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Can you expand on the red flag?
Is it for glossing over a change to the SAP? For changing it without pre-specifying and without rationale? Or something more specific to the actual analyses performed? The trial design and somewhat misleading PR are red flags enough for me but I wasn't aware of this stats issue.
Thanks
JW
OT: Company named after government agency
This question reminds me of a certain piece of early internet history... http://en.m.wikipedia.org/wiki/Whitehouse.com
Without knowing a lot about PBYI or this molecule, I'd assume the market reaction has more to do with the timeline delay than the indication? Though from reading the PR, I'm still a little confused -- if the Phase 3 trial was for the 'extended adjuvant' indication that they apparently are just now deciding to file for, why do they need to submit additional data? I guess I'm not clear how the data that is apparently now causing the delay wouldn't be something that they already have.
LUN Lundbeck CEO Leaves After Failing to Report Receiving Shares
Unless there's more to this story, this seems like more of an unfortunate mistake than anything seriously nefarious. Not saying he shouldn't leave, but I just happen to prefer a little more intrigue and drama with sudden, unexpected CEO departures :)
http://www.bloomberg.com/news/2014-11-24/lundbeck-ceo-leaves-after-failing-to-report-he-received-shares.html
H. Lundbeck A/S (LUN) said Chief Executive Officer Ulf Wiinberg will leave his post immediately after failing to disclose receiving shares in a company in which his employer later made an investment.
Wiinberg, 55, leaves “at his own request,” the Valby, Denmark-based drugmaker said today in a statement. The shares fell as much as 8.9 percent in Copenhagen before paring losses.
The company expects a new CEO will be in place by August, Chairman Haakan Bjoerklund said on a conference call today. External and internal candidates with international experience will be considered, he said. Bjoerklund will take over operational responsibilities until the board finds a new CEO.
Wiinberg was hired for the top job at Denmark’s second-biggest pharmaceutical company in 2008 after running European operations at Wyeth, now part of Pfizer Inc. He has worked to bring new drugs to the market to make up for lost revenue as patents expire on Lundbeck’s medicines, including bestselling anti-depressant Lexapro.
Lundbeck said today that Wiinberg received 55 shares in Stratified Medical Ltd. as a gift from its founder before Lundbeck made a 19 million-krone ($3.2 million) investment in the biotechnology company. Wiinberg informed Bjoerklund of the matter in the second half of October and it’s impossible to know the value of the shares as the company wasn’t publicly traded, the chairman said. Wiinberg will receive a 19 million-krone severance payment.
“I am sincerely sorry for the course of events, which on my part was unintentional,” Wiinberg said in the statement.
Lundbeck shares fell 0.1 percent to 126.30 kroner at 12:02 p.m. in Copenhagen. Under Wiinberg’s six-year tenure, the shares have gained less than 10 percent while the Bloomberg Europe Pharmaceutical Index has more than doubled.
Also, I believe ARIA gave pretty consistent enrollment updates on both the PACE Ph2 and EPIC Ph3 trial, back when those were ongoing.
And one of the nuances of the "trial enrollment" red flag is that the concern isn't just from a failure to report patient enrollment numbers on any sort of regular basis, but also from a tendency to hype trial site initiation numbers. To me, it's the latter in the absence of the former that really raises the flag.
Out of curiosity, why do you give a pass to Berger? In hindsight, most if not all of ARIA's problems seem to stem from poor clinical development decision making, which I would think is more the responsibility of lower levels of management than the BoD. Not saying that the BoD is great; I'm pretty much agnostic on ARIA's BoD.
FWIW I'm a former ARIA long that was lucky enough to make money on them on the rise to $20 pps as well as after the crater to $2 or whatever it gone down to. No interest in reinitiating a position.
Likewise, though I take the dissolvable tab formulation. I haven't looked into any data in a long time so I don't remember specifics, but I recall thinking that the data didn't really tell me anything in either direction.
Maybe it's placebo, but IMO the cost/benefit is strongly in its favor, partly due to how small the stakes are.
BMY - Any clarity on which abstract triggered the downgrade, and why?
Good catch. Is it likely that the condition pertains to the OS data (likely needs time to mature) from COMBI-d? Will be very interesting to see what kind of OS benefit the combo will offer given the surprisingly weak* PFS and ORR advantage revealed in the DHCP letter and EXEL slide.
