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Ultragenyx and Kyowa Kirin Announce Submission of Supplemental Biologics License Application to U.S. FDA for Crysvita® (burosumab) for the treatment of Tumor-Induced Osteomalacia (TIO)

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Jan. 13, 2020: Ultragenyx Pharmaceutical Inc. and Kyowa Kirin Co., Ltd. announced that they submitted a supplemental Biologics License Application (sBLA) to the U.S. Food and Drug Administration (FDA) on December 18, 2019, for Crysvita® (burosumab) for the treatment of FGF23-related hypophosphatemia associated with phosphaturic mesenchymal tumors (tumor-induced osteomalacia; TIO) that cannot be curatively resected or localized. The companies expect to hear back from FDA on submission acceptance and review designation in February 2020.

“Around half of patients suffering  with TIO have tumors that cannot be surgically removed, leaving them with no other current treatment options,” said Camille L. Bedrosian, M.D., Chief Medical Officer of Ultragenyx.

“We look forward to continuing to work closely with the FDA during the review process, with the goal of bringing Crysvita to patients with TIO in the U.S.”

The sBLA package includes data from the two single-arm Phase 2 studies, a 144-week study in 14 adult patients conducted by the Ultragenyx in the U.S. and an 88-week study in 13 adult patients conducted by the Kyowa Kirin in Japan and South Korea.

In both these studies, Crysvita was associated with increases in serum phosphorus and serum 1,25-dihydroxyvitamin D levels. Increased phosphate levels will led to improvements in osteomalacia, mobility and vitality also bone scans demonstrated in an increase in healed fractures and a decrease in new fractures during Crysvita treatment.

FDA also approved Crysvita for the treatment of X-linked hypophosphatemia (XLH) in adult and pediatric patients six months of age and older, and by Health Canada and Brazil’s National Health Surveillance Agency (ANVISA) for the treatment of XLH in the adult and pediatric patients one year of age and older.

Crysvita is approved by Japan’s Ministry of Health, Labor and Welfare (MHLW) for the treatment of FGF23-related hypophosphatemic rickets and osteomalacia.

The medicine has received the European conditional marketing authorization for the treatment of XLH with radiographic evidence of bone disease in children 1 year of age and older and adolescents with the growing skeletons, and an application for the expanded use in adults with XLH is currently under review by the European Medicines Agency. https://fda.einnews.com/pr_news/507058520/ultragenyx-and-kyowa-kirin-announce-submission-of-supplemental-biologics-license-application-to-u-s-fda-for-crysvita-burosumab-for-tumor-induced

 

BioCryst to Provide Berotralstat and BCX9930 Program Updates at 38th Annual J.P. Morgan Healthcare Conference

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Jan. 12, 2020:  BioCryst Pharmaceuticals, Inc. announced that the company will provide updates on berotralstat, an oral kallikrein inhibitor for hereditary angioedema (HAE), and BCX9930, an oral Factor D inhibitor for complement-mediated diseases, this week at the 38th Annual J.P. Morgan Healthcare Conference in San Francisco.

“BioCryst is located for transformation in 2020 with the multiple global approvals and launches of the berotralstat, and PNH proof of the concept data with BCX9930.

The $100 million in additional capital we brought into the company in Q4 2019 provides a foundation for progress and value creation in 2020.”

As formerly announced, results from an ongoing three part Phase 1 trial of BCX9930 showed rapid, sustained and >95% suppression of the alternative pathway (AP) of the complement system at 100 mg every 12 hours, as calculated by the AP Wieslab® assay.

In two initial multiple ascending dose (MAD) assessment cohorts, healthy volunteers inward 50 mg or 100 mg of oral BCX9930 or placebo (each MAD cohort randomized 10:2) administered every 12 hours for seven days.

Healthy volunteers in the MAD cohorts were prophylactically dosed with broad-spectrum antibiotic, amoxicillin/clavulanate.  https://fda.einnews.com/pr_news/507012970/biocryst-to-provide-berotralstat-and-bcx9930-program-updates-at-38th-annual-j-p-morgan-healthcare-conference

FDA grants breakthrough device designation to Reflow Medical’s temporary spur stent system for the treatment of below-the-knee (BTK) peripheral artery disease

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Jan 10, 2020: U.S. Food and Drug Administration (FDA) announced Reflow Medical’s Temporary Spur Stent System, a novel retrievable stent technology proposed for the treatment of below-the-knee (BTK) peripheral artery disease, designated for the Breakthrough Devices.

