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FDA Warns Manufacturers and Retailers to Remove Certain E-cigarette Products Targeted to Youth from the Market

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April 27, 2020: “The U.S. Food and Drug Administration issued ten warning letters to retailers and manufacturers who sell, manufacture and/or import unauthorized electronic nicotine delivery system (ENDS) products targeted to youth or likely to promote use by youth.

The warning letters were sent to establishments marketing unauthorized products, such as a backpack and sweatshirt designed with stealth pockets to hold and conceal an e-cigarette, ENDS products that resemble smartwatches, or devices appearing as children’s toys such as a portable video game system or fidget spinner.

Warning letters were also issued to companies marketing e-liquids that imitate packaging for food products that often are marketed and appeal to youth, such as candy, or feature cartoon characters like SpongeBob SquarePants.

These warning letters are part of the FDA’s ongoing enforcement efforts against ENDS and other deemed tobacco products illegally on the market.

The warning letters are also in line with the agency’s stated enforcement priorities against any ENDS product targeted to youth or likely to promote use by youth.

If the recipients of these warning letters do not cease the manufacture, distribution and/or sale of these unauthorized tobacco products, they risk additional FDA action such as an injunction, seizure and/or civil money penalty actions.

“The FDA is focused on manufacturers and retailers that make and sell ENDS products that are targeted to youth and increase their appeal. The public should really be outraged by these products.

The FDA is especially disturbed by some of these new products being marketed to children and teens by promoting the ease with which they can be used to conceal product use, which appeals to kids because it allows them to conceal tobacco product use from parents, teachers, law enforcement or other adults,” said Mitch Zeller, J.D., director of the FDA’s Center for Tobacco Products.

“Even in the midst of the COVID-19 pandemic, we have not lost our focus on protecting youth against the dangers of e-cigarettes and will do everything we can to take action.

These warning letters should send a clear message to all tobacco product manufacturers and retailers that the FDA is keeping a close watch on the marketplace. If you’re marketing or selling these products to youth, the FDA will not tolerate it.”

The following retailers and/or manufacturers or importers received a warning letter:

  • Vaprwear Gear, LLC (manufacturer, online retailer)
  • Vapewear, LLC (manufacturer, online retailer)
  • Wizman Limited (manufacturer, online retailer)
  • EightCig, LLC (online retailer)
  • Ejuicepack, LLC (online retailer)
  • Vape Royalty, LLC (online retailer)
  • VapeCentric, Inc. (online retailer)
  • Dukhan Store (online retailer)
  • VapeSourcing (online retailer)
  • Shenzhen Uwell Technology Co., Ltd. d/b/a DTD Distribution Inc. (importer, retailer)

These products appeal to youth in the way they are designed and labeled. For example, Vaprwear Gear’s pullover and backpack products hold pod systems that deliver vapor through hosing discreetly woven through hidden pockets.

This design allows the products to be used for vaping without raising the attention of parents, teachers or other adults.

Similarly, the Vapewear vWaTch Starter Kit, Wizman Puff Boy Mod and VooPoo Rota 340mAh Pod System Kit look like products that are popular with kids, such as smartwatches, video game systems and fidget spinners, that can be carried or worn without revealing they are tobacco products.

Under the Federal Food, Drug, and Cosmetic Act (FD&C Act), all these products are considered tobacco products because they are made or derived from tobacco and intended for human consumption or components or parts of such products

The FDA has also issued warning letters to 73 brick-and-mortar retailers for selling unauthorized flavored, cartridge-based ENDS products.

This follows 22 warning letters that FDA issued last month for similar violations to online and brick-and-mortar retailers and manufacturers across the country.

These warning letters are part of a series of ongoing actions consistent with the FDA’s recently issued policy of enforcement priorities for e-cigarettes and other deemed products on the market.

Last month, in line with the agency’s actions to protect the health and well-being of staff during the COVID-19 outbreak, the FDA issued a partial stop-work order to the entities the agency contracts with at the state level for activities such as compliance checks and vape shop inspections.

The inspections related to the actions announced today occurred before the stop-work order. The FDA continues to evaluate the effect of COVID-19 on its programmatic activities and will continue to communicate any changes as they occur.

Guided by health and safety considerations, the FDA will continue taking appropriate actions, as outlined by its priorities, on a rolling basis.

These warning letters notify the retailers and manufacturers that new ENDS products without a marketing authorization order are adulterated and misbranded, and selling or distributing these products to customers in the U.S. is prohibited under the FD&C Act. Retailers and distributors are encouraged to communicate with their suppliers to discuss possible options for unauthorized products in their inventory.

Additionally, as part of the agency’s efforts, the FDA has issued import alerts for unauthorized tobacco products, including certain unauthorized ENDS products, imported into the U.S. informed by the agency’s enforcement priorities outlined in FDA’s guidance.

Adulterated and misbranded tobacco products offered for import into the United States are subject to detention and refusal of admission.

The FDA has also issued letters to more than 110 companies seeking information about the legal marketing status of more than 140 ENDS products.

Ultimately, manufacturers that intend to continue marketing any deemed, new tobacco product on the market as of Aug. 8, 2016—including ENDS products—must submit an application to the FDA by Sept. 9, 2020 that demonstrates that the product meets the applicable standard in the law, such as whether the product is appropriate for the protection of the public health.

This date was recently extended (from May 12, 2020) due to the impact of the coronavirus pandemic.

As a resource for manufacturers preparing and submitting tobacco product applications for newly deemed products, the FDA recently launched a new webpage to provide a single location for all relevant information, including tips and resources on the application submission processes.

For certain deemed tobacco products, the FDA is already prioritizing its enforcement, as outlined in its guidance on enforcement priorities for ENDS and other deemed tobacco products.

All of these efforts, in addition to enforcement of the new law raising the federal minimum age for sale of tobacco products from 18 to 21 years and the recent expansion of the FDA’s public education campaign to include videos featuring teenagers sharing cautionary tales about their e-cigarette addiction, are aimed at keeping these products out of the hands of youth.

All of these efforts, in addition to enforcement of the new law raising the federal minimum age for sale of tobacco products from 18 to 21 years and the recent expansion of the FDA’s public education campaign to include videos featuring teenagers sharing cautionary tales about their e-cigarette addiction, are aimed at keeping these products out of the hands of youth.

The agency also recently released new resources with ScholasticExternal Link Disclaimer for middle and high-school educators and school administrators.

The materials, which include new lessons, worksheets and videos, are available online for free and are adaptable for virtual learning.

All of these efforts, in addition to enforcement of the new law raising the federal minimum age for sale of tobacco products from 18 to 21 years and the recent expansion of the FDA’s public education campaign to include videos featuring teenagers sharing cautionary tales about their e-cigarette addiction, are aimed at keeping these products out of the hands of youth.

The agency also recently released new resources with ScholasticExternal Link Disclaimer for middle and high-school educators and school administrators.

The materials, which include new lessons, worksheets and videos, are available online for free and are adaptable for virtual learning.

The FDA continues to monitor youth use of all e-cigarette products and will continue to expand its public education efforts and use the agency’s regulatory authority—changing course as necessary—to further ensure all tobacco products, and e-cigarette products, in particular, are not marketed to, sold to, or used by youth.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices.

