AIM secures approval for post-Covid conditions (long Covid fatigue) therapy trial protocol

The trial aims to include around 80 subjects within the age group of 18 to 60 years at up to 10 sites in the US.

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AIM ImmunoTech has received approval from the central Institutional Review Board (IRB) in the US for the protocol of its Phase ll AMP-518 clinical trial of Ampligen to treat patients with post-Covid conditions.

The approval helps AIM to commence the process of selecting sites for the trial. It comes after the firm unveiled its plan to start the trial for long Covid fatigue, in August last year.

The two-arm, randomised, double-blind, placebo-controlled, multicentre AMP-518 trial aims to assess the efficacy and safety of Ampligen in patients with post-Covid fatigue.

 Its primary outcome is change from baseline to week 13 in PROMIS Fatigue Score.

Other objectives of the trial are change from baseline to week six in PROMIS Fatigue Score, change from baseline to weeks six and 13 in distance covered during a six-minute walk test as well as in PROMIS Sleep Disturbance Score, among others.

AMP-518 plans to include around 80 subjects within the age group of 18 to 60 years at up to 10 sites in the US.

During the trial, patients will be randomised into 1:1 ratio to get twice weekly IV infusions of either Ampligen or placebo for 12 weeks with two weeks follow up period.

Enrolment of patients and dosing in the trial is anticipated to start in the second quarter of this year.

 AIM ImmunoTech CEO Thomas Equels said: “We continue to be encouraged by the pilot data demonstrated to date and believe Ampligen has the potential to meet an important growing unmet medical need, with a patient population that exceeds several million in the US alone, with even more worldwide.

“With central IRB approval, our team is working toward getting our pre-selected sites open so that patient enrolment and dosing can be up and running as quickly and efficiently as possible.”

Lung organoids could replace animal testing and boost success in clinical trials

Scientists have developed a step-by-step blueprint to create advanced human lung models in the lab, which they say will accelerate the discovery and development of new drugs and reduce reliance on animal testing.

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The research due to be published in Biomaterials Researchis available online as a preprint, and was led by the University of Sydney’s Dr. Huyen Phan with collaborators from Australia, South Korea and China.

Lab-made lungs, known as organoids or mini organs, are 3D structures grown from human primary cells that mirror real organs in the body. They serve as a testing ground for .

Senior author Professor Wojciech Chrzanowski, Professor of Nanomedicine in the Sydney Pharmacy School, Faculty of Medicine, and member of the Charles Perkins Center, said, “This work is significant because we will be able to reduce the number of animals in and accelerate the discovery of new drugs or innovative strategies to treat diseases.

“We decided to build two different lung models, one of which mimics phase one clinical trials; a healthy lung to study safety of new drugs. The other one mimics phase two trials; a diseased lung that, in our case, mirrors , enabling us to study the therapeutic effectiveness or superiority of the drugs.

“We take cells directly from patients and then build them in layers as they exist inside the body. So, first you have the , then you have the fibroblasts—we are literally creating a mimic organ that is very much like actual human lungs.”

Professor Chrzanowski said the models described in the paper, which are more accurate than traditional models, are unique for their ability to emulate the of a human lung. Similar models are now being used by AstraZeneca and the U.S. Food and Drug Administration.

“With a traditional cell culture, you put cells into a Petri dish and culture them in static conditions, which is far from what happens in a human body. What we are doing is creating environmental conditions similar to those which exist in the human body,” Dr. Phan said.

“We culture and maintain our models under the micro-environmental conditions of lungs, with air on one side and liquid interface at the bottom, combined with microcirculation, which is our circulatory system or blood.”

“These two elements combined help emulate the conditions of a human lung, making them more accurate.”

Uses for the lung models aren’t isolated to drug discovery. They can also be personalized to individual patients and be used to test a range of reactions in the lung.

“These mini-lung organoid models can also be used to test toxicity. For example, of silica dust or air pollutants, such as particulates generated during bush fires,” Professor Chrzanowski said.

“Because we can take cells directly from individual patients, we can build a patient’s own model to test the effectiveness of drugs on them.”

Professor Chrzanowski said the lung models could have a major impact on basic science, enabling the discovery of how different organs function and how to design the most effective therapeutic strategies.

The researchers said the huge advantage of their models are their reproducibility, reliability and the ability to conduct research in a cost-effective way at a large scale.

“They accelerate the process of discovery, they shorten the process of getting to clinics, but also substantially increase our confidence in the molecules we create before we go to ,” Professor Chrzanowski said.

“The normal timeline for the clinical translation of a drug is about 10 to 15 years, but when you use organoid models, you can shrink that time substantially.”

Development of these lung models brings Australia to the forefront of mini organ research, said Professor Chrzanowski, who has been calling for the establishment of a national center for medical research alternatives to animal methods.

