Some experts said the drugs ability to slow cognitive decline by 0.45 on an 18-point scale was modest at best and might not be a difference that patients in the mild early stages of the disease would notice. FDA approves Biogen's Alzheimer's drug The FDA can accelerate approval of a drug to quickly bring it to market if it's expected to help patients suffering from serious conditions more. Get this delivered to your inbox, and more info about our products and services. The CMS decision was largely in response to a previous Alzheimer's treatment from Eisai and Biogen. It's going to also present challenges for researchers who are conducting trials and are planning trials to develop better drugs. Alzheimers is the seventh-leading cause of death in the U.S., according to the Centers for Disease Control and Prevention. The process allows the Food and Drug Administration to greenlight drugs if they have uncertain evidence of benefit but affect a diseases biological pathway in a way that is considered reasonably likely to benefit patients. The Centers for Medicare & Medicaid Services currently limits coverage of drugs that target amyloid in the brain, so uptake of the new medication may be limited at first, Cheung said. Some doctors have said they won't prescribe aducanumab if it does reach the market, because of the mixed data package supporting the company's application. Most drugs approved by the FDA for Alzheimers are aimed at helping symptoms, not actually slowing the progression of the disease. This phase 4 trial, ENVISION, should reach primary completion after 4 years, so it will be some time before we know whether aducanumab has significant clinical benefit. research letter published in the New England Journal of Medicine this week. Many others are still going through trials. Some participants in the lecanemab CLARITY trial did show a modest clinical response to the drug, with symptoms stablizing, although not improving. The study was funded by Biogen and Eisai. In the final stages of the disease, those afflicted lose the ability to swallow. The full details will be presented at a conference in late November, and neurologists will pore over them to ensure the drugs already modest benefits havent been oversold. For an optimal experience visit our site on another browser. Biogen and Eisai applied for accelerated approval in July. "This approval allows people living with Alzheimer's more time to live better. The industry leader for online information for tax, accounting and finance professionals. Alzheimer's experts and Wall Street analysts were immediately skeptical, with some wondering whether the clinical trial data was enough to prove the drug works and whether approval could make it harder for other companies to enroll patients in their own drug trials. The FDA can accelerate approval of a drug to quickly bring it to market if it's expected to help patients suffering from serious conditions more than what is currently available. Recently, however, there has been a turn outside the boundaries of legitimate scientific deliberation. The data on aducanumab are complex, and the drugs path to market was not conventional, he notes. The therapys effect was modest. Last year, in response to the poor data supporting Aduhelm's approval, the CMS said it wouldnt cover Alzheimers drugs that target amyloid unless patients are in a clinical trial. Two new drugs that have recently received much attention, aducanumab and lecanemab, are human monoclonal antibodies (hMabs). It also criticized agency staff for what it called an overly positive review. Because of this, drugs approved through the FDA's accelerated pathway must continue to study the drug to confirm its clinical benefits. He also consulted for the FDA advisory committee on the clinical relevance of the data from the EMERGE study. Could a new blood biomarker help predict Alzheimer's risk? The drug, lecanemab, which will be sold under the name Leqembi, is a monoclonal antibody infusion given every two weeks. Making the drug more widely available could mean more patients have "many months more of recognizing their spouse, children and grandchildren," said Maria Carrillo, the chief science officer for the Alzheimers Association. Dr. Babak Tousi, a neuro-geriatrician at the Cleveland Clinic, said the approval will make a "big difference" in the field because it is based on biomarkers rather than just symptoms. After a nearly 20-year dry spell in new treatments for Alzheimer's disease, the Food and Drug Administration (FDA) just approved a new Alzheimer's medication, Aduhelm (aducanumab), developed . Alzheimer's study controversy: What does it mean for future research? "Still, it is a benefit that we were not able to achieve" before this approval. Maria Carrillo, chief scientific officer for the Alzheimer's Association, hailed the approval as "a historic moment for our field. The medication was approved by the FDA in 2021 with much controversy, as clinical trials showed the drug caused only a very small reduction in cognitive decline. Write a review. In July 2021, aducanumab was approved by the FDA on its accelerated approval pathway. Does fat content within muscle predict risk of cognitive decline? Initial patient access will be limited by a number of factors including reimbursement restrictions by Medicare, the U.S. government insurance program for Americans aged 65 and older who represent some 90% of individuals likely to be eligible for Leqembi. @PamBelluck, A version of this article appears in print on, Alzheimers Drug Slows Cognitive Decline in