The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.”

https://www.fda.gov/news-events/press-announcements/fda-warns-manufacturers-and-retailers-remove-certain-e-cigarette-products-targeted-youth-market

Novacyt contract with the UK Department of Health and Social Care for the supply of COVID-19 PCR tests

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April 27, 2020: Novacyt, an international specialist in clinical diagnostics, announces it has signed a supply contract with the UK Department of Health and Social Care (DHSC) for its COVID-19 (CE IVD) polymerase chain reaction (PCR) test, developed by Primerdesign, the Company’s molecular diagnostics division based in the UK.

Under the terms of the agreement, Novacyt will supply its COVID-19 test to the DHSC for an initial term of six months, starting from 4 May 2020. Novacyt has initially committed to supply 288,000 tests per week to the DHSC for use in the NHS, with the option to expand the agreement.

This partnership with the DHSC reinforces Novacyt’s existing support of the UK government’s five-pillar plan to increase testing for COVID-19.

The contract is in addition to the Company’s collaboration with AstraZeneca, GSK and the University of Cambridge, announced on 8 April 2020, where Novacyt is committed to ensure an effective workflow process within the facility for COVID-19 testing, as well as provide its COVID-19 test to generate results data.

Graham Mullis, Chief Executive Officer of Novacyt, commented: “Novacyt is committed to fighting the global COVID-19 pandemic. This partnership with the UK’s Department of Health and Social Care reinforces Novacyt’s position as a leading supplier of COVID-19 tests to the NHS.”

https://novacyt.com/wp-content/uploads/2020/04/Novacyt-DHSC-contract-ENGLISH-27.04.2020.pdf

FDA Warns of Heart Risks With Trump-Promoted Malaria Drug

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April 24, 2020: “The U.S. Food and Drug Administration on Friday warned doctors against prescribing a malaria drug touted by President Donald Trump for treating the new coronavirus except in hospitals and research studies.

In an alert, regulators flagged reports of sometimes fatal heart side effects among coronavirus patients taking hydroxychloroquine or the related drug chloroquine.

The decades-old drugs, also prescribed for lupus and rheumatoid arthritis, can cause a number of side effects, including heart rhythm problems, severely low blood pressure and muscle or nerve damage.

The warning comes as doctors at a New York hospital published a report that heart rhythm abnormalities developed in most of 84 coronavirus patients treated with hydroxychloroquine and the antibiotic azithromycin, a combo Trump has promoted.

Both drugs are known to sometimes alter the heartbeat in dangerous ways, and their safety or ability to help people with COVID-19 is unknown.

A National Institutes of Health experts panel earlier this week recommended against taking that drug combo except in a formal study because of the side effects potential.

Last month, the FDA authorized limited use of malaria drugs for hospitalized patients with COVID-19 who aren’t enrolled in ongoing research.

The FDA said the drugs’ risks are manageable when patients are carefully screened and monitored by doctors. A number of studies are testing hydroxychloroquine as a treatment or for prevention of COVID-19.

Regulators said they are now investigating dangerous side effects and deaths reported with the malaria drugs to poison control centers and other health authorities.

“It is important that health care providers are aware of the risks of serious and potentially life-threatening heart rhythm problems that can occur with these drugs,” the FDA said in a statement. The agency did not specify the number of reports it has received of side effects or deaths.

Calls to U.S. poison control centers about the malaria drugs increased last month to 79, compared to 52 in March 2019, according to Dr Christopher Hoyte of the Rocky Mountain Poison Center in Denver, Colorado. The problems reported include abnormal heart rhythms, seizures, nausea and vomiting, Hoyte said.

Trump has repeatedly touted hydroxychloroquine during his regular coronavirus briefings, suggesting its skeptics would be proven wrong. He has offered patient testimonials that the drug is a lifesaver.

But a number of early coronavirus studies have suggested problems or no benefit.
https://www.usnews.com/news/health-news/articles/2020-04-24/fda-warns-of-risks-with-trump-promoted-malaria-drug

FDA approves MenQuadfiTM, the latest innovation in meningococcal (MenACWY) vaccination

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April 24, 2020: “The U.S. Food and Drug Administration (FDA) has approved a Biologics License Application for MenQuadfiTM Meningococcal (Groups A, C, Y, W) Conjugate Vaccine for the prevention of invasive meningococcal disease in persons 2 years of age and older.

“Meningococcal meningitis remains a major global health challenge because it can strike quickly and with devastating effect, taking a life in less than 24 hours. With the ability to help prevent this disease through vaccination, Sanofi believes one case is one too many,” said David Loew, Executive Vice President, Sanofi Pasteur.

“Approval of this new vaccine in the U.S. represents an important milestone in the ongoing fight to help protect as many people as possible from meningococcal disease. It is our ambition to make this vaccine available to further expand protection to individuals worldwide.”

MenQuadfi is Sanofi’s Latest MenACWY Innovation
MenQuadfi was designed to elicit and demonstrated a high immune response across all four serogroups for multiple ages and was well tolerated. MenQuadfi is intended to protect an expanded age group.

Licensure marks MenQuadfi as the only U.S. FDA-approved quadrivalent meningococcal vaccine indicated for persons 2 through 56 years of age and older.1

MenQuadfi is the first and only quadrivalent meningococcal vaccine in the U.S. that uses tetanus toxoid as a protein carrier. It will be available in a ready-to-use liquid formulation allowing healthcare providers to avoid vaccine reconstitution.

The ongoing Phase 3 trials are investigating use in infants as young as 6 weeks of age to better address the worldwide needs for meningococcal disease prevention throughout life.

“Given the severity and unpredictability of meningococcal disease, there is a public health need to ensure immunization across multiple ages, consistent with U.S. recommendations,” said Corey Robertson, MD, Senior Director, Scientific and Medical Affairs at Sanofi Pasteur.

“MenQuadfi’s pivotal clinical trials demonstrated a high immune response across all four serogroups and provides a new vaccine option to help protect an expanded age group.”

MenQuadfi’s FDA approval is based on a robust clinical program

The FDA approval is based on clinical data from five double-blind, randomized, multicenter Phase 2 and 3 trials that assessed safety and immune responses following vaccination, with nearly 5,000 persons 2 years of age and older.

Based on study objectives, immune responses elicited by MenQuadfi achieved non-inferiority compared to those induced by licensed quadrivalent meningococcal vaccines.

Four studies evaluated MenQuadfi in meningococcal-naïve persons; the other study evaluated MenQuadfi in persons previously immunized with a quadrivalent meningococcal vaccine.

Against each of the four meningococcal serogroups (A, C, W, Y), the majority (55.4%–97.2%) of meningococcal-naïve trial participants had a vaccine-induced immune response 30 days following vaccination with MenQuadfi.

Among adolescents and adults previously vaccinated, 92.2%–98.2% demonstrated an immune response against each serogroup. The most common side effects following a first dose of MenQuadfi included injection site pain (25.5%–45.2%), muscle ache (20.1%–35.6%), headache (12.5%–30.2%), and tiredness (14.5%–26.0%).

In adolescents and adults receiving a MenQuadfi booster, similar rates of these reactions were observed.

Pivotal study results demonstrating MenQuadfi’s safety and effectiveness in inducing an immune response across all four serogroups have been published, including the performance of MenQuadfi in adolescents when the vaccine was co-administered with other routinely recommended vaccines, and its performance as a booster.

 Additional data were presented at the 2019 European Society for Paediatric Infectious Diseases Annual Meeting and IDWeek 2019.

MenQuadfi is expected to be available to providers and pharmacies nationwide in the U.S. for immunization efforts in 2021.