The Breakthrough Devices Program is designed in order to give patients and health care providers timely access to medical devices that provide for more effective treatment or diagnosis of life-threatening or irreversibly debilitating diseases or conditions.

The program offers Reflow Medical the chance to interact with experts at the FDA throughout the premarket review phase, in order to help speed the development, assessment and review of the device.

The Temporary Spur Stent System is a novel combination device  that consist of a patented retrievable stent system having a series of radially expandable spikes designed to create multiple pathways in order to deliver antiproliferative drugs for increased uptake into the vessel wall and facilitate acute luminal gain, without leaving anything behind.

The device was developed in response to unmet clinical needs resulting in the high rates of restenosis and treatment challenges in patients with BTK disease. https://fda.einnews.com/article/506936937?lcf=8DWPqPuUsDVNDakfEIxsCA%3D%3D

Novartis ligelizumab (QGE031) more effective than Xolair®(omalizumab) at inhibiting immunoglobulin E pathway responsible for chronic spontaneous urticaria

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Jan 09, 2020: Novartis, a leader in immuno-dermatology, announced mechanistic study results showing ligelizumab is more efficient at inhibiting the major pathogenic IgE/FcεRI pathway in the chronic spontaneous urticaria (CSU), than current therapy. olair® (omalizumab).

Ligelizumab can bind to IgE with an 88-fold higher resemblance than Xolair. The data demonstrate ligelizumab and Xolair recognize and bind differently to IgE, with ligelizumab resulting in a considerably enhanced blockade of IgE/FcεRI signaling.

The data, published in The New England Journal of Medicine, shows an average complete response rate of 42% for 240 mg and 72 mg of ligelizumab at Week 12, compared with 26% for those taking 300 mg of Xolair. https://www.novartis.com/news/media-releases/novartis-ligelizumab-qge031-more-effective-xolair-inhibiting-immunoglobulin-e-pathway-responsible-chronic-spontaneous-urticaria

Bayer and Evotec form a new strategic alliance focusing on the treatment of polycystic ovary syndrome

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Jan 09, 2020: Evotec SE and Bayer AG announced the expansion of their partnership in women’s health indications with a new five-year, multi-target collaboration to develop multiple clinical candidates for the treatment of polycystic ovary syndrome (“PCOS”).

As per  the terms of the agreement, both companies will contribute drug targets and a comprehensive set of high-quality technology platforms to jointly develop innovative treatment options. The strategic alliance will also have access to the targets from the recently formed partnership between Celmatix and Evotec.

Celmatix is the world leader in big data-driven target discovery that focuses on fertility and women’s health. “PCOS is a common, underdiagnosed and undertreated disease among women, with several serious co-morbidities.”

Evotec will receive € 6.5 m direct payment and € 10 m research payments over five years.

In addition, Evotec might be eligible in order  to receive pre-clinical, clinical and sales milestones of potentially over € 330 m as well as royalties up to low double-digit percentages of net sales.

In 2012, Bayer and Evotec entered their first strategic five-year, multi-target alliance. The collaboration was productively completed resulting in three clinical and one pre-clinical drug candidate currently advancing during development for the treatment of endometriosis.

A second research alliance was initiated in 2016 to develop multiple clinical candidates for the treatment of kidney diseases. https://www.evotec.com/en/invest/news–announcements/p/bayer-and-evotec-form-new-strategic-alliance-focusing-on-polycystic-ovary-syndrome-5893

Approval pathways of Fixed dose combination (FDC) in India

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Fixed dose combination (FDC) approval process is a little different from the drug approval process in India.
FDC can be divided into 5 major parts:

Category 1: FDC  which are not marketed in India and one or more active ingredient(s) is a new drug not approved in India.

It may be further divided into two parts:
Sub Category I: One of the ingredients of the FDC is an Investigational New Drug (IND). 

Sub Category II: One or more of the active ingredients of the FDC is a New Drug not approved individually in India but they are approved in other countries. 

In simplest terms we can say that, at least one active ingredients of proposed FDC should not be approved in India.

