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Friday, January 5, 2024

Florida can import prescription drugs from Canada, US regulators say

 The Food and Drug Administration on Friday cleared the way for Florida’s first-in-the-nation plan to import prescription drugs from Canada, a long-sought approach to accessing cheaper medications that follows decades of frustration with U.S. drug prices.

Republican Gov. Ron DeSantis signed the plan into law in 2019, but it required federal review and approval by the FDA, which controls prescription drug imports.

Democratic President Joe Biden has backed such programs as a way to lower prices, signing an executive order in 2021 that directed the FDA to work with states on imports.

The policy change represented a shift after years of successful lobbying by the pharmaceutical industry, which said imports would expose U.S. patients to risks of counterfeit or adulterated drugs. The FDA also previously warned of the difficulties of assuring the safety of drugs originating from outside the U.S.

The FDA said Florida’s program will be authorized for two years, though imports won’t begin immediately. Under federal requirements, state officials must first test the drugs to make sure they’re authentic and relabel them so that they comply with U.S. standards.

Florida’s health department must also provide a quarterly report to the FDA on the types of drugs imported, cost savings and any potential safety and quality issues.

“These proposals must demonstrate the programs would result in significant cost savings to consumers without adding risk of exposure to unsafe or ineffective drugs,” FDA Commissioner Dr. Robert Califf said in a statement.

DeSantis, who is battling Trump for the Republican presidential nomination, previously sued the Biden administration for allegedly delaying approval of the import program. Several other states are also awaiting federal approval.

The FDA is likely to face legal challenges over the decision, which the pharmaceutical industry’s trade group called “a serious danger to public health.”

“We are deeply concerned with the FDA’s reckless decision to approve Florida’s state importation plan,” Pharmaceutical Research and Manufacturers of America said in a statement Friday.

Many people already buy at least some of their medicines from pharmacies in Canada or Mexico, although technically it’s illegal to import them.

Work on allowing state imports began under Trump, a relentless critic of industry pricing.

Under the current regulations, states can import certain medicines through pharmacies and wholesalers. DeSantis has previously estimated taxpayers could save up to $150 million annually under the program.

The state’s proposal includes a number of drug classes, including medications for asthma; chronic obstructive pulmonary disease, or COPD; diabetes; HIV and AIDS; and mental illness.

The medications would be only for certain people, including foster children, inmates, certain elderly patients and — eventually — Medicaid recipients.

Like most developed nations, Canada sets limits on the prices drugmakers can charge if they wish to enter the market. Health officials there previously have suggested their country’s prescription drug market is too small to have any real impact on U.S. prices.

The U.S. has long had the highest prescription drug prices in the world, with essentially no government limits on what companies can charge. Only in 2022 did Congress pass a law allowing the federal government to negotiate prices for a small number of medications used by seniors in the Medicare program. The first such negotiations are set to take place later this year.

https://apnews.com/article/florida-canada-prescription-drug-imports-c2893394e952754c3d2a5a19b0edb8bd

Novartis expands production of Pluvicto

 

  • FDA approval of the company’s second US Radioligand Therapy (RLT) manufacturing facility increases RLT production capacity to 250,000 doses in 2024 and beyond

  • New 70,000-square foot RLT facility is the company’s largest and most advanced in the world to date and centrally located in the US to maximize access for patients and treatment centers

  • With four active RLT manufacturing sites and unconstrained supply, Novartis can sufficiently meet current and future demand as ongoing clinical trials may present the potential to bring Pluvicto and Lutathera® to more patients in earlier lines of treatment

  • Novartis is investigating a broad portfolio of RLTs in advanced cancers including breast, colon, neuroendocrine, lung, pancreatic and prostate to continue meeting global patient needs

Vaxcyte Update on Potential Best-in-Class Pneumococcal Conjugate Vaccine (PCV) Franchise

 Company Doses First Participants in Phase 2 Portion of Ongoing VAX-31 Phase 1/2 Study in Adults Following Independent Review of Phase 1 Safety and Tolerability Data; Topline Safety, Tolerability and Immunogenicity Data Expected in Third Quarter of 2024 --

-- Following Successful End-of-Phase 2 Meeting with FDA, Company Planning for Initiation of VAX-24 Adult Phase 3 Pivotal, Non-Inferiority Study in Second Half of 2024; Topline Data Expected in Second Half of 2025 --

-- Company Received Encouraging Input on VAX-24 Adult CMC Licensure Requirements and Plans to Seek Additional FDA Guidance as Phase 3 Program Advances --

-- Company Outlines Expected Phase 3 Timelines for VAX-24 and VAX-31 Adult Programs --

-- Enrollment in Ongoing VAX-24 Infant Phase 2 Study Continues to Progress; Topline Data from Primary Immunization Series Expected by End of First Quarter of 2025, Followed by Topline Data from Booster Dose by End of 2025 --

https://www.globenewswire.com/news-release/2024/01/04/2804307/0/en/Vaxcyte-Provides-Clinical-and-Regulatory-Progress-Update-on-Potential-Best-in-Class-Pneumococcal-Conjugate-Vaccine-PCV-Franchise.html

Weight loss drugs Ozempic and Wegovy may not increase thoughts of suicide: study

 As the popularity of weight loss and diabetes drugs has grown, so have concerns about their possible psychiatric side effects.