Sanofi’s legacy includes more than 45 years at the forefront of meningococcal disease prevention

MenQuadfi builds on Sanofi’s legacy at the forefront of meningococcal disease prevention beginning with the first monovalent vaccine for Africa in 1974.

Since then, Sanofi has worked to progressively extend protection against four of the most prevalent meningococcal disease serogroups with the first quadrivalent vaccine registered in the U.S. in 1981, followed by the first quadrivalent conjugate vaccine licensed in 2005.

Meningococcal Disease is a Public Health Concern

In the U.S., the Centers for Disease Control and Prevention recommends vaccination against meningococcal disease at 11-12 years of age and a second dose at 16 years of age.5

Despite strong public health recommendations, about half of teens have not received the recommended second dose of MenACWY vaccine by 17 years of age, leaving them vulnerable when they are at increased risk for the disease.

 Hundreds of cases of vaccine-preventable meningococcal disease (caused by serogroups B, C, W, Y) still occur annually in the U.S. and, despite treatment, one in five survivors suffer from permanent complications such as hearing loss, organ damage, and limb amputations.

Around the world, meningococcal disease is highly unpredictable, and it varies widely across regions and ages.

Accordingly, vaccination recommendations differ from country to country. Disease still occurs in unvaccinated individuals. MenQuadfi’s safety and effectiveness data are currently under review though not yet fully evaluated by other health authorities, including those in several other countries and the European Union, to help address their local vaccination recommendations.  

MenQuadfi is a vaccine given to people 2 years of age and older to help prevent invasive meningococcal disease (including meningitis) caused by serogroups A, C, W, and Y of the bacterium N meningitidis. MenQuadfi does not prevent serogroup B disease.

Important Safety Information for MenQuadfi in the U.S.

MenQuadfi should not be given to people who have had a severe allergic reaction after a previous dose of MenQuadfi, any of its ingredients, or another vaccine that contains tetanus toxoid. 

If MenQuadfi is given to people with a compromised immune system, including those receiving therapies that suppress the immune system, the immune response may be lower than expected.

People with certain complement deficiencies and people taking certain complement inhibitors (for example, eculizumab) may still be at risk for meningococcal disease even if they receive a meningococcal vaccine, including MenQuadfi.

Fainting can occur shortly before or after injecting vaccines, including MenQuadfi. 

Tell your health care provider if you ever had Guillain-Barré syndrome (severe muscle weakness) after a previous meningococcal vaccination. 

Vaccination with MenQuadfi may not protect all people who receive the vaccine.

The most common side effects after a first dose of MenQuadfi for people 2 years and older include pain where the shot is given; muscle aches, headache, and tiredness. In children 2 through 9 years of age, other common side effects include redness and swelling where the shot is given.

In adolescents and adults receiving a booster dose of MenQuadfi, the most common side effects include those occurring after a first dose. Other side effects may occur.”
https://www.sanofi.com/en/media-room/press-releases/2020/2020-04-24-07-00-00

Global leaders unite to ensure everyone everywhere can access new vaccines, tests and treatments for COVID-19

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April 24, 2020: GENEVA – Heads of state and global health leaders today made an unprecedented commitment to work together to accelerate the development and production of new vaccines, tests and treatments for COVID-19 and assure equitable access worldwide.

The COVID-19 pandemic has already affected more than 2.4 million people, killing over 160,000. It is taking a huge toll on families, societies, health systems and economies around the world, and for as long as this virus threatens any country, the entire world is at risk. 

There is an urgent need, therefore, while following existing measures to keep people physically distanced and to test and track all contacts of people who test positive, for innovative COVID-19 vaccines, diagnostics and treatments.

“We will only halt COVID-19 through solidarity,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “Countries, health partners, manufacturers, and the private sector must act together and ensure that the fruits of science and research can benefit everybody.”

Work has already started. Since January, WHO has been working with researchers from hundreds of institutions to develop and test vaccines, standardize assays and standardize regulatory approaches on innovative trial designs and define criteria to prioritize vaccine candidates. 

The Organization has prequalified diagnostics that are being used all over the world, and more are in the pipeline. And it is coordinating a global trial to assess the safety and efficacy of four therapeutics against COVID-19.

The challenge is to speed up and harmonize processes to ensure that once products are deemed safe and effective, they can be brought to the billions of people in the world who need them.

Past experience, in the early days of HIV treatment, for example, and in the deployment of vaccines against the H1N1 outbreak in 2009, shows that even when tools are available, they have not been equally available to all.

So today leaders came together at a virtual event, co-hosted by the World Health Organization, the President of France, the President of the European Commission, and the Bill & Melinda Gates Foundation.

The event was joined by the UN Secretary General, the AU Commission Chairperson, the G20 President, heads of state of France, South Africa, Germany, Vietnam, Costa Rica, Italy, Rwanda, Norway, Spain, Malaysia and the UK (represented by the First Secretary of State).

Health leaders from the Coalition for Epidemic Preparedness Innovations (CEPI), GAVI-the Vaccine Alliance, the Global Fund, UNITAID, the Wellcome Trust, the International Red Cross and Red Crescent Movement (IFRC), the International Federation of Pharmaceutical Manufacturers (IFPMA), the Developing Countries Vaccine Manufacturers’ Network (DCVMN), and the International Generic and Biosimilar Medicines Association (IGBA) committed to coming together, guided by a common vision of a planet protected from human suffering and the devastating social and economic consequences of COVID-19, to launch this groundbreaking collaboration.

They are joined by two Special Envoys:  Ngozi Okonjo-Iweala, Gavi Board Chair and Sir Andrew Witty, former CEO of GlaxoSmithKline.

They pledged to work towards equitable global access based on an unprecedented level of partnership. They agreed to create a strong unified voice, to build on past experience and to be accountable to the world, to communities and to one another.

“Our shared commitment is to ensure all people have access to all the tools to prevent, detect, treat and defeat COVID-19,” said Dr Tedros. “No country and no organization can do this alone. The Access to COVID-19 Tools Accelerator brings together the combined power of several organizations to work with speed and scale.”

Health leaders called on the global community and political leaders to support this landmark collaboration and for donors to provide the necessary resources to accelerate achievement of its objectives, capitalizing on the opportunity provided by a forthcoming pledging initiative that starts on 4 May 2020.

This initiative, spearheaded by the European Union, aims to mobilize the significant resources needed to accelerate the work towards protecting the world from COVID-19.
https://www.who.int/news-room/detail/24-04-2020-global-leaders-unite-to-ensure-everyone-everywhere-can-access-new-vaccines-tests-and-treatments-for-covid-19

Scancell to initiate development of novel DNA vaccine against COVID-19

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April 24, 2020: Scancell Holdings plc, the developer of novel immunotherapies for the treatment of cancer, announces that it has initiated a research programme to develop a vaccine for COVID-19.

The project will be led by Professor Lindy Durrant, Chief Scientific Officer and Professor of Cancer Immunotherapy at the University of Nottingham, in collaboration with scientists in the newly established Centre for Research on Global Virus Infections and the new Biodiscovery Institute at the University of Nottingham, and Nottingham Trent University1.

Scancell’s DNA vaccines target dendritic cells to stimulate high avidity T cells that survey and destroy diseased cells.

This approach was highly successful with Scancell’s lead ImmunoBody® cancer vaccine, SCIB1, which was safely administered to patients with malignant melanoma, and mediated excellent 5-year survival in a Phase 1/2 clinical trial.