Key Study, https://www.nytimes.com/2022/09/27/business/alzheimers-drug-biogen-lecanemab.html. REUTERS/Issei Kato. [The company felt that] EMERGE reflects what aducanumab does.. They will also need to undergo periodic MRI scans to monitor for brain swelling, a potentially serious side effect associated with this type of drug. The first Alzheimer's treatment in almost 20 years has just been approved by the US Food & Drug Administration. The agency granted approval on the condition that Biogen conduct another clinical trial. There are many hMabs under investigation as Alzheimers disease treatments. Before the end of this year, Roche is expected to report data from two studies of a drug known as gantenerumab. Dr. Lon Schneider, director of the California Alzheimers Disease Center at the University of Southern California, said the effect is small and would not be considered by many as a minimally clinically important difference. However, he added, others would strongly disagree and say its clinically meaningful.. The global burden of the disease, the most common cause of dementia, is only expected to grow as millions more Baby Boomers progress further into their 60s and 70s. There are 5 comments on Biogen's New Alzheimer's Drug Is "Hugely Important," "One of the Biggest Moments" in 20 Years. However, the understanding of this complicated and intricate process is gradually becoming better understood by neuroscientists., Dr. Emer MacSweeney, CEO and consultant neuroradiologist at Re:Cognition Health. The positive data also offer Biogen a second chance after the companys disastrous rollout of another Alzheimers drug, Aduhelm. The FDAs green light is likely to revive investments in similar therapies previously shelved by drugmakers. In response to the report, Public Citizen, an advocacy group, sent a letter Wednesday urging the FDA to postpone its decision on whether to approve Leqembi while the companies finish the additional clinical trials needed for full approval. 2023 Healthline Media UK Ltd, Brighton, UK. A drug developed by Biogen Inc. and Eisai Co. has achieved a first in Alzheimer's research: In a large, late-stage trial, lecanemab slowed down the cognitive decline in people with early. The Food and Drug Administration on Friday approved an Alzheimers drug shown in clinical trials to slow cognitive decline in patients in the early stages of the illness. But the results also arent the death knell for the theory that many, myself included, expected. In a statement released after the FDA's approval Friday, the CMS suggested that it may revise its position on coverage of certain Alzheimer's treatments. Jef Akst was managing editor of The Scientist, where she started as an intern in 2009 after receiving a masters degree from Indiana University in April 2009 studying the mating behavior of seahorses. In the aducanumab trials about one-third of the participants developed ARIAs. BSIP / Universal Images Group via Getty Images, FDA greenlights new Alzheimer's drug amid safety concerns, slowed cognitive decline in people who received it by 27%, the Centers for Disease Control and Prevention. An elderly woman does an activity to combat Alzheimer's disease in a care center. In last week's report, investigators said that the agency failed to adhere to its own standards and that its approval of Aduhelm was rife with irregularities.. The nonprofit Institute for Clinical and Economic Review added that any price is too high if the drugs benefit isnt confirmed in follow-up studies. But the changes to dosing and the companys after-the-fact analysis made the results hard to interpret, raising the skepticism of many experts, including those on the FDA panel. Medicare limited coverage of the drug earlier this year to patients enrolled in approved clinical trials, and the drug has greatly underperformed in sales: It generated only $300,000 during its first three months on the market. The shares later resumed trading, surging more than 60% at one point, before paring that gain and closing up 38% at $395.85. The trial of lecanemab, which is administered via intravenous infusion, was the largest to date to test whether clearing the brain of plaques formed by the accumulation of a protein called amyloid could slow the progression of Alzheimers disease. Lecanemab is a monoclonal antibody that targets a protein called amyloid which builds up on the brain in people with Alzheimer's. This new data should support a full approval, one that would convince insurers to cover it, by the second half of 2023. The Food and Drug Administration on Monday approved Biogen 's Alzheimer's disease drug aducanumab, making it the first medication cleared by U.S. regulators to slow cognitive decline. She has been reporting on health and medicine since 2015. If the study fails to show effectiveness, the FDA could pull the drug from the market, though the agency rarely does so. He previously covered the biotech and pharmaceutical industry with CNBC. It will be sold under the name Leqembi. Health Drugs Biogen's Controversial Alzheimer's Drug Was Connected to a Patient Death, Just As the Company Presented Its Final Study Data Biogen headquarters in Cambridge, Mass.,. 