Australia banned cosmetic testing on animals in 2020, and last year the United States passed legislation ending a requirement for new drugs to be tested on animals.

 

Blockbusters in waiting: Clarivate’s drugs to watch in 2023

New drugs for immunological and inflammatory diseases feature prominently among new product launches this year that could top $1 billion in annual sales by 2027 or be clinical “game changers,” according to Clarivate.

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This year’s list reflects pharma’s increasing focus on treatments that are targeted to a specific biomarker, a strategy that aims to ensure greater efficacy and less time lost searching for a drug or biologic that will arrest or reverse the progress of disease, according to the report.

1) Bimekizumab: UCB’s first-in-class dual IL-17 A/F inhibitor was approved in the EU last year as Bimzelx but turned down by the FDA only to be refiled last month. It is expected to make rapid inroads into the market for moderate to severe plaque psoriasis therapies thanks to superior skin clearance and infrequent dosing compared to current drugs, despite entering a crowded market;

2) Capivasertib: AstraZeneca’s pan-AKT kinase inhibitor for breast cancer, which has shown efficacy in patients with hormone receptor positive, HER2-negative advanced breast cancer – regardless of their PIK3CA/AKT1/PTEN mutational status – and is now in phase 3 testing;

3) Daprodustat: GSK is vying to become the first drug in the HIF-PHI inhibitor class to reach the US market with daprodustat, which is already approved in Japan as Duvroq where uptake has been impressive. The drug offers an oral alternative to injectable therapies for anaemia associated with chronic kidney disease;

4) Deucravacitinib: Bristol-Myers Squibb looks set for a winner with this first-in-class oral TYK2 inhibitor, which according to Clarivate has the potential to fill a gap in the treatment armamentarium for moderate to severe psoriasis. It was approved by the FDA as Sotyktu last September;

5) Foscarbidopa/foslevodopa (ABBV-951): Developed by AbbVie, the drug is a reformulation of a standard Parkinson’s treatment (carbidopa/levodopa) delivered by subcutaneous pump for hard-to-treat patients with advanced disease, and is in the latter stages of FDA review. It offers better efficacy than orally administered carbidopa-levodopa, dosing flexibility and a more convenient pump than existing and upcoming competitors;

6) Lecanemab: Clarivate delivers a vote of confidence in Eisai and Biogen’s anti-amyloid antibody lecanemab for Alzheimer’s disease – just approved by the FDA as Leqembi – after the debacle of their first effort Aduhelm (aducanumab). The report also says late-stage rivals from Eli Lilly (donanemab) and possibly Roche (gantenerumab) may follow suit pending the results of ongoing trials;

7) Lenacapavir: Gilead Sciences’ first-in-class capsid inhibitor makes the grade for its potential to transform the treatment of HIV thanks to a twice-yearly dosing regimen. It is approved in Europe as Sunlenca and under evaluation by the FDA as a therapy for people with HIV whose therapy is starting to lose effectiveness, and also has significant potential for pre-exposure prophylaxis (PrEP);

8) Mirikizumab: Eli Lilly’s second candidate on the blockbuster list is a monoclonal antibody targeting the p19 subunit of IL-23, heading for a first-in-class approval in ulcerative colitis and third place for IL-23-targeting drugs in Crohn’s disease after Johnson & Johnson’s Stelara (ustekinumab) and AbbVie’s Skyrizi (risankizumab);

9) Pegcetacoplan: Sold as Empaveli/Aspaveli by developer Apellis Pharma, pegcetacoplan has launched already in the US and Europe for rare blood disorder paroxysmal nocturnal hemoglobinuria (PNH) but the big payoff is expected to follow an anticipated approval and launch for geographic atrophy (GA) or ‘dry’ age-related macular degeneration (AMD), which has no approved drug treatment;

10) Ritlecitinib: Pfizer’s JAK3 inhibitor makes it onto Clarivate’s list thanks to its first-in-class status as a therapy for alopecia areata, an autoimmune form of hair loss, coupled with a rapid onset of action and expected label for both adults and adolescents. At the moment the only approved therapy – for adults only – is Lilly’s JAK 1/2 drug Olumiant (baricitinib);

11) Sparsentan: Travere Therapeutics’ first-in-class, orally active, drug is an antagonist of both endothelin type A (ETA) and angiotensin II subtype 1 (AT1) receptors, which are associated with progression of kidney disease. It’s in late-stage development for IgA nephropathy and focal segmental glomerulosclerosis (FSGS) with initial data suggesting it may halt disease progression;

12) Teclistamab: Another drug already approved for marketing in the EU, J&J’s Tecvayli is the first bispecific antibody targeted to BCMA for multiple myeloma, with ongoing phase 3 trials expected to provide confirmation of its benefit as later-line treatment setting and support use earlier in the treatment pathway both alone and in combination with other therapies;

13) Teplizumab: Provention Bio’s anti-CD3 monoclonal antibody teplizumab – partnered with Sanofi – became the first immunotherapy to launch for type 1 diabetes after it was approved by the FDA as Tzield last November. It has been highlighted by Clarivate for its potential ability to preserve the function of insulin-producing beta cells in the pancreas and delay the need for insulin treatment;

14) Valoctocogene roxaparvovec: BioMarin’s gene therapy for haemophilia A was approved in the EU as Roctavian last summer and is poised to become the first gene therapy for the bleeding disorder in the US. The one-shot therapy is expected to provide long-lasting effects, reduce the number of bleeds experienced by patients, and reduce the need Factor VIII replacement therapy.