Scancell’s aim is to utilise its proven clinical expertise in cancer to produce a simple, safe, cost-effective and scalable vaccine to induce both durable T cell responses and virus neutralising antibodies (VNAbs) against COVID-19.

As research data emerges, it is becoming increasingly clear that the induction of potent and activated T cells may play a critical role in the development of long-term immunity and clearance of virus-infected cells.

Although other vaccines may reach the clinic earlier, the Company believes its combined T cell and antibody approach should give more potent and long-lasting responses, ultimately leading to better protection. SARS-CoV-2 is a virus that causes COVID-19.

Scancell’s DNA vaccine will target the SARS-CoV-2 nucleocapsid (N) protein and the key receptor-binding domain of the spike (S) protein to generate both T cell responses and VNAbs against the SARS-CoV-2 virus.

The N protein is highly conserved amongst coronaviruses; therefore, this new vaccine has the potential to generate protection not only against SARS-CoV-2, but also against new strains of coronavirus that may arise in the future.

Initial research is underway and Scancell anticipates initiating a Phase 1 clinical trial (“COVIDITY”) in Q1 2021, subject to funding.

The Company is actively seeking development partners and additional funding (including non-dilutive funding from governments and global institutions) to support the rapid development of this vaccine.

Professor Lindy Durrant, Chief Scientific Officer, Scancell, commented: “As the COVID-19 pandemic has unfolded, Scancell has been evaluating how it can best contribute its expertise and resources to help in the global response.

Vaccines are the long-term solution and we believe our combined high avidity T cell and neutralising antibody approach has the potential to produce a second-generation vaccine that will generate an effective and durable immune response to COVID19.”

Professor Jonathan Ball, Director of the Centre for Research on Global Virus Infections at the University of Nottingham added: “Focusing the antibody responses on the receptor binding domain of the SARS-CoV-2 virus should ensure the generation of high-titre antibodies that prevent infection.

Delivering these virus targets using Scancell’s DNA vaccine platform, which has already been shown to be safe and effective in cancer patients, should enable rapid translation into the clinic for prevention of COVID-19.”

Professor Nigel Wright, Deputy Vice-Chancellor, Research and Innovation, at Nottingham Trent University, said: “Nottingham Trent University and the John van Geest Cancer Research Centre are delighted to support Scancell’s endeavours to develop an effective vaccine for COVID-19.

These are clearly challenging times and significant progress in the development of new approaches for protecting against this virus will only be possible by collaborations such as these.”

This announcement contains inside information for the purposes of Article 7 of Regulation (EU) 596/2014 (MAR).

https://www.scancell.co.uk/Data/Sites/1/media/publications/news/covid-19-vaccine-programme.pdf

Introduction to medical writing

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Medical writing is the making of scientific documents by the specialized writers. Generally a medical writer closely works with scientists, doctors and other subject matter experts in order to create effective documentation that intensely defines research results and product’s usage.

“New knowledge and insights are increasingly being applied to the medical field through an  ever-increasing number of research trials, through clinical experience and new ideas and innovations. All this information needs to be conveyed effectively to multiple stakeholders, such as doctors and other healthcare professionals, patients and customers and drug regulators.

Medical writing is the discipline of writing scientific documents by the writers in the field of medicine – the “medical writers”.

Medical writers may not be the original scientists who did the actual research, but they collaborate with the doctors / scientists involved in data generation and help to present the knowledge in a way that is relevant.

The importance of good medical writing cannot be ignored as science depends on clear and accurate reporting – otherwise, meticulous research can appear flawed if it is poorly presented.

The medical writer needs to have a clear understanding of the scientific concepts and ideas and be able to present the data and their meaning in the way that the target audience understands it.

Health authors incorporate their knowledge of science with their interpretation of study to present information to the target audience at the appropriate level. In addition, writing must fulfil the specific requirements for various types of documents.

Medical writing has become an important function in the pharmaceutical industry because it requires specialized knowledge and skills in order to be able to write well-structured and clearly presented scientific documents. In the last few years, the market for medical writing has increased considerably.

The reasons for this are numerous  more research studies are being carried out in the biomedical field today; pharmaceutical companies are creating more new drugs and medical devices, and several scientific papers need to be created for submission to regulatory authorities during their approval process; the number of biomedical journals has gone up considerably and many more scientific articles are now published than before; similarly, with the addition of a new and a powerful medium like the ‘internet’ the lot of medical information is generated as ‘web content’ for medical professionals as well as for the general public.

 The medical writing market has doubled in size in the last five years, up from an estimated $345 million in 2003 to $694 million in 2008, according to the CenterWatch analysis. Furthermore, medical writing is also the fourth most commonly outsourced service according to a separate study.

When pharmaceutical companies outsource more and more research to Asia, Indian students should look to medical writing as a viable career option, and learn the knowledge and skills needed to take this up as a full-time.”

Types of Medical Writing

“Medical writing involves writing different types of the documents for different purposes and for different audiences. Following are examples of different kinds of medical writing:

Medical Journalism: Health news is the presentation in mass media of health and medical reports and the subjects related to health.

Through delivering health-related information through mainstream media outlets it reaches the general public, rather than particular professional groups.
Articles in newspapers & magazines.

These are mostly written in a simple, non-technical language for the general public and laypeople.

Medical Education: For Physicians – textbooks, Continued Medical Education (CME) programs, slide decks, e-learning modules For the Patients – patient education material

Medical marketing of healthcare products:  Promotional literature targeted at the healthcare professionals, product monographs, brochures, handouts. Salesforce training manuals, e-learning modules Internet content for the physicians and patients (consumers)

Publication/Presentation: Journal articles / manuscripts (research articles, case reports, review articles) Abstracts Posters & presentations for scientific meetings and conferences

Research Documents
Clinical trial protocols
Informed Consent Documents
Research proposals
Investigators′ Brochure
Study reports

Regulatory Documents
Package Inserts (prescribing information) & Patient Information Leaflets
Clinical study reports, web synopses
Subject narratives

Regulatory submission documents – Common Technical Document (CTD) modules such as non-clinical and clinical overviews & summaries, expert reports, safety and efficacy summaries;  aggregated safety reports such as Periodic Safety Update Reports (PSURs), bridging reports,  Periodic Adverse Drug Experience Reports (PADERs), Annual Safety Reports (ASRs); policy papers, etc.

Each of the above types of medical writing is intended for a particular audience, e.g. medical professionals, patients & the general public, members of medical sales or drug regulators.

The language used and the level of technical information must, therefore, be appropriate to the level of comprehension of the respective audience.

For instance, while documents intended for medical professionals and regulators can be highly technical and include scientific data and their interpretation, those intended for patients and the general public need to be simple and free of technical jargon.

Therefore, regulatory submission documents are expected to meet the specified formats and frameworks, and their content is governed by regulatory rules and guidelines.

A medical writer who is interested in preparation of these documents therefore needs to be  familiar with the laws and approved formats for such documents.

Therefore, it is likely that the knowledge and skills required to write various types of medical documents are different, and  one may chooses to specialize in a particular type of medical writing, based on one’s aptitude  and  like.”

Organizations:

Several professional organizations represent medical writers around the world. These include:

American Medical Writers Association (AMWA): “AMWA is a professional association for the medical communicators, with more than 4,000 members in the U.S., Canada, and 30 other countries.