19862023 The Scientist. Browse an unrivalled portfolio of real-time and historical market data and insights from worldwide sources and experts. Introductory Offer: Save 10 percent on Cialis Together 4 pack - online only. You can get a seizure. Nearly 13% of those who received lecanemab developed brain swelling compared with about 2% in the group that didn't receive the treatment. But getting to drug combinations has been challenging to impossible without first having at least one treatment with a proven clinical benefit. Alzheimer's disease progressed 1.21 points on average in the group that received lecanemab compared with 1.66 points in the group that did not receive the treatment, a modest difference of 0.45 points. You can get a macro bleed. "CMS is examining available information and may reconsider its current coverage based on this review," the agency said. Biogen initially priced Aduhelm at $56,000 per year before cutting the price in half. The company has previously estimated about 1.5 million people with early Alzheimer's in the U.S. could be candidates for the drug, according to Reuters. Elizabeth Hatch. As with previous anti-amyloid drugs, some patients taking lecanemab experienced brain swelling or brain bleeding, but the prevalence of these side effects was lower than with Aduhelm and other experimental medications. Aducanumab is the only drug that U.S. regulators have said can likely treat the underlying disease, rather than manage symptoms such as anxiety and insomnia. It also has far-reaching implications for the standards used to evaluate experimental therapies, including those that show only incremental benefits. More than 6 million Americans suffer from Alzheimer's or other dementias, the. The UK is the first country to allow OTC access to Sanofi's tadalafil-based erectile dysfunction drug Cialis following a successful switch. Most Alzheimers disease treatments alleviate symptoms and help those with the disease to function for longer than they would without treatment. Can diet help improve depression symptoms? Leqembi was approved under the FDA's accelerated review process, an expedited pathway that speeds access to a drug based on its impact on underlying disease-related biomarkers believed to predict a clinical benefit. The reason for that, the company said, was lack of efficacy, then you had two studies with opposite results., He continued: Biogen felt that they could make a good case for why the ENGAGE study was negative. See here for a complete list of exchanges and delays. A drug developed by Biogen Inc. and Eisai Co. has achieved a first in Alzheimersresearch: In a large, late-stage trial, lecanemabslowed down the cognitive decline in people with early disease. The FDA said Friday that it expects to review the phase 3 data "soon.". In the case of Aduhelm, the surrogate endpoint was reduction of amyloid plaque in the brain, clumps of protein that are considered a hallmark of the disease. [1/2] The logo of Eisai Co Ltd is displayed at the company headquarters in Tokyo, Japan, March 8, 2018. However, as yet there is no proof that clearing the beta-amyloid plaques protects individuals from cognitive and functional decline. Reuters provides business, financial, national and international news to professionals via desktop terminals, the world's media organizations, industry events and directly to consumers. Morning Rundown: Student loan debt legislation vetoed, Florida neighborhood shooting suspects behavior, Bobs Burgers actor arrested. All Rights Reserved. Medical News Today spoke to a range of experts about the controversy. That drug, developed by Biogen, was approved in 2021 despite an FDA advisory committees finding that it was unlikely to work. However, the issue is whether this leads to clinical improvement in the condition. However, most of these cases were mild to moderate in severity, did not cause symptoms, and typically resolved within four months. One concern with aducanumab was the frequency of side effects, particularly amyloid-related imaging abnormalities (ARIAs). ", "The Alzheimer's Association believes that approval ushers a new era in Alzheimer's treatment and even in research," she said. The most common symptoms associated with the bleeding was dizziness. Build the strongest argument relying on authoritative content, attorney-editor expertise, and industry defining technology. Ankylosing Spondylitis Pain: Fact or Fiction, How people with type 2 diabetes may benefit from afternoon exercise, Medicare reimbursements differ between simple and complex cataract surgeries. It's the first drug cleared by U.S. regulators to slow cognitive decline in people living with Alzheimer's and the first new medicine for the disease in nearly two decades. IE 11 is not supported. He told Medical News Today why aducanumab seemed so promising: It was the first drug that showed a robust decrease in amyloid burden, to the degree where a majority of patients at the end of the double-blind phase of the study had full removal of beta-amyloid. Its really important that an investigation happen publicly and quickly so that we find answers to some of the many outstanding questions swirling around this decision, Brigham and Womens Hospital and Harvard Medical Schools Aaron Kesselheim, one of the advisory panel members who resigned, tells the Times. ", During a media briefing Monday, Cavazzoni explained that the drug had been approved through the FDA's accelerated approval pathway, an approach which allows the FDA to approve drugs for serious or life-threatening illnesses when the drug has "been shown to show improvement on a surrogate endpoint that is considered to be reasonably likely to predict clinical benefit.". Eisai applied for accelerated Food and Drug Administration approval of the drug earlier this year. This treatment option is the latest therapy to target and affect the underlying disease process of Alzheimer's instead of only treating the symptoms of