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Pictured: FDA headquarters surrounded by pill bottles/Taylor Tieden for BioSpace The FDA’s busy March continues with six target action dates remaining on the calendar. Over the next two weeks, the regulator will decide on investigational therapies for Duchenne muscular dystrophy, chronic kidney disease anemia, a rare metabolic disorder and more. Read below for more. Orchard/Kyowa Kirin Eye First FDA Approval for Metachromatic Leukodystrophy Orchard Therapeutics is proposing Libmeldy (atidarsagene autotemcel) for the treatment of metachromatic leukodystrophy (MLD), a rare metabolic disease. The FDA’s target action date is March 18, 2024. If approved, Libmeldy would become the first treatment for early-onset MLD in the U.S. The approval would also mark the first major regulatory victory for Kyowa Kirin since it acquired Orchard in October 2023 for approximately $477.6 million. Affecting one in every 100,000 live births, MLD is a heritable and life-threatening disease characterized by the toxic build-up of sulfatides in the brain, liver, kidneys and other organs. This accumulation can lead to organ damage and neurological issues such as cognitive, behavioral and motor decline. MLD patients also suffer from severe seizures and over time lose their ability to talk, swallow, eat, move and see. MLD is caused by a pathological mutation in the arylsulfatase-A (ARSA) gene. Libmeldy, an autologous gene therapy, addresses the underlying mechanism of MLD by using a patient’s own stem cells to deliver functioning copy of the ARSA gene. The European Union approved Libmeldy for the treatment of MLD in December 2020. In the U.S., Libmeldy, also known as OTL-200, has been granted the FDA’s Rare Pediatric Disease and Regenerative Medicine Advanced Therapy designations. Its Biologics License Application (BLA), which the regulator accepted in September 2023, has been given Priority Review. Libmeldy’s regulatory bid is backed by data from the OTL-200 clinical development program, which enrolled a total of 39 pediatric patients and used data from 49 untreated natural history controls. Results showed that Libmeldy could preserve motor function and cognitive development in treated patients. ITF Awaits Verdict for DMD Candidate ITF, the U.S. subsidiary of Italian pharma Italfarmaco Group, is proposing its investigational HDAC blocker givinostat for the treatment of Duchenne muscular dystrophy (DMD). The FDA’s verdict is due on March 21, 2024. Designed to be orally available, givinostat works by blocking histone deacetylases (HDACs), a group of enzymes that affect gene expression in muscles. The “deregulation of HDACs is a major consequence of the lack of dystrophin associated with DMD,” ITF head Matt Trudeau told BioSpace in a previous interview. Givinostat’s mechanism of action can potentially “inhibit HDAC pathological overactivity and thereby impact the cascade of events leading to muscle damage which, in turn, may counteract disease pathology and slow muscle deterioration,” Trudeau explained. ITF’s New Drug Application (NDA), which was submitted in June 2023, includes data from the Phase III EPIDYS trial, which enrolled 179 ambulant boys aged six years and older. Givinostat was given on top of steroid treatment. Patients who received the HDAC blocker showed a significantly slower decline than placebo recipients in the time it took to climb four stairs, according to a June 2022 readout. Givinostat also aced its secondary endpoints, including the time to rise test and the North Star Ambulatory Assessment, which measures patient function. Givinostat was initially granted Priority Review and was due for an FDA decision in December 2023. However, the regulator informed Italfarmaco weeks before its target action date that it would extend the review period by three months to allow additional review time. Merck Seeks to Open New Treatment Approach for PAH By March 26, the FDA will release its decision on Merck’s investigational activin signaling inhibitor sotatercept, which the company is proposing for the treatment of pulmonary arterial hypertension (PAH). In a statement alongside the BLA acceptance, Joerg Koglin, senior vice president of global clinical development at Merck Research Laboratories, said sotatercept “has the potential to transform the treatment of patients with PAH.” Sotatercept is a fusion protein therapeutic composed of the extracellular domain of the human activin receptor and the Fc domain of an IgG1 antibody. This structure allows sotatercept to trap TGF-β ligands, thereby helping to restore balance between growth-promoting and growth-limiting pathways. Preclinical models have demonstrated that sotatercept’s mechanism of action can modulate vascular cell proliferation and reverse vascular and ventricle remodeling. Merck is supporting sotatercept’s regulatory bid with data from the pivotal Phase III STELLAR study, a double-blinded and placebo-controlled trial that enrolled more than 320 patients. The results, published in The New England Journal of Medicine, showed that sotatercept could significantly increase six-minute walk distance after 24 weeks. Sotatercept likewise outperformed placebo in several secondary metrics, including pulmonary vascular resistance, improvement in WHO functional class and time to death or clinical worsening. Akebia Anticipates Long-Awaited Decision for CKD Anemia Drug After a long back and forth, the FDA is set to announce its verdict on Akebia’s NDA seeking approval for vadadustat