Astellas licenses companion drug for Pompe gene therapy

Astellas has licensed rights to a drug developed by Selecta Biosciences that could make more patients eligible for treatment with its gene therapy for inherited neuromuscular disorder Pompe disease.

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The exclusive deal – which includes an upfront payment of $10 million and up to $340 million in milestone payments at the back end – covers the use of Selecta’s immunoglobulin G (IgG) protease drug IdeXork (Xork) alongside Astellas’ AT845, currently in the phase 1/2 FORTIS study in late-onset Pompe disease (LOPD) in adults.

Xork is designed as a pre-treatment to overcome one of the key limitations to adeno-associated virus (AAV) based gene therapies like AT845, namely that some patients have existing antibodies against the AAV vector that interfere with the treatment.

Other IgG proteases are being developed to tackle the issue of pre-existing immunity against AAV, but according to Selecta chief executive Carsten Brun these tend to be derived from common human pathogens – which means they themselves can be the target of existing antibodies.

Xork has been designed to have low cross-reactivity to pre-existing antibodies in human serum, said Brun, and has “the potential to expand access to life-changing gene therapies.”

Selecta is also developing its ImmTor (immune tolerance) platform to inhibit the formation of neutralising antibodies after AAV-based gene therapies, opening up the possibility of repeat dosing.

The new Astellas agreement comes a few months after the FORTIS study of AT845 was placed under a clinical hold by the FDA after a serious adverse event – peripheral sensory neuropathy – was seen in one of the trial participants.

The trial involves a single dose of AT845 delivered by intravenous infusion to a cohort of 12 patients with LOPD, and was due to complete last month with follow-up until early 2027. There has been no update from Astellas since the clinical hold was imposed last June.

“This agreement provides an opportunity to deliver potentially transformative gene therapy treatments to a specific population of LOPD adult patients who might otherwise be ineligible for clinical trials or treatment with Astellas’ investigational product” commented Naoki Okamura, Astellas’ chief strategy officer.

Astellas’ aspirations in gene therapy have been knocked back by a series of setbacks, including cases of liver toxicity and deaths in a trial of its AT132 gene therapy candidate for rare disease X-linked myotubular myopathy (XLMTM) which resulted in a clinical hold in 2021. In April 2022, the company also announced it was halting the development of three gene therapy candidates for Duchenne muscular dystrophy (DMD).

AT845 uses the same AAV8 capsid platform as AT132, designed to allow gene expression directly in target tissues like skeletal muscle, but so far there have been no reports of liver toxicity with the Pompe candidate.

NICE backs “artificial pancreas” tech for type 1 diabetics

More than 100,000 people in England and Wales with type 1 diabetes that they find hard to control with current therapy could soon be offered new technology via the NHS.

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In draft guidance, the NICE committee has recommended the use of hybrid closed loop systems – which pair a continuous glucose monitor (CGM) under the skin that measures how much insulin should be delivered using a pump – to help patients manage their blood glucose levels more effectively.

For example, the systems can vary insulin delivery if blood glucose starts to go too low or too high, such as after vigorous exercise or during sleep.

The technology has been described as a step towards an “artificial pancreas” and could help type 1 diabetics avoid the serious complications that can accompany poorly controlled blood glucose levels like blindness, amputations, and kidney damage.

The technology also allows patients to go about their daily lives without having to keep using finger prick testing to monitor whether their blood glucose levels are too high or too low.

The decision follows a pilot study of closed-loop systems in 1,000 patients that got underway in 2021 at around 25 specialist centres across England.

Following the pilot, NICE has now recommended that the systems can be used in patients who are unable to control their condition despite using an insulin pump, or real-time or intermittently scanned continuous glucose monitoring, and are at risk of long-term complications.

That is defined as someone who has a level of haemoglobin A1c (HbA1c) – a market of glucose control over time – of 8.0% or more, well above the 6.5% target set out in NICE guidelines to minimise the risk of long-term complications from diabetes.

Hybrid closed loops systems are only recommended if the companies and NHS England agree a cost-effective price for the systems, according to the guidance.