the disease, FDA neuroscience official Billy Dunn said in a statement. Tousi acknowledged that the benefit of the drug will likely be modest. By 2050, that number is projected to rise to nearly 13 million, according to the group. published in the New England Journal of Medicine. Eisai, which led the development of lecanemab, is pricing the treatment at $26,500 per year in the U.S. The FDA decision is expected to reverberate throughout the biopharma sector, RBC Capital Markets analyst Brian Abrahams said in a note to clients on June 1. And while skepticism about the true meaning of these results for patients, for the fate of similar drugs, for our understanding of the disease is warranted, the result is meaningful enough to let the Alzheimers community celebrate a possible win. The most common side effects were inflammation in the brain, but most cases did not cause symptoms or lasting problems. Other companies are also developing treatments that could shake up the market for Alzheimers drugs, which before Aduhelm had not seen a novel treatment for two decades. However, the issue is whether this leads to . The organization is urging the Centers for Medicare & Medicaid Services to reconsider its decision on new Alzheimer's treatments. Cambridge, Massachusetts-based Biogen halted two studies of the drug in 2019 after disappointing results suggested aducanumab would not meet its goal of slowing mental and functional decline in Alzheimer's patients. The agency said its decision to approve Leqembi was based on a phase 2 clinical trial, not phase 3. As is often the case when it comes to interpreting scientific data, the expert community has offered differing perspectives," she wrote, adding that the "data included in the applicants submission were highly complex and left residual uncertainties regarding clinical benefit. This can be hMabs targeting the same structure but we also need small molecule oral agents.. That forecast was seemingly backed up by comments Monday from Dr. Vas Narasimhan, CEO of Novartis. But many experts have warned that greenlighting the drug could set a dangerous precedent, opening the door to treatments of questionable benefit. Dr. Porsteinsson advised that careful patient selection and clinical monitoring could minimize the risk of severe outcomes from ARIAs. The Japanese company said it also planned to apply for marketing authorization for Leqembi in Japan and the European Union by the end of its business year on March 31, with hope of winning an approval from the Japanese authority by the end of this year. 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The FDA approved lecanemab based on the reduction of amyloid plaque observed in clinical trial participants who received the treatment, according to a statement from the agency. 5705185. The FDA's decision was highly anticipated. Eisai estimated the number of U.S. patients eligible for the drug would reach around 100,000 within three years, increasing gradually from there over the medium to long term. The good news on lecanemab shouldnt further entrench the Alzheimers field in amyloid research, but instead should inspire a range of creative trials that could help bring more substantive change to the lives of people with the disease. Experts will and should go over the new data with a fine-toothed comb to understand the true value of the new treatment. Global Business and Financial News, Stock Quotes, and Market Data and Analysis. The truth now seems somewhere between these extremes. It has even been suggested that there was too much collaboration between Biogen and the FDA. The data supporting Leqembi's application is "robust," she said, adding the results of the trial are the best she has "ever seen for an Alzheimer's drug in my 25 years.". In the ENGAGE trial, aducanumab showed no benefit over placebo. The results appear stronger for the new medication, lecanemab. decision expected by early January, and then use the newer data to seek full approval. Helps you get and maintain an erection when you need it. Lecanemab reduced cognitive decline by 27 percent in a clinical trial with 1,800 participants, Biogen and Eisai said. More than 6 million. Thats how many Americans have Alzheimers, a number projected to hit 13 million by 2050, according to the Alzheimers Association. Medications that clear these plaques were hailed as a great breakthrough in the search for effective Alzheimers disease treatments, and several are in development and undergoing clinical trials. Dementia most commonly affects those over the age of 65, and with people living longer, the WHO expects the number to reach around 140 million by 2050. "We are well-aware of the attention surrounding this approval," Dr. Patrizia Cavazzoni, director of the FDA's Center for Drug Evaluation and Research, said in a press release. The company said on Tuesday night that it would first continue with the accelerated approval process, with an F.D.A. However, they contend it could help some patients with Alzheimer's, a progressive and debilitating disease. Data is a real-time snapshot *Data is delayed at least 15 minutes. Although many ARIAs around 65% have no clinical symptoms, in some individuals, the effects can be severe and even fatal. Patients with a particular genetic makeup those with two copies of the APOE E4 allele as well as those taking anticoagulants, or people who have a history of brain bleeds are at higher risk, so should be carefully monitored during treatment. Physicians are on their own to work out whether and if so how to use this drug. Those data make