in anemia due to chronic kidney disease (CKD) in adult patients on dialysis. Vadadustat is an investigational inhibitor of the hypoxia-inducible factor prolyl hydroxylase (HIF-PH) enzyme, which is involved in the cellular response to low oxygen levels. Vadadustat mimics the physiological effects of altitude on oxygen availability and can promote the production of red blood cells and the delivery of oxygen to tissues. In March 2022, the FDA rejected vadadustat, citing safety concerns. Phase III data for the candidate, released in September 2020, showed that while vadadustat aced its primary and key secondary endpoints, it failed its chief safety outcomes. Compared with darbepoetin alfa, major adverse cardiovascular events occurred more readily in the vadadustat arm. To demonstrate a more favorable risk-benefit profile, the FDA suggested that Akebia conduct new clinical trials to support vadadustat. Following the rejection, Akebia in November 2022 filed a Formal Dispute Resolution Request with the FDA, insisting on the “favorable balance of the benefits and risks of vadadustat,” CEO John Butler said in an investor call at the time. The FDA then requested additional information to support Akebia’s appeal, but in February 2023 ultimately decided to defer the decision to the Office of New Drugs. In May 2023, the FDA handed Akebia a victory when it decided the biotech no longer needed to conduct additional studies for a resubmission. Instead, it could re NDA to target CKD patients on dialysis and include post-approval data from Japan. The new application would also include the risk of heart- or liver-related side effects in the proposed label. Esperion Seeks Expanded Label for Cholesterol Drugs Esperion is proposing to expand the labels for its bempedoic acid drugs Nexletol and Nexlizet, allowing their use to lower cardiovascular risk in patients with or at risk of atherosclerotic cardiovascular disease. The FDA’s decision is due on March 31. Bempedoic acid is a non-statin oral drug that lowers low-density lipoprotein cholesterol (LDL-C) via the inhibition of the ATP citrate lyase enzyme. The drug was first approved in February 2020 as Nexletol, becoming the first FDA-approved non-statin therapy to lower LDL-C since 2002. In March 2023, Esperion presented full data from the Phase III CLEAR study demonstrating that Nexletol cut the risk of major adverse cardiovascular events (MACE) by 13% to 15%. The drug also lowered the risk of heart attack and coronary revascularization by 23% and 19%, respectively, Esperion reported. In an accompanying statement, Esperion CEO Sheldon Koenig called the results “practice changing.” In an investor call, he added that if the label expansion is approved, Esperion could see major growth in sales and Nexletol could reach blockbuster status. Investors were not as impressed, however, and the biotech’s shares dropped around 20% in reaction to the readout. Esperion’s partner Daiichi Sankyo was also unimpressed with the data, refusing to pay a $300 million milestone that Esperion insists it will be owed once cardiovascular risk reduction data are included in Nexletol’s European label. According to an SEC filing from Esperion, it was entitled to a milestone payment if Nexletol could show at least a 20% cardiovascular risk reduction. The 23% decrease in heart attack risk, according to the biotech, qualified it for the milestone. Daiichi Sankyo disagreed, insisting that the analysis should focus on the 13% drop in MACE risk, which fell short of this milestone. In January 2024, the partners reached an amicable end to the payment spat, with Daiichi Sankyo agreeing to pay Esperion $125 million in two separate tranches. Regeneron Eyes Follicular Lymphoma, DLBCL Approval for Bispecific Antibody Capping off the FDA’s month is a target action date for Regeneron’s BLA proposing its investigational bispecific antibody odronextamab for relapsed or refractory follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL). The regulator is set to release its verdict on March 31. Regeneron is supporting its application with data from Phase I and pivotal Phase II trials, which were presented at the 64th American Society of Hematology meeting in December 2022. One study evaluated odronextamab as a treatment for grade I to IIIa relapsed or refractory FL and found it elicited an 82% objective response rate (ORR), with 75% seeing a complete response. The median response time was 20.5 months. The trial also found that median progression-free survival was 20 months, while median overall survival at the time had not been reached. The second study tested odronextamab in relapsed or refractor DLBCL, for which the investigational antibody demonstrated a 49% objective response rate in CAR-T-naïve patients. In this subgroup, 31% achieved complete response. In those who had previously been exposed to CAR-T therapy, the ORR was 48%, with a 32% complete response rate. Odronextamab is an investigational bispecific antibody designed to target CD20, which is typically expressed on cancer cells, and CD3, which is found on T cells. This mechanism of action allows odronextamab to bring the immune cell closer to the tumor cell, facilitating the body’s cancer-killing activity. If approved, odronextamab would become the first bispecific antibody authorized to treat both FL and DLBCL. Tristan Manalac is an independent science writer based in Metro Manila, Philippines. Reach out to him on LinkedIn or email him at tristan@tristanmanalac.com or tristan.manalac@biospace.com.