AMWA includes a variety of medical communicators, including administrators, advertisers, authors’ editors, college and university professors, journal editors, pharmaceutical writers (and those involved in pharmaceutical publication planning), public relations specialists, publishers, reporters, researchers, statisticians, and translators.

Many members are freelance writers and editors. Membership in the AMWA is open to anyone interested in any aspect of medical communication. AMWA’s headquarters are located in Rockville, Maryland, United States”.

Australasian Medical Writers Association (AMWA)

• European Medical Writers Association (EMWA)

• Indian Medical Writers Association (IMWA)

• Chinese Medical Writers Community (CMWC)

“These organizations provide a forum for medical authors to meet and share knowledge and experience. They encourage quality in professional development and reporting practices and help writers find career opportunities. All of those entities offer basic instruction in medical writing.

Who requires medical writers?

Media writers work mostly with the pharmaceutical industry. Nonetheless, there are many other situations where you need medical writers:  Pharmaceutical /healthcare services firms including medical device companies Contract research organizations (CROs) & Business / Knowledge process outsourcing firms (BPOs / KPOs) Scientific information and healthcare service providers (Functional Service Providers) Press & Publishing firms and Scientific Journals Educational medical institutions, Research / scientific Societies.

Healthcare Websites

So the scope is tremendous and growing for medical writers. This is also an occupation that can be pursued separately either as a freelancer or as an employee in an organisation, depending on one’s background, level of expertise and like. Taking medical writing can thus be the beginning of a career that lasts for life.

Requirements for becoming a Medical Writer

Of course, familiarity with medical concepts and terminology is the basic prerequisite for becoming a medical writer.

An academic qualification in one of the life sciences such as medicine or paramedic sciences such as pharmacy, microbiology, nutrition and dietetics, biochemistry, and biotechnology can provide the right background to familiarize the writer with scientific concepts and data from research Another important prerequisite is writing ability.

Since a medical writer’s basic requirement is to communicate scientific information to the target audience, it is most important to have some degree of command over the language, reflected in the ability to write grammatically correct text, and the ability to express and present information clearly and succinctly.”

General Knowledge and Skills

  • Language & grammar: “A medical writer must pass on scientific information. Besides understanding the scientific aspects, the writer needs to present the information in a clear manner and at an appropriate level of understanding for the target audience.

Use of grammatically correct language, simple and short sentences, active voice, adequate punctuation marks and a logical flow of ideas can go a  long way in making the information readers understand. Especially for the non-medical audience, avoiding the use of highly complex technical jargon also makes writing more lucid.

  • Literature/reference searching: There’s now a massive amount of scientific information available in the public domain. Databases such as Medline, PubMed, EMBASE, Micromedex are commonly used for the sourcing of medical information in addition to books and medical journals.

 Looking for information relevant to your purpose through all medical records and health-care pages is like looking for a proverbial needle in the haystack.

Keep in mind what exactly you are looking for, know where to search and select only the authentic sources, plan your search strategy, use the correct keywords to search and then perform the search according to the set plan is more likely to generate useful information.

It is equally important to analyze your search results and determine whether the information is relevant and to regularly identify and file useful information for later retrieval.

Interpretation and presentation of research data

Writing scientific papers involves reviewing and interpreting research data, presenting such data in text, tables and graphs, and developing a logical discussion and conclusions on what the data means.

Medical writers need to have sufficient knowledge of the research topic, and should be able to understand the research design and data in order to explain and present it to their readers”.

Ethical & legal issues: Issues of concern to scientific authors include – presenting accurate and complete information including adverse results, following copyright laws, not indulging in plagiarism, meeting authoring requirements for research papers, and adhering to journal review processes. So, what makes a good medical writer? The following qualities differentiate a good medical writer from a mediocre one:

 • Ability to understand the reason and requirements of the project

 • Ability to write at a level suitable to the target audience

 • Thorough research of the subject

• Ability to think, logical organization of thoughts and ideas

• Scientific accuracy

 • Ability to work across teams (often remotely) as well as independently

• Good communication & coordination with different people involved in the process

• Attention to details

• Good time management and meeting deadlines and commitments

Steps in writing scientific documents

  • Understanding the project brief: “Before you start writing, the medical writer needs to understand the purpose of the document being written and what the sponsor wants to achieve through it.

 In addition, the timelines to be followed, the data to be studied and the review/approval process to be followed need to be known.

  • Literature search & review of information: Adequate preparation and time spent on reading and analyzing literature will provide valuable information that a professional writer can use to validate the text being written properly.
    A proper search strategy and sorting into accessible chunks of the collected information is very critical.
  • Authoring & compiling the document: The drafting of the document’s first edition usually takes the most time. Creating the draft involves familiarity with the type of text, its purpose and its contents. The use of a predefined template simplifies the work. Having adequate language skills and adopting the in house or company style guide at this juncture, apart from the scientific part of the text, is useful for minimizing subsequent review and revision times. The paper may contain a number of appendices, in addition to the main text. Nevertheless, it is the duty of the medical writer to ensure that the final version of the text is compiled with accurate and relevant appendices.
  • The review process: Scientific document review process involves content review and editorial/formatting review. The former is typically done by a senior medical writer with more experience, and a specialisation the subject matter who may be an expert in the clinical or therapy field.
    Also required is quality control (QC) of contents involving the cross-checking of all verifiable information with the source data.
    Typically this is performed by a pair of scientific doctors. The medical writer must, however, do a comprehensive ‘self-examination’ of the document’s first draft  before it goes for further inspection.”
  • Formatting & editing: “Formatting (checking text font and size consistency, line and paragraph spacing, headers and footers, margins, page numbers, etc.) and editing (speaking, e.g., U.S. or British English, spelling, punctuation marks, correct use of tense, appropriate reference style, etc.) of documents is a skill that every writer needs to learn to make their document more presentable and acceptable.

    Reports that are needed for publication or electronic publishing must be carefully edited, proof-read and reviewed for specifications for formatting.
  • Approval and sign off: All scientific papers require approval and sign-off from the appointed approver, typically an expert. The approver may be in house or external, and the approver must be given sufficient time to review the document and sign it off.
  • Electronic publishing: Electronic publishing is about making the material available for online access in digital format. There are now a number of software tools available for e-publishing, and a modern-day medical writer may need to be familiar with their use.

Training and Professional Resources for Medical Writers

There is no formal degree / diploma, or medical writing certification course. Training in this discipline usually involves

1. In house training organizations that hire medical writers typically provide new recruits with the requisite general and project-specific training.

This may include training in the process of drug development (Type of clinical studies, Phases of trials, efficacy, effectiveness, bridging studies etc) exposure to drug safety and medical statistics, various types of regulatory documents and their requirements, as well as in house templates, work processes and style guides.

Related: How to Become a Medical Writer in 2020
Medical writing Module 2: Epidemiology and Evidence-Based Medicine

2. Short courses/workshops by professional bodies can organize one or two-day training courses or workshops on specific topics, e.g. CSRs, writing protocols, or statistics etc.

3. Education ‘ mentor guided ‘ on the job this is usually given by a senior medical writer who is more experienced in writing various types of papers.
Education focuses more on specific types of documents that are managed by the organization.

4. Motivated “self-study” this is the pillar of preparation for a medical researcher. A writer who is self-motivated and knowledgeable can do a great deal in educating him/herself on different types of medical writing”.