At the moment an average annual cost for the technology is £5,744, which is higher than what NICE considers a cost-effective use of NHS resources. Manufacturers of the devices or software used in the systems include Medtronic, Tandem Diabetes Care, CamDiab, Dexcom, Advanced Therapeutics UK, and Insulet.

The announcement was warmly welcomed by the Juvenile Diabetes Research Foundation (JDRF), which has been involved in funding research into artificial pancreas technology and has been pushing for it to be made available to UK patients.

“At a time when the number of people with diabetes is rising, we have to focus on what matters most to people who use NHS services by balancing recommending the best care with value for money,” commented Mark Chapman, interim director of medical technology at NICE.

“Our committee has reviewed the real-world data generated by the NHS and evidence generated by randomised controlled trials which show there are clear benefits of recommending the technology’s use.”

The draft guidance is open for comment until the end of the month.

Chiesi expands rare disease portfolio with Amryt Pharma acquisition

Biopharma and healthcare group Chiesi Farmaceutici S.p.A. is to acquire the 2015-established Amryt Pharma Plc. in an all-cash transaction at $14.50 per American Depositary Share (ADS). Each ADS represents five Amryt ordinary shares.

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Supported by voting agreements from leading Amryt shareholders and directors, and unanimously approved and recommended by the boards of both companies, the total transaction is worth up to $1.48 billion, with upfront consideration of $1.25 billion representing a 107% premium to Amryt ADSs’ closing price of $7.00 on 6th January.

The transaction also includes Contingent Value Rights (CVRs) of up to an additional $2.50 per ADS, representing an approximate additional $225 million of potential consideration, based on certain milestones being achieved with Amryt’s Filsuvez, that will see the Italian company expand its rare disease medicine portfolio. Filsuvez is used to treat adults and children aged 6 months or older with epidermolysis bullosa (EB), an inherited skin disease that makes the skin very fragile and causes severe blistering and scarring.

Chief executive officer of Chiesi Group, Marco Vecchia, said: “This addition of the Amryt portfolio, as well as their expertise, will help us on our journey to bring medicines to patients, no matter how rare their condition may be.”

He continued: “Amryt has steadily brought innovative products to new markets and, by adding them to the Chiesi portfolio, we hope to make them available to even more patients who may require them.”

Chief executive officer and co-founder of Amryt Pharma, Dr Joe Wiley, added: “Chiesi is aligned with Amryt’s commitment and passion, and I believe Chiesi will further maximise the value of Amryt’s current portfolio and pipeline and, most importantly, will accelerate our ability to reach more patients in need globally.”

Amryt’s leading shareholders include funds managed by Athyrium Capital Management LP and Highbridge Capital Management, as well as founders Wiley, Rory Nealon, and chairman Ray Stafford.

The transaction will be effected by means of a UK scheme of arrangement under Part 26 of the UK Companies Act 2006, subject to approval of Amryt shareholders, sanction by the High Court of Justice of England and Wales, and other customary closings, including regulatory/antitrust approvals.

The transaction is anticipated to close by the end of the first half of this year, subject to the satisfaction of all closing conditions.

The acquisition comes after Amryt reported $188.8m in revenue in the first nine months of 2022, reaffirming its full-year forecast for revenue of $260m to $270m. Additionally, its top-selling drug, Myalept or Myalepta, had third-quarter sales of $37.9m.

The news comes only months after Chiesi Group unveiled its new €85 million Biotech Centre of Excellence in Parma, Italy – where the company was founded and is based. The development is for expansion of the company’s in-house drug development of biologicals and rare disease targeting and the site is due to become operational from 2024, with FDA, IFA, and EMA approvals due to be sought for 2025.

Novartis licenses cocaine use disorder therapy to Stalicla

Swiss biotech Stalicla has continued to diversify its pipeline from a focus on autism therapies with a deal to license Novartis’ mavoglurant, in clinical trials for cocaine use disorder (CUD) as well as neurodevelopmental disorders (NDD).

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Geneva-based Stalicla has acquired worldwide rights to mavoglurant (also known as AFQ056) across all its potential indications for an undisclosed upfront fee and equity, and up to $270 million in development and commercial milestone payments.

The twice-daily oral therapy is a metabotropic glutamate receptor 5 (mGluR5) antagonist that has been shown in a phase 2 trial to help cocaine users abstain from using the drug without suffering withdrawal symptoms, and is poised to start a phase 3 programme.

It also has potential in NDD, although it was discontinued as a treatment of fragile X syndrome in 2014 after disappointing phase 2b trial results. Novartis paused development across all its potential indications three years later, citing more pressing priorities in its pipeline – so, Stalicla’s licensing deal has resurrected a dormant programme.

Stalicla said it will use its precision neurobiology drug development platform (DEPI), which has demonstrated proof-of-concept in other neurodevelopmental programmes, to detect subgroups of patients with NDDs who are likely to respond to mavoglurant treatment.