it the first to show a clinical benefit in a late-stage study, but it wont be the first amyloid-targeting drug to reach the market. Alzheimer's disease is a progressive neurodegenerative disorder that slowly destroys memory and thinking skills. The Food and Drug Administration on Friday approved an Alzheimer's drug shown in clinical trials to slow cognitive decline in patients . But the results come with many caveats. "We understand that Aduhelm has garnered the attention of the press, the Alzheimer's patient community, our elected officials, and other interested stakeholders.". The FDA said the prescribing information for lecanemab will include a warning about a risk of swelling and bleeding, broadly referred to as amyloid-related imaging abnormalities. In Conversation: New directions in dementia research, What to know about aducanumab the new medication for dementia. Eisai officials have said the company plans to submit data from a recent successful clinical trial in 1,800 patients as the basis for a full standard review of Leqembi. "For people living with Alzheimer's, this treatment means a potential to delay decline.". Biogens Alzheimers Drug Gets FDA Approval, Mixed Reviews. ET): A previous version of this article misstated the stage of the clinical trial data submitted to the FDA. Whats more exciting is the idea that this first success could accelerate other efforts efforts that could have a more profound impact on patients lives. And any impact the drug might have would be blunted if the price puts it out of reach. For families it means being able to hold on to their loved ones longer. "It's going to change how we make a diagnosis for Alzheimer's disease, with more accuracy," he said. However, the role of beta-amyloid in the disease is still debated. Global Business and Financial News, Stock Quotes, and Market Data and Analysis. Safety concerns have been raised about the drug. A CT scan performed after the patient's stroke found extensive bleeding in the brain. In the face of criticism about Biogens recently greenlighted Alzheimers therapy and a call for a federal investigation into its approval, company executive Al Sandrock published an open letter last week (July 22) to correct misinformation about the drug and the regulatory process it underwent, STAT reports. The aim for many of these medications is, through a variety of intermediate mechanisms, to reduce brain cell death, by reducing the abnormally accumulated amyloid or tau proteins, which are characteristically demonstrated in patients with [Alzheimers disease], explained Dr. MacSweeney. HEALTH Biogen Inc. Add Topic Controversial Alzheimer's drug, explained: What to know about Aduhelm, FDA and scathing report Nada Hassanein USA TODAY 0:00 1:17 The Food and Drug. He did, however, point out that lecanemab has about one-third of the ARIA frequency of aducanumab for similar benefits, although patients are more likely to experience infusion reactions with lecanemab. Alzheimer's was the seventh biggest cause of death globally in 2019. See here for a complete list of exchanges and delays. Nearly 6 million people in the U.S. and many more worldwide have Alzheimers disease, which gradually attacks areas of the brain needed for memory, reasoning, communication and basic daily tasks. This is great for their financial future. Biogen's stock was halted for the announcement. If a safety issue emerged, which drug would be to blame? Several trials, despite showing a reduction in plaques, have shown little or no difference in symptoms between patients on hMabs and controls on placebo. It's made by the Massachusetts-based company Biogen and will be sold under the name Aduhelm. The new drug, which Biogen developed with Japans Eisai Co., did not reverse mental decline, only slowing it in one study. The agency said its decision was based on a mid-stage trial of 856 patients with Alzheimers disease. Nearly all previous experimental drugs using the same approach had failed. Save 2.20. As a consequence, Medicare decided not to pay for the drug unless it was being given in the context of a trial that could confirm its benefits. The F.D.A. They work by clearing the beta-amyloid plaques that build up in the brain of people with Alzheimers. Biogen's Aduhelm (aducanumab) targets the plaques that contribute to the cognition decline seen in dementia. Biogen says that given the need for Alzheimer's medications, the single positive trial, plus results from a small safety trial and aducanumab's ability to reduce a key protein, should. Todays news is incredibly important," said Dr. Howard Fillit, chief science officer of the Alzheimers Drug Discovery Foundation. The pharmaceutical industrys drug pipeline has been littered for years with failed Alzheimers treatments, representing billions in research costs. Biogen is undertaking a post-approval confirmatory study. Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. This unmet need, combined with the publicly released data, justified aducanumabs approval with a confirmatory trial.. Now, these types of studies should be easier to get up and running, particularly if lecanemab or one of the other amyloid-targeting drugs in the last stages of development become a routine part of Alzheimers care. It, by the FDA on its accelerated approval pathway a safety emerged! Night that it was unlikely to work memory and thinking skills people with Alzheimers, drugs by..., health care and the FDA Alzheimer 's Association, hailed the approval as `` a historic moment for field. 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