But a major new study finds that semaglutide — the ingredient in Ozempic and Wegovy — has a significantly lower risk of suicidal thoughts compared to other weight-loss medications.

"We can confidently state that our analyses do not support claims of increased suicidality in patients who are prescribed semaglutide," said Dr. Nora Volkow, director of the National Institute on Drug Abuse. The agency was keen to look into semaglutide because it's also under investigation as a potential treatment for drug addiction.

"It would be vital to ensure it does not cause negative mental health effects to put an already vulnerable population at even greater risk of harmful health outcomes," Volkow said.

The research, published Friday in Nature Medicine, analyzed the medical records of nearly 1.6 million patients with type 2 diabetes and 240,618 patients with obesity.

Patients who had been prescribed semaglutide were up to 73% less likely than patients prescribed other weight loss or diabetes medications, such as metformin, to report suicidal thoughts while taking the drugs.

"It's great to see this positive data," said Dr. Andres Acosta, an associate professor of medicine at the Mayo Clinic in Rochester, Minnesota, who was not involved with the new study. "It's quite exciting to see that these medications do not increase the risk for suicidal ideation."

Semaglutide, a GLP-1 agonist, works by helping to regulate appetite and insulin levels by targeting glucagon-like peptide 1 receptors (GLP1R) in the body.

The Food and Drug Administration approved Ozempic in 2017 to help manage type 2 diabetes. Wegovy arrived in 2021 to treat obesity.

Prescriptions for the drugs rose dramatically as they hit the U.S. market, increasing by 4,200% from 2018 to 2023, according to Epic Research, a data analysis company.

Since their widespread use, the drugs have been found to act in different ways in the body. One study found that Wegovy can reduce the risk of heart attack and strokes. Some patients reported abdominal pain, nausea and vomiting and more severe stomach problems. Others said they had thoughts of suicide while taking the drugs.

The FDA is looking into reports of these potential side effects.

"The FDA continues to monitor the safety of all approved products, including monitoring for suicidal behavior and ideation associated with use of GLP-1 receptor agonists for all approved uses, and will inform the public and take regulatory action to protect the public health if appropriate," the agency said in a statement.

Other GLP-1 receptor agonists in the agency's investigation include Mounjaro, Trulicity and Zepbound.

Novo Nordisk, which makes Ozempic and Wegovy, said in a statement that while the company is "continuously performing surveillance" of the drugs, it "remains confident in the benefit risk profile of the products and remains committed to ensuring patient safety." Novo Nordisk did not play a role in the new study.

Longer-term research is needed, as the NIDA study only looked at 6 months of data.

"It's very feasible that someone who is affected by excess weight could be on medication like this for decades," said Dr. David Creel, a psychologist and registered dietitian at the Cleveland Clinic. "We need to look for evidence that there could be any problems with long-term use." Creel was not involved with the NIDA study.

Still, the findings are in line with what doctors say they have generally observed with patients on semaglutide. The drugs work so well so quickly, especially for people trying to lose weight, that mood is generally positive — at least in the short-term.

"If you've been trying your whole life to lose weight and nothing's ever worked, and you're depressed about it, and then all of a sudden you start taking a medication that's making moves," said Dr. Shauna Levy, medical director of the Tulane Weight Loss Center in New Orleans, who was not involved with the new study, "your spirits are going to be lifted."

https://www.nbcnews.com/health/health-news/ozempic-wegovy-lower-suicidal-thoughts-weight-loss-drugs-study-rcna132181

Why Medical Properties Trust Stock Is Crashing

 Shares of Medical Properties Trust (NYSE: MPW) were crashing 29.7% lower as of 10:20 a.m. ET on Friday. The steep decline came after the company provided an update following the market close on Thursday about its tenant, Steward Health Care System.

Steward recently told Medical Properties Trust that "its liquidity has been negatively impacted by significant changes to vendors' payment terms." Because of this, Steward's total unpaid rent rose to around $50 million as of the end of 2023. The hospital operator is also continuing to make only partial monthly rent payments.