The market potential of the CUD and NDD indications alone could top 2 billion euros ($2.12 billion) globally, the company noted.

“Stalicla stratifies patient subgroups and identifies compounds that may provide medical benefit in neurodevelopmental indications with clear unmet need,” said its founder and chief executive, Lynn Durham.

“With two phase 2 and a phase 3 trial slated to start within a year, alongside strong IP, we are well positioned to continue our exciting growth trajectory,” she added.

The Swiss biotech’s current pipeline is headed by autism spectrum disorder (ASD) therapies STP-1 (ibudilast/bumetanide) and STP-2 (stabilized, synthetic sulforaphane), which are due to start phase 2 testing this year. STP-2 was licensed from Evgen Pharma in October last year.

In 2020, Roche offloaded an mGluR5 antagonist to Swiss start-up Noema, which is developing the drug for persistent seizures in tuberous sclerosis complex and severe pain in trigeminal neuralgia.

The US as a country has the highest number of trials, followed by China and India – New year, new trials: analysis reveals clinical trial activity trends in 2023

With the start of the new year, GlobalData released a new report providing a glimpse into what to expect in the clinical trial space in 2023. The report reviews clinical trials that are planned to start and complete this year.

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GlobalData is the parent company of Clinical Trials Arena.

“This yearly report gives an early snapshot of what 2023 looks like,” says Brooke Wilson, associate director of research and analysis at GlobalData. The data includes planned clinical trials with a start date in 2023 and planned or ongoing trials with an end date in 2023, which were captured on GlobalData’s Clinical Trials Database as of 15 December 2022.

 

The trials that are set to start or complete this year were analysed and segmented by Phase, sponsor type, geography, therapy area, and indication. Also, this year’s annual report looks at the use of decentralised clinical trials (DCTs) for the first time. Clinical Trials Arena reviews some of the key highlights from the report.

Planned clinical trials in 2023

The report reveals that up to 43% of the planned trials this year are Phase II. Within Phase II, most of the trials have a planned start date in January. This is followed by Phase I (25%), Phase III (22%), and Phase IV (10%).

When it comes to single versus multinational trials, single-country trials are dominating 2023 with 89.8% compared to multinational trials with 10.2%. While non-industry sponsors account for the majority of single-country trials (63.1%), industry sponsors are leading the multinational trials (74.2%).

Such trends might be explained by the availability of resources. Wilson explains that non-industry sponsors, which are typically universities and institutions, may have limited funding to reach other countries to set up trials. Also, pharma companies tend to investigate new molecular entities, and they need to test in a wide array of geographical locations with genetic diversity.

Oncology as a therapy area and pain as an indication have the highest number of upcoming trials in 2023, and this is something that has not changed in the past few years, Wilson says. Covid-19 took over the clinical trial space in 2021, but even then the number of Covid-19 trials dramatically declined compared to 2020. In 2023, this indication is dropping to fourth place. Wilson explains this is likely due to approved vaccines and available therapeutics.

With DCTs rising in the past decade and accelerated by the Covid-19 pandemic, 6% of the planned trials have reported the use of one or more decentralised components. However, the report points out that this is not the final observation, and more information might be added as the trials progress. Clinical Trials Arena has previously reported on the DCT use per therapy area in H1 2022 and  decentralisation archetypes per therapy area in the past decade.

Estimated completions in 2023

Similar to planned trials, most studies with completion dates in 2023 are in Phase II (46%), followed by Phase I (21%), Phase IV (18%) and Phase III (15%). The biggest proportion of these trials are currently ongoing and recruiting, while less than a third are yet to be initiated. Most of the trials in 2023 will be completed by non-industry sponsors.

Regionally, Asia-Pacific (APAC) has the highest number of trials with estimated end dates in 2023, followed by North America and Europe. Most of these trials are single-country studies.

However, the US as a country has the highest number of trials, followed by China and India. The report indicates that the top three countries were the same last year. After a five-year decline in trial activityand slow recovery after the pandemic, this year, the UK saw a glimmer of hope and has moved up in the rankings.

As for decentralisation, 5% of clinical trials with an estimated completion date in 2023 have at least one DCT component. While North America, Europe and APAC are leading the single-country trials with decentralisation elements, multinational DCTs are conducted more in the Middle East and Africa, as well as South and Central America. The latter trend might be explained by the low number of trials that are run in those regions. As a result, sponsors may incorporate neighbouring countries, Wilson notes.

With FDA Accelerated Approval Of Alzheimer’s Drug Lecanemab Likely January 6th, Discussion Turns To Price And Reimbursement

According to the Institute for Clinical and Economic Review (ICER), the beta amyloid-directed monoclonal antibody, lecanemab, must be priced lowerthan $20,600 a year to be cost-effective. Specifically, ICER’s calculations suggest that the Alzheimer’s Disease drug’s demonstrated benefits in a Phase 3 trial – a modest but statistically significant slowing of cognitive decline – are valued at between $8,500 and $20,600 per year.