Books on medical writing

“Stephanie Deming of the Council of Science Editors compiled in 2003 a list of books that might be helpful in medical and/or science writing. In 1978 the BMJ editor Stephen Lock recommended Hawkins’s 1967 book Speaking and writing in medicine and 4 other books.”

Lynparza demonstrated overall survival benefit in Phase III PROfound trial for BRCA1/2 or ATM-mutated metastatic castration-resistant prostate cancer

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April 24, 2020: AstraZeneca and MSD Inc. announced further positive results from the Phase III PROfound trial of Lynparza (olaparib) in men with metastatic castration-resistant prostate cancer (mCRPC) who have a homologous recombination repair gene mutation (HRRm) and have progressed on prior treatment with new hormonal agent (NHA) treatments (e.g. enzalutamide and abiraterone).

Results from the trial showed a statistically significant and clinically meaningful improvement in the key secondary endpoint of overall survival (OS) with Lynparza versus enzalutamide or abiraterone in men with mCRPC selected for BRCA1/2 or ATM gene mutations, a subpopulation of HRR gene mutations.

The Phase III PROfound trial had met its primary endpoint in August 2019, showing significantly improved radiographic progression-free survival (rPFS) in men with mutations in BRCA1/2 or ATM genes, and had met a key secondary endpoint of rPFS in the overall HRRm population.

José Baselga, Executive Vice President, Oncology R&D, said: “Overall survival in metastatic castration-resistant prostate cancer has remained extremely challenging to achieve. We are thrilled by these results for Lynparza and we are working with regulatory authorities to bring this medicine to patients as soon as possible.”

Roy Baynes, Senior Vice President and Head of Global Clinical Development, Chief Medical Officer, MSD Research Laboratories, said: “Lynparza has demonstrated significant clinical benefit across key endpoints in PROfound, including overall survival for patients with BRCA or ATM mutations, and this reinforces its potential to change the treatment standard for patients with metastatic castration-resistant prostate cancer.

These data further support MSD and AstraZeneca’s commitment to uncovering the ways in which Lynparza can help patients impacted by cancer.”

The safety and tolerability profile of Lynparza was generally consistent with previous trials. The data will be presented at a forthcoming medical meeting.

Lynparza was granted Priority Review in the US for patients with HRRm mCRPC in January 2020, with regulatory reviews ongoing in the EU and other jurisdictions.

AstraZeneca and MSD are exploring additional trials in prostate cancer including the ongoing Phase III PROpel trial, with first data expected in 2021, testing Lynparza as a 1st-line medicine for patients with mCRPC in combination with abiraterone acetate versus abiraterone acetate alone.

Metastatic castration-resistant prostate cancer

Prostate cancer is the second-most common cancer in men, with an estimated 1.3 million new cases diagnosed worldwide in 2018, and is associated with a significant mortality rate. 

Development of prostate cancer is often driven by male sex hormones called androgens, including testosterone. In patients with mCRPC, their prostate cancer grows and spreads to other parts of the body despite the use of androgen-deprivation therapy to block the action of male sex hormones.

 Approximately 10-20% of men with advanced prostate cancer will develop CRPC within five years, and at least 84% of these men will have metastases at the time of CRPC diagnosis.

Of men with no metastases at CRPC diagnosis, 33% are likely to develop metastases within two years. Despite advances in treatment for men with mCRPC, five-year survival is low and extending survival remains a key goal for treating these men.

HRR gene mutations: HRR mutations occur in approximately 20-30% of patients with mCRPC. HRR genes allow for accurate repair of damaged DNA in normal cells. HRR deficiency (HRD) means the DNA damage cannot be repaired, and can result in normal cell death. 

This is different in cancer cells, where a mutation in HRR pathways leads to abnormal cell growth and therefore

cancer.  HRD is a well-documented target for PARP inhibitors, such as Lynparza. PARP inhibitors block a rescue DNA damage repair mechanism by trapping PARP bound to DNA single-strand breaks which leads to replication fork stalling causing their collapse and the generation of DNA double-strand breaks, which in turn lead to cancer cell death.

PROfound is a prospective, multicentre, randomised, open-label, Phase III trial testing the efficacy and safety of Lynparza versus enzalutamide or abiraterone in patients with mCRPC who have progressed on prior treatment with NHA treatments (abiraterone or enzalutamide) and have a qualifying tumour mutation in BRCA1/2, ATM or one of 12 other genes involved in the HRR pathway.

The trial was designed to analyse patients with HRRm genes in two cohorts: the primary endpoint was rPFS in those with mutations in BRCA1/2 or ATM genes and then, if Lynparza showed clinical benefit, a formal analysis was performed of the overall trial population of patients with HRRm genes (BRCA1/2, ATM, CDK12 and 11 other HRRm genes; a key secondary endpoint).

Lynparza (olaparib) is a first-in-class PARP inhibitor and the first targeted treatment to block DNA damage response (DDR) in cells/tumours harbouring a deficiency in homologous recombination repair, such as mutations in BRCA1 and/or BRCA2.

Inhibition of PARP with Lynparza leads to the trapping of PARP bound to DNA single-strand breaks, stalling of replication forks, their collapse and the generation of DNA double-strand breaks and cancer cell death. Lynparza is being tested in a range of PARP-dependent tumour types with defects and dependencies in the DDR pathway.

Lynparza is currently approved in a number of countries, including those in the EU, for the maintenance treatment of platinum-sensitive relapsed ovarian cancer.

It is approved in the US, the EU, Japan, China, and several other countries as 1st-line maintenance treatment of BRCA-mutated advanced ovarian cancer following response to platinum-based chemotherapy.

It is also approved in the US, Japan, and a number of other countries for germline BRCA-mutated, HER2-negative, metastatic breast cancer, previously treated with chemotherapy; in the EU, this includes locally advanced breast cancer.

 Lynparza is approved in the US and several other countries for the treatment of germline BRCA-mutated metastatic pancreatic cancer. Regulatory reviews are underway in several jurisdictions for ovarian, breast, pancreatic and prostate cancers.

Lynparza, which is being jointly developed and commercialised by AstraZeneca and MSD, has been used to treat over 30,000 patients worldwide.

 Lynparza has the broadest and most advanced clinical trial development programme of any PARP inhibitor, and AstraZeneca and MSD are working together to understand how it may affect multiple PARP-dependent tumours as a monotherapy and in combination across multiple cancer types.

 Lynparza is the foundation of AstraZeneca’s industry-leading portfolio of potential new medicines targeting DDR mechanisms in cancer cells.

The AstraZeneca and MSD strategic oncology collaboration 

In July 2017, AstraZeneca and Merck & Co., Inc., Kenilworth, NJ, US, known as MSD outside the US and Canada, announced a global strategic oncology collaboration to co-develop and co-commercialise Lynparza, the world’s first PARP inhibitor, and Koselugo (selumetinib), a MEK inhibitor, for multiple cancer types.

Working together, the companies will develop Lynparza and Koselugo in combination with other potential new medicines and as monotherapies. Independently, the companies will develop Lynparza and Koselugo in combination with their respective PD-L1 and PD-1 medicines.
https://www.astrazeneca.com/content/astraz/media-centre/press-releases/2020/lynparza-shows-overall-survival-in-prostate-cancer.html

For more News: Lynparza recommended by FDA advisory committee for 1st-line maintenance treatment of germline BRCA-mutated metastatic pancreatic cancer, not Progressed on Platinum-Based Chemotherapy

HHS Announces CARES Act Funding Distribution to States and Localities in Support of COVID-19 Response

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April 23, 2020: “The Department of Health and Human Services (HHS) is announcing upcoming action by the Centers for Disease Control and Prevention (CDC) to provide additional resources to state and local jurisdictions in support of our nation’s response to the 2019 novel coronavirus (COVID-19).