Medical Properties Trust said that it has engaged a financial advisor and a law firm to advise it on options to collect the money that Steward owes. The real estate investment trust (REIT) has agreed to fund a $60 million bridge loan to Steward and defer unpaid rent. It also plans to write off around $225 million in rent in the fourth quarter of 2023.

How bad is Medical Properties Trust news?

Make no mistake about it, Steward's ongoing financial difficulties are bad for Medical Properties Trust. But just how bad? Steward is the REIT's top tenant, accounting for 19.98% of its total assets and 23% of its total revenue in the third quarter of 2023. Medical Properties Trust also has made a sizable investment in the hospital operator.

It's possible that Steward's outlook could improve, though. The hospital chain hopes to either sell or find new tenants for some of its facilities as well as divest some noncore operations. It's also taking steps to improve its collections process.

Is Medical Properties buy on pullback?

I genuinely thought that the worst was over for Medical Properties Trust as 2023 came to a close. The REIT's Q3 update in October gave some reasons to be cautiously optimistic. However, the latest news about Steward's troubles changes my perspective considerably.

Buying Medical Properties Trust stock on the pullback likely is not a good move at this point. Investors will be better off waiting to see what happens with the Steward situation.

Applied Therapeutics fails heart disease phase 3, seeks partner to bring molecule to market

 Applied Therapeutics’ stock market winning streak has come to an end. Having seen its shares soar over the past year, the biotech suffered a setback Thursday when it reported the failure of a phase 3 heart disease trial to hit its primary endpoint.

Last year, updates on Applied’s rare disease drug candidate govorestat sent the stock up and up, despite a primary endpoint miss, a trend that continued early this week when news of the acceptance of regulatory filings brought the biotech’s stock gains over the past year up above 325%. Phase 3 data on another candidate, AT-001, offered Applied the opportunity to climb higher still.

Instead, the biotech reported the failure of AT-001, an aldose reductase inhibitor, to beat placebo on its primary endpoint. The trial randomized patients with diabetic cardiomyopathy at high risk of progression to overt heart failure to receive AT-001 or placebo twice daily.

Over 15 months of treatment, Peak VO2, a measure of cardiac functional capacity, fell by 0.01 ml/kg/min in the AT-001 cohort and 0.31 ml/kg/min in the placebo group. The numerical difference fell short of statistical significance, causing the study to miss its primary endpoint with a p value of 0.210.

Investors responded by sending Applied’s share price down 29% to $2.70 in after-hours trading, wiping out the gains made over the past month. But the biotech called the results “encouraging,” pointing to the fact cardiac functional capacity stabilized in patients on AT-001 and a pre-specified subgroup analysis of the 62% of participants who weren’t taking SGLT2 or GLP-1 therapies for diabetes to make its case.

In the subgroup, Applied tracked a 0.54 ml/kg/min worsening of Peak VO2 in the placebo group and a 0.08 ml/kg/min improvement in the AT-001 cohort. More patients on placebo, 46%, than AT-001, 32.7%, suffered a 6% or more worsening of cardiac capacity, a decline associated with long-term survival and hospitalization for heart failure. 

Applied saw no substantial differences in serious adverse events or treatment emergent adverse events between the AT-001 and placebo groups, leading chief medical officer Riccardo Perfetti, M.D., Ph.D., to argue the molecule is an “important potential tool” for treating diabetic cardiomyopathy. No drugs are approved in the indication, although the cardiovascular labels of SGLT2 inhibitors may cover the patients.

The biotech wants a partner to help bring AT-001 to market. Applied, which ended September with $37.5 million, plans to focus on bringing govorestat to market as a treatment for classic galactosemia. Like AT-001, govorestat is an aldose reductase inhibitor that is designed to avoid the off-target toxicity that undid earlier efforts to target the enzyme.

https://www.fiercebiotech.com/biotech/applied-therapeutics-fails-heart-disease-phase-3-seeks-partner-bring-molecule-market

agilon 2023 Guidance Update, Initial 2024 View

Revised 2023 expectations and early outlook for 2024 reflect higher medical and non-medical costs

Company is taking targeted actions to improve visibility, balance risk-sharing, and improve predictability of results in 2024 and over the long term

agilon health to host conference call at 8:00 AM Eastern Time today

agilon health will host a conference call to discuss the company’s updated guidance for 2023 and initial 2024 outlook on Friday, January 5, 2024 at 8:00 AM Eastern Time. The conference call can be accessed by dialing (800) 590-8290 for U.S. participants and +1 (240) 690-8800 for international participants and referencing participant code AGL2024. A simultaneous webcast can be accessed by visiting the “Events & Presentations” section of agilon’s Investor Relations website at https://investors.agilonhealth.com. A replay of the call will be available via webcast for on-demand listening shortly after the completion of the call.

https://www.businesswire.com/news/home/20240105032829/en/