While GLP-1 receptor agonists continue to post impressive weight loss data – and attract a slew of high-priced deals – the drugs face several shortcomings in obesity, including the duration of effect after treatment ends. Resalis is aiming to fill those holes with a complementary therapy: an antisense oligonucleotide (ASO) that targets miR-22, which controls multiple pathways associated with the metabolic root of obesity.The company raised €10 million in a series A Thursday that will enable the start and finish of a Phase I trial of its miR-22 targeting ASO, RES-010. The round, which comes a year after Resalis’ initial €10 million seed funding, was led by Sunstone Life Science Ventures with participation from existing investors including Claris Ventures and angel investors. One target, many pathwaysResalis’ strategy for a disease-modifying obesity therapeutic hinges on one microRNA (miRNA). Riccardo Panella began investigating miR-22 as a postdoc at Harvard Medical School and discovered its importance in multiple metabolic pathways – and its potential as a therapeutic target for obesity. Soon after, he started collaborating with Sakari Kauppinen to further explore the biology of miR-22, thanks to a grant from the Novo Nordisk Foundation, and they designed ASOs that could inhibit the target. After settling on a lead compound and amassing pharmacological and animal model data, the pair founded Resalis in 2021. Panella serves as chief scientific officer; Kauppinen is the company’s chief technology officer. “Because they’re very short, one miRNA can interact with a lot of different targets, depending on what is expressed at that moment in a cell or tissue,” Panella told FirstWord. Some of the key targets of miR-22 the Resalis team has identified include FGF21, ACLY, PGC-1α, and SIRT1 – all which have key roles in metabolic pathways.The ability to affect multiple targets is especially attractive in obesity because it’s a complex, multi-tissue, multi-pathway disease. With RES-010, “We found a way to hit multiple birds with one stone,” Panella said. “By silencing miR-22, we can deregulate multiple players at the same time that are important for driving the obesity phenotype.”Getting at the metabolic rootThe end goal is to rewire our cellular metabolism – making it harder for the body to store fat, and promoting energy consumption, Resalis CEO Alessandro Toniolo said. Mice data hints at what the result of such rewiring could look like in humans. In a study published last year in the International Journal of Molecular Sciences, Panella and Kauppinen found that when two groups of mice were fed high-fat diets, those with a miR-22 knockout gained significantly less weight than those with the target intact. Plus, another mice study showed that miR-22 inhibition only triggered fat loss, not muscle – another drawback to GLP-1 receptor agonism. Toniolo said the team found that, unless the mice had an excess of fat, they did not lose body weight. Because GLP-1 receptor agonists are appetite suppressors, patients often lose both fat and muscle mass, which can be unhealthy for the elderly. Another shortcoming facing the modality is that when patients stop taking the drugs, they often regain weight.However, Toniology believes pairing a GLP-1 receptor agonist with RES-010 for a course of treatment could resolve these issues. He doesn’t see the ASO replacing GLP-1s, but rather as a complementary therapy. Resalis plans to start a Phase I dose-ascending study of RES-010 in Europe this half.