Using funds from the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020, CDC is awarding $631 million to 64 jurisdictions through the existing Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) cooperative agreement.

These funds, along with the previous support CDC has providedexternal icon, will help states with their efforts to re-open America.

“This new funding secured from Congress by President Trump will help public health departments across America continue to battle COVID-19 and expand their capacity for testing, contact tracing, and containment,” said HHS Secretary Alex Azar.

“The professionals who staff America’s state, local, tribal, and territorial public health departments have played a vital role in protecting Americans throughout the COVID-19 pandemic, by reporting and analyzing surveillance data, tracing the spread of the virus, and developing scientific guidelines appropriate for local communities.

As we look toward re-opening the economy, the work of these dedicated public health officials is only going to get more important, and the Trump Administration and CDC will be working right alongside them to assist.”

“This infusion of additional funding into the nation’s public health infrastructure will strengthen our capacity to implement tried and true containment measures,” said CDC Director Robert R. Redfield, M.D. “

The ability to implement aggressive contact tracing, surveillance and testing will be fundamental to protecting vulnerable populations as the nation takes steps to reopen and Americans begin returning to their daily lives.”

CDC will use existing networks to reach out to state and local jurisdictions to access this funding, which may be used for a variety of activities including:

  • Establishing or enhancing the ability to aggressively identify cases, conduct contact tracing and follow up, as well as implement appropriate containment measures.
  • Improving morbidity and mortality surveillance.
  • Enhancing testing capacity.
  • Controlling COVID-19 in high-risk settings and protect vulnerable or high-risk populations.
  • Working with healthcare systems to manage and monitor system capacity.” https://www.cdc.gov/media/releases/2020/p0423-CARES-act.html

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Lopinavir/Ritonavir, Umifenovir Ineffective for Mild COVID-19

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April 23, 2020: “For patients hospitalized with mild/moderate COVID-19, lopinavir/ritonavir (LPV/r) or umifenovir (Arbidol) monotherapy offers little benefit, according to a study published online April 17 in Med.

Yueping Li, M.D., Ph.D., from the Guangzhou Eighth People’s Hospital in China, and colleagues conducted an exploratory randomized trial assessing the efficacy and safety of LPV/r or umifenovir monotherapy for treating patients with mild/moderate COVID-19.

Eighty-six patients were enrolled with 34 randomly assigned to LPV/r, 35 to umifenovir, and 17 to no antiviral medication as control.

The researchers found that the rate of positive-to-negative conversion of severe acute respiratory syndrome coronavirus 2 nucleic acid (primary end point) was similar between the groups.

No between-group differences were seen in secondary end points of rates of antipyresis, cough alleviation, or improvement of chest computed tomography at days 7 or 14. At day 7, a deterioration in clinical status from moderate to severe/critical was seen for 23.5, 8.6, and 11.8 percent of patients in the LPV/r, umifenovir, and control groups, respectively.

During the follow-up period, 35.3 and 14.3 percent of patients in the LPV/r and umifenovir groups, respectively, experienced adverse events. In the control group, there were no adverse events reported.”

“Our findings suggest that we need to cautiously consider before using these drugs,” Li said in a statement. “Researchers need to keep working to find a really effective antiviral regimen against COVID-19, but meanwhile, any conclusions about antiviral regimens need strict and scientific clinical trials and appropriate caution.”
https://www.drugs.com/news/lopinavir-ritonavir-umifenovir-ineffective-mild-covid-19-89803.html

Novartis announces data showing Jakavi® (ruxolitinib) more effective than best available therapy in acute graft-versus-host disease

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Apr 22, 2020: “Data from the Phase III REACH2 study published today in The New England Journal of Medicine show Jakavi® (ruxolitinib) improves outcomes across a range of efficacy measures in patients with steroid-refractory acute graft-versus-host disease (GvHD) compared to best available therapy (BAT).

The results of REACH2, the first Phase III study in acute GvHD to have met its primary endpoint, reinforce findings of the previously reported Phase II REACH1 study. The new data was also selected for presentation at the Presidential Symposium of the European Society for Blood and Marrow Transplantation (EBMT) Annual Meeting, to be held 30 August to 2 September in Madrid.

In REACH2, patients treated with Jakavi experienced significantly greater overall response rate (ORR) vs. BAT (62% vs. 39%; p<0.001) at Day 28, the primary endpoint of the study. For the key secondary endpoint, patients treated with Jakavi maintained significantly higher durable ORR (40% vs. 22%; p<0.001) at eight weeks.

Additionally, Jakavi was associated with longer median failure free survival (FFS) than BAT (5.0 months vs. 1.0 months; hazard ratio 0.46, 95% CI, 0.35 to 0.60), and showed a positive trend with other secondary endpoints, including duration of response.

“Patients with acute graft-versus-host disease face life-threatening challenges with limited treatment options, particularly for the nearly half of individuals who do not respond to initial steroid therapy,” said Robert Zeiser, University Hospital Freiburg, Department of Haematology, Oncology and Stem Cell Transplantation, Freiburg, Germany. “These new data from REACH2 showing superiority of Jakavi over current standard-of-care therapies add to a growing body of evidence on how targeting the JAK pathway can be an effective strategy in this difficult-to-treat condition.”

No new safety signals were observed in REACH2, and adverse events (AEs) attributable to treatment were consistent with the known safety profile of Jakavi. The most common AEs were thrombocytopenia, anemia and cytomegalovirus infection. While 38% and 9% of patients required Jakavi and BAT dose modifications, respectively, the number of patients who discontinued treatment due to AEs was low (11% and 5%, respectively)1.

Compelling results from REACH2, the first successful randomized Phase III trial in patients with steroid-refractory acute graft-versus-host-disease, give us confidence in the potential of Jakavi to confront this difficult condition,” said John Tsai, Head Global Drug Development and Chief Medical Officer, Novartis. “We look forward to initiating discussions with ex-US regulatory authorities.

In 2019, the US Food and Drug Administration approved ruxolitinib (marketed by Incyte Corporation in the U.S. as Jakafi®) for the treatment of steroid-refractory acute GvHD in adult and pediatric patients 12 years and older based on results of the single arm Phase II REACH1 trial5. The Phase III REACH3 study in patients with steroid-refractory chronic GvHD is ongoing and results are expected in the second half of this year.


Jakavi (ruxolitinib) is an oral inhibitor of the JAK 1 and JAK 2 tyrosine kinases. Jakavi is approved by the European Commission for the treatment of adult patients with polycythemia vera (PV) who are resistant to or intolerant of hydroxyurea and for the treatment of disease-related splenomegaly or symptoms in adult patients with primary myelofibrosis (MF) (also known as chronic idiopathic MF), post-polycythemia vera MF or post-essential thrombocythemia MF.

Jakavi is approved in 101 countries for patients with MF, including EU countries, Switzerland, Canada, Japan and in more than 75 countries for patients with PV, including EU countries, Switzerland, Japan and Canada. The exact indication for Jakavi varies by country. Additional worldwide regulatory filings are underway in MF and PV.