Category  2:
FDC which is not marketed in India but the active ingredients are approved/ marketed individually and there is possibility of  PK/PD interactions among ingredients if given as FDC.

It can be divided into three parts:
Sub Category I: FDC which is approved in other countries

Sub Category II: FDC, which is not marketed anywhere but individual active ingredients used concomitantly.

Sub Category III: FDC, which is not marketed and individual active ingredients are not used concomitantly
In simplest terms, all the active ingredients of FDC should be approved individually in India.
Category 3 :  FDC which are marketed in India but some changes are sought.

Category 4: FDC which are Only for convenience (no significant changes from clinical point of view)

Category 5: Approvals of a FDC already approved in the country.
Documents needs to be submitted as per proposed FDC category, Indication and nature of drugs etc.

Requirements of Clinical and Non Clinical Data

  • If the Fixed dose combination is not marketed in India, and one or more of its active ingredients are not approved in any country:  In this case first applicants for each proposed FDCs must conduct a full, four-phase clinical trial.
  • If the FDC is marketed in other countries. In this case only the Phase III clinical trial (‘bridging studies’) is needed.
  • If  active ingredients of FDCs are approved and marketed in India and FDC is approved in other countries, then regulatory authority asks for in vitro studies.
  • If FDC is not marketed in any other country but has a history of concomitant use in India; then only ‘adequate evidence’ of their safe and effective concomitant use may be necessary for approval ( if published data is not available).
  • If applicant is seeking minor changes for the FDCs marketed in India, then regulatory authority asks for in vitro studies. BA/BE study is necessary if regulatory authority is not satisfied with the claim.

 The same guidelines are applicable to FDCs which are combined only to bring convenience, and whose individual ingredients have been in concomitant clinical use.

Follow the link for List of approved FDCs (Fixed Dose Combinations) Approved by DCG (I) Since 1961 Till February, 2013:http://www.cdsco.nic.in/Approved%20FDCs%20by%20DCG(I).pdf

References: https://journals.sagepub.com/doi/full/10.1177/0971721818762931
http://www.globalresearchonline.net/journalcontents/v13-2/004.pdf
https://www.jbsoweb.com/admin/php/uploads/298_pdf.pdf https://cdsco.gov.in/opencms/opencms/system/modules/CDSCO.WEB/elements/download_file_division.jsp?num_id=MzI1MQ==

When to Start and Stop collecting Adverse Events

When to start and when to stop? Before answering this question, let’s understand where the confusion relies.

Generally we start recording the adverse event just after singing the informed consent form. It is collected even for those subjects who failed to meet all inclusion criteria after signing the informed consent form.
It is to be noted that as per the ICH (E2A), adverse event can be recorded at or after the first treatment. It does not suggest recording it just after singing the informed consent form.
Definition of adverse event as per ICH:
“Adverse Event (or Adverse Experience) any untoward medical occurrence in a patient or clinical investigation subject administered a pharmaceutical product and which does not necessarily have to be a causal relationship with this treatment.

An adverse event (AE) can be any unfavorable and unintended sign (including an abnormal laboratory finding, for example), symptom, or disease temporally associated with the use of the medicinal product, whether or not considered related to the medicinal product.”

So ICH excludes the collecting of adverse event before investigational product administration. But many protocols and country specific guidelines mandate to report adverse event before IMP administration and after signing the informed consent form.

Now question comes; how it is useful to record adverse event before IMP administration and just after signing informed consent form. Please see the below list answering this question:

  • Sponsor can have a good risk management if they report serious medical events caused by protocol-imposed screening tests or diagnostic procedures.
    Case I:
    Few screening procedures may cause potential injury to subjects, for example angiogram in certain cardiovascular studies and biopsies in oncology studies.  It is advised to start recording AE just after signing the informed consent form in these cases.
    Case II:
    Sponsor may consider collecting adverse event only after IMP administration, if the study contains less invasive and routine procedures only, which does not cause any health risk and considered relatively  safe. For example routine X ray, lab assessments etc.
  • Sponsor can monitor withdrawal symptoms because of removal of existing treatment (washout period) before starting study IMP.
  • Based on the severity and frequency of adverse event during washout period, sponsor can modify the study protocol and study can be halted.

