ventavia staff for reporting these types of problems.

Hours later, the FDA emailed her back, thanking her for her input but notifying her that they would not comment on any investigation which may result.

That said, in August of this year, the FDA published a summary of its inspections of Pfizer's pivotal phase III trial. They looked at just nine out of the trial's 153 sites, and did not look at any of Ventavia's operations. Further, no inspections were conducted following the December 2020 emergency authorization of the vaccine.

Other employees corroborate Jackson's complaints

Two former Ventavia employees spoke with The BMJ anonymously, and confirmed 'broad aspects' of Jackson's account.

One said that she had worked on over four dozen clinical trials in her career, including many large trials, but had never experienced such a “helter skelter” work environment as with Ventavia on Pfizer’s trial.

I’ve never had to do what they were asking me to do, ever,” she told The BMJ. “It just seemed like something a little different from normal—the things that were allowed and expected.

She added that during her time at Ventavia the company expected a federal audit but that this never came.

After Jackson left the company problems persisted at Ventavia, this employee said. In several cases Ventavia lacked enough employees to swab all trial participants who reported covid-like symptoms, to test for infection. Laboratory confirmed symptomatic covid-19 was the trial’s primary endpoint, the employee noted. (An FDA review memorandum released in August this year states that across the full trial swabs were not taken from 477 people with suspected cases of symptomatic covid-19.)

I don’t think it was good clean data,” the employee said of the data Ventavia generated for the Pfizer trial. “It’s a crazy mess.” -The BMJ

The second employee told The BMJ that working at Ventavia was unlike any environment she had experienced in 20 years of research.

Since her firing, Jackson has reconnected with several Ventavia employees who either left or were fired themselves. One of them sent her a text message, which reads "everything that you complained about was spot on."

Meanwhile, since Jackson reported issues with Ventavia to the FDA in September 2020, Pfizer has contracted with the company for four other vaccine clinical trials.

One has to wonder - if the FDA is auditing less than 10% of trials, how many more potential whistleblowers could there be?

https://www.zerohedge.com/covid-19/falsified-data-pfizer-vaccine-trial-had-major-flaws-whistleblower-tells-peer-reviewed

Integra LifeSciences Report Upbeat Q3 Results; Raises Full-year Earnings Outlook

 Integra LifeSciences Holdings Corporation (IART) on Tuesday reported higher earnings in the third quarter driven by strength across most of its product portfolio. The company also raised its full-year adjusted earnings outlook, better than analysts' view.

Integra reported net income of $43.2 million, or $0.51 per share, in the third quarter, compared with $32.3 million, or $0.38 per share, in the prior year.

Excluding items, earnings of $73.1 million or $0.86 per share beat the average estimate of thirteen analysts polled by Thomson Reuter at $0.72 per hare.

Revenue for the quarter increased 4.5% year-over-year to $386.9 million. The consensus estimate was for $384.58 million.

Further, the company has raised its full-year adjusted earnings per share outlook to the range of $3.16 to $3.20 from $2.98 to $3.05. The consensus estimate stands at $3.02 per share.

Full-year revenue is expected in the range of $1.54 billion- $1.55 billion. Analysts see revenue of $1.54 billion for the period.

Looking forward to the the fourth quarter, Integra expects revenue of $403 million and adjusted earnings per share to be in a range of $0.82 to $0.86.

Analysts expect the company to report earnings of $0.81 per hare on revenue of $409.65 million in the fourth quarter.

https://www.nasdaq.com/articles/integra-lifesciences-report-upbeat-q3-results-raises-full-year-earnings-outlook-2021-11-02

Lilly pulls COVID-19 treatment from EU review

 Eli Lilly has retracted a request for European Union approval of its antibody-based treatment for COVID-19, citing a lack of demand from EU member states as the bloc focuses on other suppliers.

The European Medicines Agency (EMA) said on Tuesday it had ended its rolling review of a cocktail of two monoclonal antibodies known as etesevimab and bamlanivimab after the U.S.-based drugmaker withdrew from the process https://www.ema.europa.eu/en/news/ema-ends-rolling-review-antibodies-bamlanivimab-etesevimab-covid-19-following-withdrawal-lilly.

Lilly's letter https://www.ema.europa.eu/en/documents/withdrawal-letter/withdrawal-letter-bamlanivimab-etesevimab_.pdf to the regulator, dated Oct. 29, said that lack of demand in the trading bloc did not justify submitting further required data on its manufacturing plan.

"At this point Lilly is not in a position to generate the additional data required by the CHMP (EMA's human medicines committee) to progress to a formal marketing authorization application," the company said.

The news comes on the day that the U.S. government agreed to buy 614,000 additional doses of Lilly's antibody combo for $1.29 billion, which follows the purchase of 388,000 doses of etesevimab in September to supplement stocks of bamlanivimab it had previously bought.

The United States had already given emergency approval for the drug cocktail for patients at an early stage of the disease to prevent deterioration and for some people who have been exposed to the virus.

Even though the EU in September procured 220,000 courses of bamlanivimab and etesevimab, contingent on approval, the EU Commission in mid-October omitted the combination from a list https://ec.europa.eu/commission/presscorner/detail/en/IP_21_5366 of 10 treatments most promising for COVID-19.

The EU in March signed a deal with Roche for an antibody cocktail developed with Regeneron, and in July struck another deal for GlaxoSmithKline and Vir's antibody drug.

Federal Judge Blocks Hospital From Putting Unvaccinated Workers On Unpaid Leave

 by Jack Phillips via The Epoch Times,

A federal judge temporarily blocked an Illinois hospital system from allegedly putting workers with religious exemptions on unpaid leave.

In late October, several employees at the Chicago-area NorthShore filed a legal complaint against the company, arguing that the firm’s vaccine mandate discriminated against them by forcing them to decide between a vaccine and their jobs.

Liberty Counsel, which is representing the 14 health care workers, said in an emailed statement last week that the “plaintiffs have shared these religious beliefs, and others, with NorthShore, and have asked NorthShore for exemption and reasonable accommodation for these beliefs, but NorthShore has unlawfully and callously refused.”

U.S. District Judge John Kness on Friday issued a temporary restraining order against the hospital system.

“They can’t be fired and they can’t be placed on what is effectively, in my mind, unpaid leave,” Kness said during a hearing on the lawsuit, reported the Chicago Tribune.

NorthShore is “going to have to keep paying them. If you wish to require them to show up to work and use [personal protective equipment] and go through testing because you need the help and you don’t want to pay them to be off site, that’s up to the hospital,” he added.

Liberty Counsel said that more than a week ago, “NorthShore had already started purging those employees with sincere religious objections to its ‘Mandatory COVID-19 Vaccination Policy'” and removed many employees with religious exemptions from its November work schedule. That included staff members with appeals that were pending, Liberty Counsel said.

Federal Equal Employment Opportunity Commission guidelines say that employees may ask to be exempted from vaccine requirements due to religious or medical reasons. However, workplaces do not necessarily have to grant the exemptions under certain circumstances, the agency’s guidance adds.

Horatio Mihet, a lawyer representing the plaintiffs, told the Chicago Tribune that unvaccinated workers can still work there while wearing personal protective equipment and getting weekly testing.

NorthShore previously told The Epoch Times that it understands “that getting vaccinated may be a difficult decision for some of our team members” and values “their committed service and respect their beliefs.” On Monday, NorthShore didn’t immediately respond to a request for comment.

“We must prioritize the safety of our patients and team members in support of our broader mission,” the hospital system said.

NorthShore, in a statement to local media last week, disputed several claims in the lawsuit and had “considered each request based on multiple criteria” on exemptions.