SAN DIEGO, Nov. 12, 2023 /PRNewswire/ -- A new study by Hospital for Special Surgery (HSS) investigators has found that an initial high-risk antibody profile for antiphospholipid syndrome (APS) tended to remain high in pediatric patients. The results were presented today in a poster session at American College of Rheumatology (ACR) Convergence 2023, the ACR's annual meeting.1 "There are a lot of unanswered questions about how APS affects pediatric patients since evidence to date has been very limited," said Jheel Pandya, MD, a pediatric rheumatology fellow at HSS and lead author of the research. "Our study reveals that an initial high-risk antiphospholipid antibody profile is unlikely to be transient in pediatric patients, indicating their risk of serious health problems remains elevated and they should be followed carefully." APS is a rare autoimmune disorder in which antibodies made by the immune system, called antiphospholipid antibodies (aPL), attack proteins that bind the phospholipid cell walls of blood cells located on the inner layer of arteries and veins. The disorder increases the risk of dangerous blood clots inside blood vessels, strokes, and heart attacks, and can cause pregnancy problems. For patients with symptoms, rheumatologists use three laboratory tests to evaluate the presence of aPL: lupus anticoagulant (LA), anticardiolipin antibody (aCL) and anti-beta-2-glycoprotein-1 antibody (aβ2GPI). An international team of rheumatologists, including HSS investigators, recently published new criteria for classifying adult APS patients for research purposes using these tests,2 but there are not yet established criteria for classifying pediatric patients. Dr. Pandya and colleagues analyzed electronic medical records for aPL-positive patients ages 10 to 18 who were treated at HSS between 2016 and 2022. They divided patients with initially positive results into high- and low-risk groups as follows: those with a positive LA test and/or higher level aCL and aβ2GPI antibodies into the high-risk group; and those with a negative LA test and/or lower levels of aCL and aβ2GPI antibodies into the low-risk group. The investigators assessed subsequent aPL results, as well as the demographic and clinical characteristics of patients with persistently positive aPL results reported at least 12 weeks apart. The analysis revealed that aPL persisted for 25 of 27 patients (93%) in the higher-risk group. By comparison, aPL persisted for only seven of 15 patients (47%) in the lower-risk group. Among 32 patients in either group with aPL results that remained positive over time, blood clots occurred in 9 (28%) patients in the high-risk group, while none occurred in the low-risk group. For 26 patients who did not have persistently positive antibody results, none experienced blood clots, one had a skin rash, and two experienced migraines. "The more we can learn about differences in APS development and progression in pediatric patients compared with adults, the more we can optimize their diagnosis and treatment," said co-author Karen Brandt Onel, MD, chief of Pediatric Rheumatology at HSS. "This study underscores the importance of continuing to follow pediatric patients with higher-risk profiles and transitioning them to adult care after the age of 18." "Our results highlight the need for a large-scale, international effort to better understand how APS affects pediatric patients," said senior author Doruk Erkan, MD, MPH, a physician-scientist at the Barbara Volker Center for Women and Rheumatic Diseases, attending rheumatologist at HSS and professor of medicine at Weill Cornell Medicine. "An international effort has been initiated to pool pediatric APS data and ultimately guide the development of classification criteria for pediatric patients." Dr. Erkan was co-principal investigator for the recently published 2023 ACR/EULAR Adult APS Classification Criteria.2 HSS is one of the leading centers in the United States providing care for adults and children with APS, with a team of 18 rheumatologists who see APS patients, including five who see pediatric patients. HSS is the lead coordinating center of the APS ACTION Clinical Database and Repository, an international collaboration of clinician researchers dedicated to advancing the understanding and management of APS. Dr. Erkan is chair of the APS ACTION Executive Committee. Authors: Jheel Pandya, MD, Karen Onel, MD, Doruk Erkan, MD, MPH. References Jheel Pandya, MD, Karen Onel, MD, Doruk Erkan, MD. "The Clinical Relevance of Different Antiphospholipid Antibody Profiles in Pediatric Rheumatology Patients." Presented at: American College of Rheumatology (ACR) Convergence 2023, November 10-15, San Diego, California. ACR Convergence 2023 Abstract 0100. Barbhaiya M, Zuily S, Naden R, et al. The 2023 ACR/EULAR Antiphospholipid Syndrome Classification Criteria. Arthritis Rheumatol. 2023;75(10):1687-1702. doi:10.1002/art.42624 About HSS HSS is the world's leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 14th consecutive year), No. 2 in rheumatology by U.S. News & World Report (2023-2024), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report "Best Children's Hospitals" list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fourth consecutive year (2023). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. . SOURCE Hospital for Special Surgery