*surprisingly weak as compared to the overwhelmingly positive Phase I/II data
[OT] My impression from the article you posted is that the issue is not whether the patient had given informed consent or not, but whether it was legally possible for the patient's consent to be "informed". Given the misdiagnosis, any consent that the patient gave could not, by definition, be informed. Also, it sounds like the communication breakdown w/r/t the immunodeficiency condition wasn't between the patient and the diagnosing doctor, but between the doctor and the pathologist?
Again, this is all based on the article, so it's tough to know how accurate that is without actually looking at the court documents.
[OT] Makes you wonder what kind of record-keeping (or lack thereof) was happening for the hematopathologist to not know the patient had and was being treated for the immunodeficiency condition.
Not sure if much blame or responsibility can be put on the patient -- the issue isn't that the "risky procedure" (ABMT) was contra-indicated due to the patient's other condition, it's that the patient never should have been given the option of that procedure because the cancer diagnosis itself was inaccurate/negligent.
FYI: Veliparib is ABT-888, a PARP inhibitor. ABT-199 is a Bcl-2 inhibitor, and is being studied in an array of heme malignancies.
I imagine it's true for many other markets as well, though I don't have any numbers handy. US, and to a lesser extent other regulated market, drug prices basically subsidize drug availability in developing markets. Sovaldi is another example of this practice, yes, but it isn't anything new in kind, IMO.
Have to start with the obvious-but-significant caveat that I am not a healthcare professional or at all qualified to make recommendations regarding individual treatment choices...
However, I think if I received such a diagnosis, I would want to:
1) find out what anti-PD-1/anti-PD-L1 trials are available and if I am eligible. I just quickly searched Sarah Cannon's trial page and it looks like there are a number of options for anti-PD-L1 trials in lung cancer, and there may be even more options for Phase 1 trials in patients with solid tumors
2) If I am not eligible for any PD-1/PD-L1 trials at my local center, I would then see if there were any that I would be eligible for at relatively nearby centers
3) Find out my molecular subtyping to understand other targeted treatment options (e.g., ALK+? EGFR-mutation?)
Although the response rates with anti-PD-1/PD-L1 therapies haven't been quite as spectacular in NSCLC as they have in melanoma, they are still an improvement over chemo and, in my opinion, the best chance for a durable/long-term response.
Here's the Sarah Cannon trials page: http://sarahcannonresearch.com/for-patients/search-clinical-trials/lung.dot
[Continuing the "Does generic = brand?" thread]
http://www.law360.com/lifesciences/articles/515187?nl_pk=108c332a-78f2-4138-8e88-7c15072002c6
GSK Can't Escape Suit Over Reed Smith Atty's Suicide
In a groundbreaking ruling Friday, an Illinois federal judge determined that GlaxoSmithKline PLC can be held liable for a Reed Smith LLP corporate and securities partner's suicide even though he took a generic version of the antidepressant Paxil, not the brand-name version made by the company.
The decision contradicts dozens of court rulings nationwide that brand-name drugmakers cannot be held liable for an injury caused by a generic drug. Only a handful of courts, including the Alabama Supreme Court, a California state appeals court and a Vermont federal court, have held otherwise.
The case appears to be the first time a court in the Seventh Circuit has considered the issue, according to the opinion by U.S. District Judge James Zagel.
The suit concerns the 2010 suicide of Stewart Dolin, the onetime chairman of Reed Smith's corporate and securities group. Six days after he began taking paroxetine hydrochloride, a generic version of Paxil, to treat work-related anxiety and depression, he left his Chicago office and killed himself by jumping in front of an “L” train.
Dolin's wife Wendy sued GSK and the manufacturer of the generic drug he took, Mylan Inc., claiming they failed to warn patients that adult users of paroxetine were at greater risk of suicidal behavior.
Judge Zagel dismissed Mylan from the suit but granted only part of GSK's motion for summary judgment. While GSK cannot be held strictly liable for Dolin's suicide, the company can be found negligent, he said.
The judge rejected GSK's contention that the negligence claims were product liability claims in disguise, saying Illinois law did not require him to construe one as the other.
“The injury here did indeed occur in connection with a product. And GSK manufactures products. Yet plaintiff has not brought suit against GSK for tortious conduct committed strictly as a manufacturer of products. And, though GSK implicitly urges to the contrary, I see no reason why all suits brought against GSK must be brought against GSK qua manufacturer,” he said.
In order to determine whether a defendant owes a duty to a plaintiff even if they are not directly connected, Illinois courts are supposed to consider four factors, Judge Zagel said: the reasonable foreseeability of an injury, the injury's likelihood, the burden of guarding against the injury and the consequences of putting that burden on the defendant.