Note: Adverse events which are collected, starting from the Informed consent form singing, can be divided into two parts: A) Treatment emergent AE (TEAE)-  Adverse events which occurred after IMP administration. And B) Non-Treatment emergent AE (Non-TEAE)- Adverse events which are collected before IMP administration and after singing the informed consent form.

Now Question arises, when to stop reporting adverse event:
 There is no clear guidance on this. It depends mainly on study specific protocol. It is a common practice to continue adverse event reporting even after completion of treatment (follow up period).

The collection of AE largely depends on half life of drug, nature of drug candidate or population (adults or pediatric).
Long term follow up (more than six month) for AE is not quite common.

Reporting of Adverse event for discontinued subjects:
Subject can withdraw informed consent form any time or discontinued from the treatment because of adverse event.

Discontinued subjects may remain in the study and it is very important to collect AE of discontinued subjects till certain period of time which is defined in the protocol (In accordance with regulatory authority and local guidelines).

Note: Any medically important significant findings which are noticed before signing informed consent form, should be captured as Medical history in database

Ref: http://onbiostatistics.blogspot.com/2018/01/adverse-event-collection-when-to-start.html?a=X&ved=2ahUKEwjM7d6hlvvmAhVSaCsKHeJZASkQFjAAegQIBRAB

Almirall signs a deliberate agreement with 23andMe to license rights of a bispecific monoclonal antibody designed to blocks all three isoforms of IL-36 cytokine

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Jan 09, 2020: Almirall, a leading global pharmaceutical company focused on medical dermatology, and 23andMe, the leading consumer genetics and research company, have signed an agreement allowing Almirall to in-license 23andMe’s bispecific monoclonal antibody designed to block all the three members of the IL-36 cytokine subfamily.

IL-36 is a part of the IL-1 cytokine family, which is associated with the multiple inflammatory diseases, including different dermatological conditions. Almirall will secure the rights in order to develop and commercialize the antibody for worldwide use.

This agreement will reinforce Almirall’s early-stage research portfolio.23andMe’s Therapeutics team was established in 2015 with the goal of influencing the human genetic information to improve the way drug discovery is currently conducted.

With more than 10 million kits sold, and 80% of the customers consenting to research, 23andMe has the world’s largest set of genotypic information paired with billions of phenotypic data points contributed by occupied customers.

Based upon strong genetic evidence, 23andMe’s team generated a bispecific antibody that blocks the IL-36 cytokine family, has out-licensed its bispecific monoclonal antibody to Almirall in order to influence Almirall’s expertise in medical dermatology and accelerate the development of this preclinical program.

Almirall will further progress the antibody with the goal of taking it through clinical trials in humans and on top of the market. https://www.almirall.com/media/press-releases/media-detail-new?title=almirall-signs-a-strategic-agreement-with-23andme-to-license-rights-of-a-bispecific-monoclonal-antibody-that-blocks-all-three-isoforms-of-il-36-cytokine-1&articleId=4225082&id=4225083

Hikma and Arecor announce exclusive agreement to co-develop a new, ready-to-use injectable medicine in the US using Arestat™ technology

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Jan 09, 2020: Hikma Pharmaceuticals and Arecor new joint agreement is set to co-develop new, ready-to-use injectable medicine in the US through Hikma’s affiliate, Hikma Pharmaceuticals USA.

The companies have revealed that the product is being developed using Arecor’s proprietary drug formulation technology platform Arestat and currenty used to enhance the properties of approved therapeutic proteins and peptides in order to deliver new reformulations of existing, complex products.

Hikma said that it will looking for approval for the product under the US Food and Drug Administration’s 505(b)(2) regulatory pathway, with filing expected in 2021. https://www.hikma.com/newsroom/article-i4639-hikma-and-arecor-announce-exclusive-agreement-to-develop-and-commercialise-ready-to-use-medicine-using-arestat-technology/

Bayer and Exscientia collaborate to influence the potential of artificial intelligence(AI) in cardiovascular and oncology drug discovery

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Jan 09, 2020: Bayer and Exscientia Ltd. entered into a three-year multi-target collaboration, will work on early research projects combining Exscientia’s proprietary AI drug discovery platform and drug design know-how with Bayer’s data and drug discovery capabilities.

They aim is to identify and optimize novel lead structures for potential drug candidates to treat cardiovascular and oncological diseases. Exscientia may be entitled to receive up to EUR 240 million, together with upfront and research payments, near term and clinical milestones.