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FILE – This file photo shows a closeup of a human brain affected by Alzheimer’s Disease. Lecanemab, … [+]AP2003

Lecanemab’s PDUFA* date for its potential accelerated approval is January 6th. The product could launch after its approval by the Food and Drug Administration (FDA). And so now the discussion turns to what price it will be launched at, as well as whether it will eventually be reimbursed by Medicare, the predominant payer for a product such as lecanemab.

 We don’t know yet what lecanemab’s price will be. However, in June 2022, Eisai, one of the two sponsors of lecanemab, published its own analysis concluding that lecanemab would be cost-effective at between $10,000 and $35,000 per year.
Eisai and Biogen may draw some lessons from the Aduhelm (aducanumab) debacle. Independent of the regulatory irregularities, at the outset Aduhelm was priced “unjustifiably high” at $56,000. This was prior to Biogen cutting the price in half in a seemingly desperate move to try in vain to boost uptake.
 However, it’s important to note that whatever price Eisai and Biogen decide on, it may not matter in the short term, at least as far as Medicare’s reimbursement is concerned.

The January 6th accelerated approval of lecanemab is notbased on the Phase 3 data that was presented in November at the 15th annual Clinical Trials on Alzheimer’s Disease (CTAD) conference in San Francisco. Rather, the accelerated approval is based on a smaller study that is more narrowly focused on the surrogate marker, beta amyloid plaque reduction.

If the Food and Drug Administration (FDA) approves lecanemab on January 6th, this is not likely to impact the Centers for Medicare and Medicaid Services’ (CMS) National Coverage Determination (NCD) regarding coverage of beta amyloid-directed monoclonal antibodies. As a reminder, the NCD issued by CMS in April 2022 restricted coverage of allbeta amyloid-directed monoclonal antibodies to a post-marketing randomized controlled clinical trial (RCT). Medicare will only reimburse a regularly approved product outside of an RCT if the therapeutic agent unequivocally demonstrates cognitive or functional benefits and is considered reasonably safe.

 The expected accelerated approval of lecanemab in January will be followed by a submission to the FDA of an application for a regular approval. To reiterate, the application for a regular approval will be based on the Phase 3 trial data presented in November at the CTAD conference.

In this trial, at 18 months, lecanemab reduced cognitive decline on a clinical outcomes scale by 27% compared to placebo. About 21% of patients treated with lecanemab experienced brain swelling or brain bleeding that was visible on PET scans. Also, scientists have tied a third clinical trial death to lecanemab.

If lecanemab is approved by FDA at some point in 2023 going the traditional route, this will have implications for the NCD and ultimately reimbursement by Medicare Administrative Contractors and Medicare Advantage Plans.

Lecanemab’s positive Phase 3 data and subsequent regularFDA approval may lead to a loosening of Medicare coverage restrictions that were put in place for beta amyloid-directed monoclonal antibodies. It’s likely that should FDA give the nod CMS will drop the randomized trial requirement, though it could still require the establishment of a patient registry, as way to systematically collect post-marketing evidence on lecanemab’s safety and effectiveness in the real world.

To determine what to do about coverage of lecanemab, the Centers for Medicare and Medicaid Services (CMS) will evaluate whether the incremental increase in efficacy and the findings on safety meet the so-called reasonable and necessary standard. Under the reasonable and necessary standard, CMS is only obliged to reimburse those items, technologies, and medical services the agency deems safe and effective; not experimental; and appropriate for Medicare patients.

In this context it’s important to note that regardless of what price Eisai and Biogen decide upon for lecanemab, it will not(and has not) factor(ed) into CMS’s decision-making at the national level. That is, CMS is prohibited from determining what’s “reasonable and necessary” to reimburse on the basis of price or cost.

It’s not unambiguously clear whether lecanemab meets the litmus test CMS imposed, namely answering the question CMS posed in the NCD in the affirmative: “Does the anti-amyloid mAb meaningfully improve health outcomes (i.e., slow the decline of cognition and function) for patients in broad community practice?”

Also, even if CMS relaxes restrictions, in the end lecanemab’s uptake will also hinge on whether physicians and patients find the data convincing. For example, while some clinical neurologists believe the data posted by the sponsors is promising, others have said they do “not foresee much meaningful change in patients’ lives.” For lecanemab, as for any medicine or healthcare intervention for that matter, statistical significance does not necessarily imply a meaningful drug to individual patients and their caregivers.