The factors indicate GSK owed a duty to Dolin, according to the judge. GSK should have expected generics manufacturers would make paroxetine once the patent for Paxil expired, and it knew the companies would have to follow GSK's label for the drug, he said. GSK failed to show that the likelihood of an injury was so remote that it eliminated its duty of care, he said.
To guard against the risk of suicide by someone like Dolin, GSK could have simply changed its warning label, Judge Zabel said. There is a danger of overwarning about a risk, but GSK did not argue that the danger outweighed the duty it owed to Dolin, he said.
“That GSK did not manufacture the pill Mr. Dolin ingested is largely immaterial on this point,” the judge said. “GSK will not be tasked with the burden of crafting one new warning label for Paxil, and then other discrete warnings for various generic iterations of the drug — that all of the iterations of paroxetine are bioequivalent and require the same warning is precisely the point.”
GSK “has been compensated for taking responsibility for paroxetine's design and warning label” through the Hatch-Waxman Act, which extended brand-name makers' exclusivity over sales of their drugs, according to Judge Zabel.
R. Brent Wisner of Baum Hedlund Aristei & Goldman PC, an attorney for Wendy Dolin, praised Judge Zagel for eliminating the “doughnut hole of liability” faced by Illinois generic-drug users seeking to hold a manufacturer accountable for their injury.
“If you create a drug and know that it poses serious risks, regardless of whether consumers use the brand-name or generic version of that drug, you have a duty to warn,” Wisner said in a statement.
GSK criticized the ruling, saying that nearly 90 other decisions, including all six federal appeals court decisions to date, have rejected brand-name maker liability for generic-drug injuries.
“Holding a branded manufacturer liable for its generic competitor's product forces the branded manufacturer into the role of an insurer for the generic industry … [s]uch a result would chill research and innovation,” the drugmaker said in a statement.
A Reed Smith representative declined comment on the ruling, saying the case was not a firm matter. Reed Smith has represented GSK in other product liability matters.
Judge Zagel dismissed Mylan from the suit based on the U.S. Supreme Court's landmark Bartlett ruling last year, in which it held that federal law preempts design defect claims against generic-drug makers.
Wendy Dolin is represented by Bijan Esfandiari, Michael Baum, Frances Phares and R. Brent Wisner of Baum Hedlund Aristei & Goldman PC and Joshua Weisberg and Lindsey Epstein of Rapoport Law Offices PC.
GSK is represented by Alan Gilbert and Melissa Economy of Dentons and Andrew Bayman, Todd Davis and Christopher Benson of King & Spalding LLP.
Mylan is represented by Robert Haley of Swanson Martin & Bell LLP and Clem Trischler and Jason Reefer of Pietragallo Gordon Alfano Bosick & Raspanti LLP.
The case is Dolin v. SmithKline Beecham Corp. et al., case number 1:12-cv-06403, in the U.S. District Court of the Northern District of Illinois.
Re: ARIA's next drug
From your description of Berger's talk about the next drug, I'm a bit confused. Maybe I'm just not understanding the terminology correctly, but the drug is both "first in class" and inhibiting a validated target that has seen multiple other failures? Does he mean validated preclinically? Does he mean that the other drugs failed because they weren't true inhibitors of the target, whereas ARIA's is? Otherwise, I don't see how it could be called first in class?
For the sake of throwing out a guess, I'll say p53. I also was thinking Akt or PI3K, though neither of those would meet the first in class criteria, I think.
ARQL - MetMAb fails Ph3 2L lung trial due to lack of OS benefit at interim analysis
Is this a positive because the biggest competitor to tiva is set back, or a negative because of its implications on targeting MET?
http://www.roche.com/investors/ir_update/inv-update-2014-03-03.htm
Roche provides update on phase III study of onartuzumab in people with specific type of lung cancer
Roche (SIX: RO, ROG; OTCQX: RHHBY) announced today that an independent data monitoring committee has recommended that the phase III METLung study be stopped due to a lack of clinically meaningful efficacy.
The study evaluated if onartuzumab (MetMab) in combination with Tarceva (erlotinib) helped patients with previously treated, advanced non-small cell lung cancer (NSCLC) whose tumours were identified as MET-positive live longer compared to Tarceva alone. Overall adverse event rates were generally similar between the two groups. Data will be submitted for presentation at a forthcoming medical meeting.