Novartis licensed ruxolitinib from Incyte Corporation for development and commercialization outside the United States. Ruxolitinib is marketed in the United States by Incyte Corporation as Jakafi® for patients with PV who have had an inadequate response to or are intolerant of hydroxyurea, for patients with intermediate or high-risk MF, and steroid-refractory acute GvHD in adult and pediatric patients 12 years and older5.

The recommended starting dose of Jakavi in PV is 10 mg given orally twice daily. The recommended starting dose of Jakavi in MF is 15 mg given orally twice daily for patients with a platelet count between 100,000 cubic millimeters (mm) and 200,000 mm, and 20 mg twice daily for patients with a platelet count of >200,000 mm. Doses may be titrated based on safety and efficacy.

There is limited information to recommend a starting dose for MF and PV patients with platelet counts between 50,000/mm and <100,000/mm. The maximum recommended starting dose in these patients is 5 mg twice daily, and patients should be titrated cautiously.

Jakavi is a registered trademark of Novartis AG in countries outside the United States. Jakafi is a registered trademark of Incyte Corporation. The safety and efficacy profile of Jakavi has not yet been established outside of its approved indications.

Jakavi Important Safety Information for Treatment of Myelofibrosis (MF) and Polycythemia Vera (PV)
Jakavi can cause serious side effects, including a decrease in blood cell count and infections. Complete blood count monitoring is recommended. Dose reduction or interruption may be required in patients with any hepatic impairment or severe renal impairment or in patients developing hematologic adverse reactions such as thrombocytopenia, anemia and neutropenia.

Dose reductions are also recommended when Jakavi is co-administered with strong CYP3A4 inhibitors or fluconazole. Use of Jakavi during pregnancy is not recommended, and women should avoid becoming pregnant during Jakavi therapy.

Women taking Jakavi should not breast feed. Progressive multifocal leukoencephalopathy (PML) has been reported. Physicians should be alert for neuropsychiatric symptoms suggestive of PML. Hepatitis B viral load (HBV-DNA titer) increases have been reported in patients with chronic HBV infections.

Patients with chronic HBV infection should be treated and monitored according to clinical guidelines. Non-melanoma skin cancer (NMSC) has been reported in Jakavi treated patients. Periodic skin examination is recommended.

Very common adverse reactions in MF (>10%) include urinary tract infections, anemia, thrombocytopenia, neutropenia, hypercholesterolemia, dizziness, headache, alanine aminotransferase increased, aspartate aminotransferase increased, bruising and weight gain. Common adverse reactions in MF (1 to 10%) include herpes zoster and flatulence. Uncommon adverse reactions in MF include tuberculosis.

Very common adverse reactions in PV (>10%) include anemia, thrombocytopenia, hypercholesterolemia, hypertriglyceridemia, dizziness, alanine aminotransferase increased and aspartate aminotransferase increased. Common adverse reactions in PV (1 to 10%) include urinary tract infections, herpes zoster, weight gain, constipation and hypertension.”
https://www.novartis.com/news/media-releases/novartis-announces-data-showing-jakavi-ruxolitinib-more-effective-best-available-therapy-acute-graft-versus-host-disease

For more News: Novartis announces plan to initiate clinical study of Jakavi® in severe COVID-19 patients and establish international compassionate use program


AstraZeneca and Saint Luke’s Mid America Heart Institute initiate Phase III DARE-19 trial with Farxiga in COVID-19 patients

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April 23, 2020: “AstraZeneca and Saint Luke’s Mid America Heart Institute have initiated a randomised, global Phase III trial to assess the potential of Farxiga (dapagliflozin) as a treatment in patients hospitalised with COVID-19 who are at risk of developing serious complications, such as organ failure.

The goal of the trial, called DARE-19, is to assess whether Farxiga, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, can reduce the risk of disease progression, clinical complications, and death due to COVID-19 in patients who also have cardiovascular (CV), metabolic or kidney risk factors.

Cardiac, renal and metabolic comorbidities have been associated with poor outcomes and death in COVID-19 patients. The trial design is supported by extensive data on the protective effect of Farxiga in patients with heart failure with reduced ejection fraction (HFrEF), chronic kidney disease (CKD)or type 2 diabetes (T2D).

Mene Pangalos, Executive Vice President, BioPharmaceuticals R&D, said: “AstraZeneca is committed to finding new solutions to fight COVID-19 by investigating the application of our new and existing medicines. With the Phase III DARE-19 trial, we aim to test whether Farxiga can prevent serious complications such as organ failure in those patients with pre-existing health conditions, a critical goal when treating COVID-19.

Mikhail N. Kosiborod, M.D., cardiologist at Saint Luke’s Mid America Heart Institute, Vice President of Research at Saint Luke’s Health System, and principal investigator of DARE-19 said: “Dapagliflozinhas demonstrated cardio and renal protective benefits and improved outcomes in high-risk patients with type-2 diabetes, heart failure with reduced ejection fraction, and chronic kidney disease.

Patients with COVID-19 and underlying cardiometabolic disease appear to be at the highest risk of morbid complications. Through DARE-19, we hope to decrease the severity of illness, and prevent cardiovascular, respiratory and kidney decompensation, which are common in patients with COVID-19.”

The DARE-19 trial is open for enrolment in the US and other European countries with a high COVID-19 burden and aims to recruit approximately 900 patients.

DARE-19 is an international, parallel-group, randomised, double-blind, placebo-controlled, investigator-sponsored Phase III trial evaluating the efficacy and safety of Farxiga in addition to background local standard of care therapy, on the risk of all-cause death or disease progression and complications in adults who are hospitalised with COVID-19 at the time of trial enrolment.

Patients enrolled in DARE-19 also have a medical history of hypertension (HTN), atherosclerotic CV disease, heart failure with reduced or preserved ejection fraction, T2D or CKD Stage III to IV. The primary efficacy outcome of the trial is time to first occurrence of death from any cause or new/worsened organ dysfunction through 30 days of follow-up.

Some of the patients at highest risk of COVID-19 complications appear to be those with cardiometabolic disease. 6,7,8 CV complications, including acute myocardial injury and heart failure (HF) are common in COVID-19, and appear to be key drivers of poor outcomes and death especially in patients with pre-existing CV disease and/or CKD. 

COVID-19 and AstraZeneca Research: AstraZeneca is rapidly mobilising its COVID-19 research efforts to focus on key areas: identifying novel coronavirus-neutralising antibodies against the SARS-CoV-2 virus to prevent or treat disease progression; and investigating the application of our new and existing medicines to suppress the body’s overactive immune response, or protect from serious complications, such as organ failure caused by COVID-19 disease.

Farxiga is a first-in-class, oral, once-daily SGLT2 inhibitor indicated in adults for the treatment of insufficiently controlled T2D as both monotherapy and as part of combination therapy as an adjunct to diet and exercise to improve glycaemic control, with the additional benefits of weight loss and blood-pressure reduction. In the DECLARE CV outcomes trial in adults with T2D, Farxiga reduced the risk of the composite endpoint of hospitalisation for HF or CV death versus placebo, when added to standard of care.”
https://www.astrazeneca.com/content/astraz/media-centre/press-releases/2020/astrazeneca-and-saint-lukes-mid-america-heart-institute-initiate-phase-iii-dare-19-trial-with-farxiga-in-covid-19-patients.html

For more News: Farxiga reduced the incidence of heart failure worsening or cardiovascular death in a sub-analysis from landmark Phase III DAPA-HF trial