Google Cofounder Sergey Brin Has Quietly Donated More Than $1 Billion Toward Parkinson’s Disease

A dozen years ago, Google cofounder Sergey Brin disclosed in a rare interview that he has a much higher chance of getting Parkinson’s disease than the general population, due to a genetic mutation. Since then, without fanfare, Brin—now the world’s 12th-richest person, worth $78 billion, per Forbes—has quietly become the largest individual donor to Parkinson’s research, with a heavy emphasis on advancing basic science.

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Forbes has learned that to date, Brin has funneled $1.1 billion to fund research of the disease, according to people familiar with his philanthropic giving. That makes him one of just a few people alive today to have donated more than $1 billion toward a specific disease.

 Parkinson’s disease, which causes tremors, slow movement, stiffness and difficulties in balance, and can progress slowly over many years, affects 10 million people worldwide–more than a million of who are in the United States. The annual economic burden in the U.S. alone is estimated at $58 billion, with a little less than half of that tied to the cost of medications and hospitalization, and the remainder due to non-medical costs like missed work, lost wages, forced early retirement and the cost of caregiving, according to a report commissioned by the Michael J. Fox Foundation and the Parkinson’s Foundation.

Over the past dozen or so years, there have been intriguing new discoveries about Parkinson’s. Researchers have identified about 20 genes associated with the disease, including a mutation in the LRRK2 gene–which both Brin and his mother have; she was diagnosed with Parkinson’s more than a decade ago. In the past eight years, 18 new drugs for Parkinson’s have been approved; while none of them slow or halt the disease, they do help manage symptoms, says Deborah Brooks, CEO of the Michael J. Fox Foundation for Parkinson’s Research.

 Despite these advances, many key facts about Parkinson’s are still a mystery. “We don’t know what causes the disease, we don’t know why it progresses, we don’t know how to measure it, and we don’t know how to stop it,” laments Dr. James Beck, the chief scientific officer of the Parkinson’s Foundation. “We don’t understand the biology of the disease.” Without such knowledge, it’s far more difficult to develop drugs that will meaningfully slow or cure it.
In 2017, Brin’s philanthropic team–which at that point had donated more than $200 million toward Parkinson’s research–decided to shift toward funding basic research in a new, meaningful and coordinated way. They created an entity called Aligning Science Across Parkinson’s (ASAP for short) and tapped Randy Schekman, a Nobel laureate and University of California at Berkeley professor of molecular and cell biology, as scientific director, and Ekemini Riley, a Ph.D. in molecular medicine, as managing director. For Schekman, the role has a strong personal connection. His wife was diagnosed with Parkinson’s when she was 48, and declined slowly over two decades; she died in 2017. “It’s an awful disease,” says Schekman. “When my wife died, I thought, ‘What better could I do with my life?’”

Together, Schekman and Riley came up with a framework that awards grants of up to $9 million over three years to collaborative teams of researchers around the globe, including lead investigators who have not studied Parkinson’s before—plus experts in stem cells, cancer immunotherapy and more. The first grants were awarded in 2020.

“ASAP is looking to fill the discovery gaps,” says Riley. “We’re working to accelerate the pace of discovery and inform the paths to cure Parkinson’s disease.” Rather than fund drug discovery or clinical trials, the ASAP grant money is for basic research. “We need new clues that will give us new targets that have not yet been the subject of the pharmaceutical industry,” explains Schekman. Todd Sherer, a neuroscientist and the Chief Mission Officer at the Michael J. Fox Foundation, predicts that Parkinson’s will have targeted therapies for subpopulations of the disease. “You need to pair the drug development work with a greater understanding of the basic science,” he says.

Altogether, the ASAP Initiative is backing 35 research teams in 14 countries supported by $290 million in funding. And the effort will likely continue for the rest of this decade. Research papers are required to be published in open science journals that require no subscription fee to access; all work done by teams is shared internally. In April, nearly 200 ASAP-backed researchers convened in the Bahamas for the first group-wide in-person meeting; discussions about their research began right away, while some were waiting for the hotel shuttle bus.

Dario Alessi, a biochemical engineer at the University of Dundee in Scotland, leads an ASAP-funded team that is investigating the LRRK2 gene, which he says is linked to 1% to 2% of Parkinson’s cases. He spoke to Forbes in early December while in San Francisco; he and five colleagues from his university had flown in to spend three days working with their team members at Stanford University, led by cell biologist and biochemist Suzanne Pfeffer.

“This is probably the biggest experiment with Parkinson’s disease, certainly in the history of science,” Alessi says of ASAP. “It’s a once-in-a-lifetime opportunity to really throw the kitchen sink at the problem and really do everything you can possibly dream of doing.” That’s partly due to the generous funding, he explains—his lab has been able to double to six the number of people devoted to LRRK2 research. But more important, he says, is the network. “Each lab has a small set of expertise. I’ve always thought that to make really big progress, it’s important that you bring labs with complementary expertise together, working in a truly collaborative manner.” Traditionally, academic science has been a more siloed enterprise. Brin’s ASAP team is betting that bringing new people together—including early career researchers as well as veterans—will lead to breakthroughs.