"These results are disappointing because new options are needed for patients with lung cancer, the most common and deadly cancer worldwide,” said Sandra Horning, M.D., Chief Medical Officer and Head of Global Product Development. "We remain committed to helping patients with lung cancer and are studying several investigational medicines in this disease.”
Roche is evaluating the implications of the METLung study results across the ongoing onartuzumab clinical programme.
About the METLung Study (NCT01456325)
METLung is a Phase III, randomised, double-blind study evaluating the efficacy and safety profile of onartuzumab in combination with Tarceva in patients with previously treated (second- or third-line) advanced NSCLC identified to be MET-positive. The METLung study included a companion diagnostic immunohistochemistry (IHC) test that was co-developed with Ventana Medical Systems, Inc., a member of the Roche Group.
Four hundred and ninety-nine patients were randomized to receive 150 mg of Tarceva taken daily plus either:
Intravenous 15 mg/kg of onartuzumab every three weeks
Intravenous placebo every three weeks
The primary endpoint is overall survival. Secondary endpoints include progression-free survival, objective response rate and safety profile.
The results announced today are from a pre-specified interim analysis.
Not sure what part of the complaint is contrary to my judgment or opinion? I actually think Section 11 of the Introduction directly supports the opinion behind my question; that NCE status has no "ipso facto" value, but is only valuable insofar as it provides additional exclusivity.
So you think it would be worth AMRN suing the FDA even if NCE status did not come with additional exclusivity protection? Can you explain why? I am hard-pressed to think of a good reason, which makes me think that Dew's reasoning is fairly uncontroversial.
[NFLX] Was just about to post the same exact thing. Yeah, telecoms have high infrastructure related capital investment requirements, but isn't that something that consumers are already paying for? And I'm pretty sure Verizon and others are already charging consumers a premium for higher download speeds. Content providers like NFLX aren't mooching at all. They're just trying to keep the telecoms' anticompetitive practices out of the internet.
That was a very long, evasive spiel that completely sidestepped the question. I'm getting an increasingly PPHM-y vibe from the PRAN bull case here. I don't know enough about the companies and their management to make a comparison there, but the arguments you're putting forth are of the same tenor as those we've all heard for bavi. I'm not the mod here so hopefully I'm not overstepping my bounds, and obviously I know nothing about you or your real intentions (pumping vs. analyzing), but if you're interested in the latter, I think you should be a little more willing to respond to and engage with criticism and analysis of PRAN's data and strategy. Otherwise you're just going to alienate yourself as another irrational company-talking-points parrot.
[Slightly OT] I think you both missed on some material NFLX news: http://www.theonion.com/video/netflix-introduces-new-browse-endlessly-plan,35308/?playlist=newsroom
Sorry, couldn't help myself. :)
I kind of feel like there is a "having it both ways" issue going on here. If PRAN bulls want to say that the trial was too small and underpowered for any of the non-stat sig results to suggest that the drug doesn't work, then you can't turnaround and say that the one outcome that was stat sig (or maybe wasn't, when analyzed in a more rigorous way?) meaningfully shows that the drug is active/efficacious/has a real effect. As Dew mentioned, I think the trial results on their own are neutral - they show that the drug is safe and tolerable and there are at least efficacy signals. However, the reaction of the company (as I've seen it characterized here, I haven't actually looked into it myself) seems like a red flag to me. They really think these results justify a Phase 3 next?
Also, one always has to be cautious of listening to the investigators of a trial describe its results, I think, especially in the context of a disease that has no effective treatments, as there is potential for bias and hope to bleed into objectivity.
For disclosure, I have no position or plans to initiate a position in PRAN - just adding my 2 cents to the debate! :)
The operative phrase in that LA Times article is "ALL the known health risks", emphasis on the "all" mine. Gx drugs have labels now, but they cannot be changed by Gx manufacturers with additional safety data (or any other data) because the law says they have to be identical, either in full or in a subset, to the branded reference drug label. The proposed legislation is to allow Gx manufacturers to change their labels, thus extending responsibility for updating safety data as well as liability.
[OT] Interested in your thoughts on the article. Here are my Friday afternoon ramblings:
I agree that Tyrone Hayes* comes across as a bit paranoid and eccentric, which affects his image and credibility, but unfortunately, his paranoia and eccentricity seem entirely justified given the look into Syngenta's communication plan against him. I'm generally not one to bemoan the ubiquity of industry-funded scientific research - it's important to be aware of, but not the sign of some insidious conspiracy - but it's behavior like that of Syngenta that understandably breeds the public distrust of industry-funded science.