As part of the agreement, Exscientia might also receive sales royalties. Bayer owns the rights to novel lead structures generated as part of the collaboration.

AI has the potential to accelerate the drug discovery and improve the drug development productivity in terms of quality, cost and cycle time.

Exscientia’s AI-driven drug discovery technology provides novel chemical matter for difficult-to-address targets and could recognize novel drug candidates more powerfully through less optimization cycles.
https://media.bayer.com/baynews/baynews.nsf/id/Bayer-Exscientia-collaborate-leverage-potential-artificial-intelligence-cardiovascular-oncology

FDA approves Blueprint Medicines Ayvakit (avapritinib) ,first targeted therapy to treat a rare mutation in patients with Unresectable or Metastatic PDGFRA Exon 18 Mutant Gastrointestinal Stromal Tumor

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Jan 09, 2020: The U.S. Food and Drug Administration approved Blueprint Medicines, Ayvakit (avapritinib) for the treatment of adults with unresectable (unable to be removed with surgery) or metastatic (when cancer cells spread to other parts of the body) gastrointestinal stromal tumor (GIST) – a type of tumor that occurs in the gastrointestinal tract, most commonly in the stomach or small intestine – harboring a platelet-derived from growth factor receptor alpha (PDGFRA) exon 18 mutation.

This approval includes GIST that harbors a PDGFRA D842V mutation (most common exon 18 mutation). Ayvakit is a kinase inhibitor that blocks a type of enzyme called a kinase and helps keeps the cancer cells from growing.

GISTs occurs from specialized nerve cells found in the walls of the gastrointestinal tract. One or more sudden changes in the DNA of one of these cells may lead to the development of GIST. These cells aid in the movement of food all the way through the intestines and control various digestive processes.

More than half of the GISTs start in the stomach. Most of the others begins in the small intestine, but GISTs can start anywhere along the gastrointestinal tract.

The activating mutations in PDGFRA have been linked to the development of GISTs, and up to around 10% of GIST cases involve mutations of this gene.

Based on the results of a clinical trial, FDA approved Ayvakit involving 43 patients with GIST harboring a PDGFRA exon 18 mutation, including 38 patients with PDGFRA D842V mutation.

Patients received Ayvakit 300 mg or 400 mg orally once daily until disease progression or they experienced undesirable toxicity.

For patients harboring a PDGFRA exon 18 mutation, the overall response rate was 84%, 7% have a complete response and that have 77% partial response Ayvakit may cause harm to a developing fetus or newborn baby, should advise pregnant women.

Additionally, the FDA advises health care professionals to advice females of reproductive potential, and males with female partners of reproductive potential, to use effective contraception during treatment with Ayvakit and for six weeks after the final dose. https://fda.einnews.com/pr_news/506787911/fda-approves-the-first-targeted-therapy-to-treat-a-rare-mutation-in-patients-with-gastrointestinal-stromal-tumors

Daiichi Sankyo ENHERTU® is Now Available in the U.S. for the HER2 Positive Unresectable or Metastatic Breast Cancer Following Two or More Prior Anti-HER2-Based Regimens

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Jan 6, 2020: Daiichi Sankyo Company ltd announced that ENHERTU® (trastuzumab deruxtecan), a HER2 directed antibody drug conjugate, is now available by prescription in the U.S. ENHERTU was granted the accelerated approval by the U.S. Food and Drug Administration (FDA) on December 20, 2019 for the treatment of adult patients dealing with unresectable or metastatic HER2 positive breast cancer who have received two or more prior anti-HER2-based regimens in the metastatic setting.

This indication is approved below the accelerated approval based on tumor response rate and duration of response. Continued approval for this indication may be contingent upon the verification and description of clinical benefit in a confirmatory trial.

ENHERTU is approved with a Boxed WARNING for the Interstitial Lung Disease (ILD)/pneumonitis and Embryo-Fetal Toxicity.

The safety of ENHERTU has been evaluated in a pooled analysis of 234 patients with the unresectable or metastatic HER2 positive breast cancer who received at least one dose of 5.4 mg/kg ENHERTU in the DESTINY-Breast01 trial and a phase 1 trial. https://www.daiichisankyo.com/media_investors/media_relations/press_releases/detail/007092.html