The Brin Family Foundation’s key partner with ASAP is the Michael J. Fox Foundation, the largest foundation in the country focused on Parkinson’s research and advancing care. It is named for the popular 61-year-old actor, who has been living with Parkinson’s disease for three decades. The grant money to ASAP researchers is distributed through the Fox Foundation. Brin also donates to the Fox Foundation’s other efforts, including the Parkinson’s Progressive Markers Initiative, a study launched in 2010 that gathers data from volunteers, both those with and without Parkinson’s and from people who have risk factors for Parkinson’s including loss of smell and REM sleep behavior disorder—in which people punch and kick in their sleep.

Some might question the amount of funding going to one subset of Parkinson’s—LRRK2—with the same genetic mutation as the field’s biggest individual donor. But experts push back on that. “In my opinion, genetic forms of Parkinson’s—though rare—really provide the best opportunity to solve [the disease],” says Beck of the Parkinson’s Foundation. “I do not think Brin’s emphasis on LRRK2 has so upset the balance of overall [Parkinson’s] funding that other potential causes of [the disease], genetic or otherwise, have been left by the wayside.”

Brin’s generous funding of Parkinson’s research is part of an American tradition. “There is a fairly long history of major donors giving to support a particular disease, going back to the Rockefeller Foundation’s focus on yellow fever and hookworm,” notes Phil Buchanan, president of the Center for Effective Philanthropy. The John D. Rockefeller-funded Rockefeller Foundation worked in the early part of the 1900s to combat hookworm in the U.S. and also developed a vaccine to control yellow fever.

But only a few individuals have ever given $1 billion or more to a specific disease. The Leona M. and Harry B. Helmsley Charitable Trust—funded by the late real estate billionaire Harry Helmsley (d. 1997) and his wife—has committed more than $1.1 billion since 2008 toward Type 1 diabetes. And the Bill & Melinda Gates Foundation—funded by billionaires Bill Gates, Melinda French Gates and Warren Buffett—has given nearly $5 billion to date toward eradicating polio, and recently pledged another $1.2 billion to the cause. Now Brin joins that small number of really big disease-specific givers.

For many billionaires, giving large sums of money away is a badge of honor they are happy to discuss. Not so Brin. “He’s not secretive about his commitment to Parkinson’s in any way. He’s just unusually low-key and not a self-promoter around it,” says the Fox Foundation’s Brooks, who first met Brin more than a decade ago, at a dinner with former Intel CEO Andy Grove, who had Parkinson’s and was an engaged donor to the Fox Foundation. Perhaps not surprisingly, Brin declined to comment for this article.

While Brin wholly supports the Parkinson’s research efforts, he doesn’t get overly involved in the details. ASAP’s Schekman says he’s met Brin just once, and that’s just fine. “Ekemini [Riley] and I and now [ASAP deputy director] Sonya [Dumanis] have built what we think is a fairly unique approach. It’s made even more powerful by the rather hands-off position of Mr. Brin. The way he operates is he picks people and he gives them trust,” says Schekman.

Outside of ASAP, Brin’s philanthropic team also makes some donations to other researchers, including those working on projects that could serve Parkinson’s patients sooner. At Stanford University, Dr. Peter Tass, a neurosurgery professor, has developed gloves that deliver a stimulus to the fingertips and in a pilot study reversed Parkinson’s symptoms in some patients. One man with Parkinson’s who needed a cane to walk wore the gloves and was able to walk normally after just hours; he soon recovered his sense of smell and taste, and months later ran his first marathon. Brin’s team is talking to a potential partner to help Tass get his invention to market faster.

The dollar amount of Brin’s giving toward Parkinson’s has ticked up in recent years, primarily to fund the ASAP teams. This year, Brin has donated $225 million toward Parkinson’s, including a $43 million gift to the Michael J. Fox Foundation, according to a person familiar with his philanthropic giving. Last year, Brin’s donations to Parkinson’s hit $233 million; of that, the Sergey Brin Family Foundation donated $101 million to the Fox Foundation. For context, those figures come close to the amount that the U.S. National Institutes of Health spends annually on Parkinson’s: an estimated $263 million in the fiscal year through September 2022, and $254 million in the prior fiscal year. The difference: Most of Brin’s donations go toward basic research, while a significant percentage of the NIH funding goes to clinical and translational research—per its mandate.

Brin has done some of his giving via the Sergey Brin Family Foundation, but also donates shares of Alphabet stock and makes donations from donor-advised funds, according to a person familiar with his philanthropy. Forbes estimates that two thirds of the $1.1 billion in Parkinson’s donations were made via gifts of stock or from donor-advised funds.

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