I'm not very familiar with the agribusiness sector, so I don't have much context for how the safety of herbicides is established, but the impression I get from the article is that the EPA is much more in the pocket of industry than the FDA. Not to say this isn't expected, as protecting human health will always receive more scrutiny and priority (and therefore funding) than protecting environmental health. Just seems that we (humans) often fail to appreciate how the latter affects the former! And I can't help but wonder what an analogous case would be in terms of pharmaceuticals? Vioxx comes to mind immediately, but Syngenta's behavior seems at least an order of magnitude worse.
*I had forgotten his name, so I just googled it. As mentioned in the article, the first hit is an ad for a webpage titled "Tyrone Hayes Not Credible - The Truth About Dr. Tyrone Hayes?". Never seen anything like that in the realm of serious academia and industry before!
That particular FDA page you linked isn't guidance or a list of official requirements; it's just a general overview of how drugs are developed. In that sense, it's pretty clear that the FDA page is saying that, in general, drugs are only brought to Ph3 after showing signs of efficacy in Ph2 [because sponsors don't want to risk a Ph3 if there are no signs of efficacy]. It's not saying that signs of efficacy are mandated by the FDA before Ph3.
I don't have the share numbers, but a good analog to consider would be Tasigna (bid) vs. Sprycel (qd) in second line CML. The biggest problem with this analog is that, IIRC, Tasigna launched substantially after Sprycel.
A more fundamental problem with looking for an analog, which I think Dew has spoken to before, is that we're talking about, in the scheme of things, a very short treatment duration, while compliance is usually thought of more on terms of chronic diseases. So while compliance might logically be worse for ABBV/ENTA, I don't know how important this will be to prescribers or payers, especially given how hard it would be to actually prove a difference in compliance between regimens.
I may be missing something, but the 0.75 HR was for PFS, not OS, and the 95% CI still passed 1.0. Afinitor and palbociclib have both demonstrated PFS HRs of <0.40, so I'm not sure if these ITT results are really that exciting.
However, I am intrigued that the HR for OS < the HR for PFS (can't think of a mechanistic explanation for this, which makes me wonder if it's a red flag), and also by the biomarker data. If MACK/SNY really want to bring this to Ph3, I think they'd benefit from a biomarker strategy, but at least based on the press release, it's hard to tell if this Ph2 data is robust enough to not need additional Ph2 validation.
To be honest, I was really only drawn into this discussion for the sake of arguing about semantics, not about the actual science or underlying biology. I don't really know a whole lot about MF or have any interest in GERN or INCY. :)
That said, if I had a gun to my head I'd say that it sounds like it might be logical on paper to expect these early BM/PBM effects to translate into a full CR with additional follow-up, but that when dealing with medicine and human biology, I'd have a hard time saying that just because something is logical on paper it is any more likely to actually happen or be real. That's why "paradoxical" is such a relatively common word in medicine!
Actually, there will not be more data on 11/7. Today the PACE manuscript was ePublished ahead of print, but it will appear for the first time in print in the 11/7 NEJM issue. If you read the manuscript, you'll notice that the Discussion section refers to the clinical hold and accumulation of thrombotic events through 24 months of follow-up, though the authors remain agnostic and vaguely optimistic about the degree to which the events are attributable to ponatinib.
Also, the authors suggest that combining ponatinib with anti-platelet drugs could potentially mitigate the thrombotic risk, though they also cite that ponatinib has demonstrated anti-platelet effects before. Dew, did you consult on this publication? ;)
Agreed, the new format has too much going on. Simplicity was one of the best features of the iHub boards - bring it back!
Not an expert on generics, so excuse me if this is a naive question - in this case, was there any effective negative consequence of not filing the infringement suit in the 45-day window for Novartis? They didn't get a 30-month stay, but it's been much more than 30 months since Sun first issued the Para IV challenge...
Also, how likely is it that this most recent declaratory judgment suit by Sun against Novartis to be able to market a generic upon the CoM expiry (July 2015) instead of the beta crystal patent expiry (November 2019) will be decided before the CoM expiry? That is, could this take so long to get through court that there will be a period of time where the CoM patent has expired but no declaratory judgment has been made, so there would still be no generic?
LOL indeed. So where again in the CS report does it state that they think Bosulif will become a preferred 1L agent? Thanks in advance for your help, I'd look it up myself but I can't read.
Maybe it's just based on Russia being the only health authority listed at the bottom of the ClinicalTrials.gov page?
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